December 11, 2023

Abortion Doulas and the Care They Provide

In a society where reproductive rights are becoming a polarizing issue, access to abortion care is a prominent concern. Without legal government protections, people trying to get reproductive services are met with little to no help in ensuring that they are respected and treated with dignity through any procedure. Specifically, abortions have come under attack after the Dobbs decision was made in June of 2023, reversing the right for a person to have an abortion that was previously established in the Roe v. Wade ruling. With some states limiting abortion access to as early as six weeks, there is a greater need for safe and dignified abortion clinics. One profession that has been helping to promote such a supportive environment is doulary. Birthing doulas are already commonly used to advocate on behalf of pregnant people with how they want their birth to be. Similarly, abortion doulas are used to provide emotional and physical support through the process of having an abortion. These doulas are essential to empower people who have abortions and to make them feel secure in their decisions. The work that they perform can save lives and liberate bodies that are being controlled and commodified.

Understanding the history of abortion care can better illustrate how abortion doulas are not a new concept. Going back to the fourteenth century, women healers were under attack for using unconventional healing methods compared to the methods of male healers. Institutionalized medicine was pushed to the point where practices deemed unnatural or different became criminal acts. Women who provided care to other women were called witches and were involved in the witch hunt for having medical knowledge. What we now call midwives and doulas were persecuted during the witch craze for helping and healing women. They were accused of using magic since they could heal ailments that male healers were unable to. Despite the risks, these “witches” put themselves in harm's way to help other women, especially those living in poverty who could not afford formal medical care. The care that women healers provided was based on nurturing and listening to their patients to understand what they needed. Through practice, they developed skills to trust their abilities and heal ailments with medications or natural remedies such as herbs and charms. Healers relied on a patient’s body language and attitude as opposed to male physicians who relied on physical evidence of medical issues. Ultimately, doulas and midwives were punished for their medical knowledge since it was “by women, for women, as acts of liberation and empowerment” (Schoen 6). Alternative treatments and care threatened institutionalized medicine that was controlled by men and the more privileged which led to the persecution of women and community-based medical care.

Present-day doulas perform similarly to fourteenth-century witches. They are certified to work with patients but don’t use a medical degree to support their work. Likewise, they rely on their senses to provide emotional, physical, and informational support services. Birth doulas support pregnant people throughout their pregnancy, labor, and postpartum. Their job consists of answering questions related to procedures, helping with comfort during childbirth, and reducing stress and anxiety during pregnancy and childbirth. Studies show that people who utilize birth doulas tend to have better health outcomes including shorter labors and lower rates of cesarean section and preterm birth. Abortion doulas do like work but instead support people who have abortions at any stage in their pregnancy. They offer guidance and advice – if wanted – in addition to explaining the procedure and normalizing that abortions are safe, moral, and can be a positive experience. An abortion doula's sole job is to be there for the patient in whatever way they need. Typically a patient will discuss with their doula beforehand how they like to be comforted and what they want their abortion experience to be like. Some patients need emotional support and a space to talk about their feelings while others want a distraction and a light-hearted conversation during the procedure. The ultimate goal is to create a positive atmosphere for the person having an abortion, especially considering that “providing information and support can ensure safe, complete abortions with few or no complications” (Zurbriggen, et al. 113). The mere presence of abortion doulas allows for advocacy on behalf of the patient’s overall well-being.

People who are seeking abortions typically have to pass protestors on their way into clinics. This combined with the lack of attention that physicians pay to patients’ emotional needs can make for a stressful procedure that can put the patient at further risk of complications. Trained abortion doulas take on the patients’ emotional needs and hold space for them to be heard and supported. It is important to note that abortion doulas do not work for medical professionals and answer only to the person they are supporting. Patient-centered communication and care are the basis for what abortion doulas do. There is often a power imbalance between providers and patients that results in a worse quality of care and patients being uninformed of their options. Abortion doulas work as an advocate for the rights of the patient and can simplify medical information to be understandable and accessible. Some doulary networks partner directly with healthcare providers to make it easier to access doula services as well as having clear communication among providers, patients, and doulas. Doulas are educated on medical terminology in addition to disparities and discrepancies that exist within the medical system. Having this knowledge helps patients understand procedural details and aids in the general protection of the person having an abortion. Being aware of medical disparities can also inform abortion doulas as to who may need more protection from systemic discrimination. 

Another important role of abortion doulas is before and aftercare. This can be meeting the person in recovery with their belongings, providing long-term emotional care, helping with time off from work, and even bringing food to the patient. Care before abortions that can be done by abortion doulas includes scheduling appointments at clinics, providing transportation to the abortion facility, and helping a patient financially afford an abortion in the first place. Doulas can be a part of the abortion process for as little or as much as the patient needs. They are there for whatever a patient needs and what it looks like for them. More recently, doulas have begun supporting people who have self-managed abortions, also known as medication abortions. With self-managed abortions, patients take mifepristone and/or misoprostol and do not need to be in a medical facility. However, abortion doulas can still provide emotional and physical support for the person, whether that be virtually or in person. This care and support reduces isolation during the abortion process and can empower the person choosing to end their pregnancy.

The presence of abortion doulas can facilitate patient-provider relationships where power dynamics likely exist. Obstetric violence “links unnecessary and abusive treatment and neglect during reproductive health care to underlying systems of inequality related to gender, race or ethnicity, class, age, and geography” (Suh 11). A doula present during procedures and conversations with medical providers allows for an advocate to be there for the patient. Having someone to fight for a person’s rights and respect in a medical setting can decrease rates of obstetric violence. However, restrictive abortion laws can also be interpreted as a form of obstetric violence since it leaves “women, and low-income women, in particular, to resort to unsafe procedures” (Suh 11). Restrictive legislation can be combated by the use of abortion doulas as they can intervene on the patient’s behalf to make sure that their rights are respected and their physical and emotional needs are met at every stage throughout the process of having an abortion.

Following the Dobbs decision in which Roe v. Wade was overturned, people in some states across the country lost their right to have abortions. This resulted in states with abortion access becoming flooded with out-of-state patients seeking reproductive care. Despite the ruling and subsequent consequences, the work of abortion doulas did not drastically change. Their work remains to provide physical, emotional, and at times, financial support with the most significant differences after the ruling being the workload and fear of being prosecuted for helping people obtain abortions. Safe, equitable, and dignified abortion access is more important than ever, thus, making the work of abortion doulas essential. Those who can access abortions tend to be stratified by region, race, and class. People seeking abortion care in the South and rural areas are among the most vulnerable. Transportation and finances are a part of accessing an abortion which can be unrealistic and unmanageable for lower-income people who live in more rural regions; moreover, restrictions on abortions create an additional barrier to overcome. Access to abortion care is just as important as creating a safe and positive environment throughout the experience. Certain groups of people disproportionately cannot access the medical care they need to begin with. Abortion care is only equitably beneficial “if information and reliable medicines are available to all women, regardless of their location or the restrictions of their legal system” (Jelinska, Yanow 86). The current restrictive legislation in place across the country exasperates systemic problems of racism, sexism, and classism that have existed since the founding of the United States.

As discussed earlier, the work that abortion doulas perform is not new. In addition to formal care, women have been providing community-based abortion care for each other well before Roe v. Wade even guaranteed the right to an abortion. Caring for people during pregnancies and abortions “was a social responsibility shared by neighboring women” in which “[f]emale friends and relatives determined when the situation had become an emergency” and would use their best judgment to provide protected care (Reagan 9). These women typically had connections with certain doctors that they knew would help with any abortion procedures and complications with discretion. They created a network of abortion care and performed similar duties that abortion doulas do now. Providing care to neighbors and friends was not considered a job but rather an obligation shared amongst trusted people. In fact, “female relatives, neighbors, and friends were more important than husbands in assisting married women having abortions” (Reagan 11). Women have always been united in their assertion of making their own decisions about their reproduction. A common theme from pre-Roe to post-Dobbs that we see is that people will continue to have abortions through self-made methods and networks if the state does not guarantee safe reproductive care. 

When unpacking the role of abortion doulas, it is important to touch on the care labor that they perform. Historically speaking, women have been the primary people doing care work as it is viewed less as work and more as a woman’s duty. In the same sense that mothers are expected to be the caretakers for their children, women are expected to be caregivers in every aspect of care labor. There tends to be little to no compensation for this labor and it tends to be less recognized despite how revolutionary and honorable it is, not to mention the emotional and physical burden that goes along with it. This goes back to patriarchal expectations in which men are to provide financially while women are to provide physically, emotionally, and mentally and do the impossible work that is care labor. Furthermore, men are the majority of politicians who vote against protecting reproductive rights which makes for women to have to develop their underground abortion services. There is also a racial aspect to care labor; Black women have been taking care of white babies for centuries in addition to raising their own children. Women of color still make up the majority of people who perform care work as it is an embedded expectation in our society that people of color should be doing this labor so as to not burden white people, specifically white men. Racial capitalism, the concept that racial exploitation and capital accumulation are mutually reinforcing, commodifies the labor of Black women and purposefully does not recognize care work to profit off of free labor. The queer community also has a history of doing care work with no recognition. In a similar manner that women have provided abortion care networks for each other, the LGBTQ2S community has made collective networks to support queer folks’ physical and emotional well-being. The radical work that abortion doulas execute is disproportionately done by the most marginalized groups: women, people of color, and the queer community. The lack of acknowledgment and compensation that abortion doulas receive is no coincidence considering the history of care labor.

Abortion doulas provide essential work to create an atmosphere of support, safety, and respect for people having abortions. The history of abortion care demonstrates that the labor of doulas has existed in both formal and informal systems for centuries. It is a continuous battle that women are fighting for not only their reproductive rights but also for their bodily autonomy. The presence of abortion doulas can provide a level of protection for the patient as there is someone to advocate on behalf of their basic human rights. Abortion care creates safer outcomes and empowers people in their decision to end their pregnancies. Normalizing abortions as any other medical procedure helps to destigmatize the experience and assure the patient of their safety and rights. After the Dobbs decision has taken away reproductive rights, abortion doulas play a prominent role in ensuring that people have access to reproductive care and have a positive experience throughout it. More specifically, as patient advocates, they can help to decrease the rates of obstetric violence, especially for more vulnerable groups of people such as women of color. The work of abortion doulas is extensive and includes being there for every single step of the process of getting an abortion if needed. Many doulas remain unpaid for their work since it is not seen as profitable labor in our capitalist society. Care labor is profitable to the people who are being tended to and having their bodily freedom protected. Abortion doulas are doing work that is community-based, safe, and effective to ensure positive abortion experiences, which is labor that must not be taken for granted.

References

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Jelinska, K., & Yanow, S. (2018). Putting abortion pills into women’s hands: Realizing the full potential of medical abortion. Contraception, 97(2), 86–89. https://doi.org/10.1016/j.contraception.2017.05.019

Our history — the doula project. (n.d.). The Doula Project. Retrieved December 10, 2023, from https://nycdoulaproject.org/our-history

The vital work and history of abortion doulas. (n.d.). Retrieved December 10, 2023, from https://www.thepulpmag.com/articles/the-vital-work-and-history-of-abortion-doulas?

Uwumarogie, V. (2023, September 30). Understanding the work of abortion doulas in A Post-Roe V. Wade america. Essence. https://www.essence.com/lifestyle/abortion-doula/

Whaley, N., & Sufrin, C. (2016). The women who serve: A qualitative study of abortion doulas. Contraception, 94(4). https://doi.org/10.1016/j.contraception.2016.07.063

What’s an abortion doula? One woman shares her story. (2022, July 19). theSkimm. https://www.theskimm.com/news/whats-an-abortion-doula-one-woman-shares-her-story

Wright, M. (2023, June 23). Abortion doulas: Care work as a theory of change. Ms. Magazine. https://msmagazine.com/2023/06/23/abortion-doulas-you-or-someone-you-love-book-review/

Zurbriggen, R., Keefe-Oates, B., & Gerdts, C. (2018). Accompaniment of second-trimester abortions: The model of the feminist Socorrista network of Argentina. Contraception, 97(2), 108–115. https://doi.org/10.1016/j.contraception.2017.07.170