The Radical Idea of Providing Doulas for Abortions

Poster by 4000 Years for Choice.

In 2007, three reproductive justice advocates had a revolutionary idea: people having abortions should have continuous, nonjudgmental physical, emotional, and educational support just like people giving birth. So New York City-based activists and doulas Lauren Mitchell, Mary Mahoney, and Miriam Zoila Pérez founded The Abortion Doula Project. After about a year they realized that the demand for their care expanded beyond abortion to include people having miscarriages, stillbirths, and other pregnancy outcomes. The first full spectrum doula organization, The Doula Project, was born. Almost 10 years and 40,000 pregnant clients later, the project has helped change the way people think about doula practice and abortion care, and bridging a gap between activist work and direct care.

Now their book The Doulas: Radical Care for Pregnant People, co-written by Mitchell and Mahoney, is set to come out in November from The Feminist Press. The book is part organizational memoir, part how-to manual for full spectrum doula groups, and part platform to amplify untold stories about pregnancy and doula care. I talked to the duo about why they started the organization and how it’s evolved, navigating the sometimes tricky interplay between client advocacy, provider relationships, and activism, the politics of abortion doula work, and creating a more inclusive organization.

REBECCA KOON: I thought we could start with a little bit of background about The Doula Project. Can you tell me about the history of the organization and why you felt full spectrum doula care was important?

MARY MAHONEY: I think we really started The Doula Project as a political act. We were literally standing with people who were having abortions. And we were taking this reproductive justice framework that promotes access to quality healthcare for everyone, no matter their race, class, or sexual orientation and we were putting that ideology into on-the-ground, direct care practice. And now, 10 years later, we’ve really developed this strong model of story-based care, meaning everyone comes to us with a story and everyone’s story is different and so we try to meet them where they’re at.

One of the most interesting things to me about the book was thinking about the tension that can exist between supporting pregnant people and their choices, cultivating positive relationships with providers, and working to change a system that doesn’t always serve patients. I’m wondering if there are particular examples of client interactions where you felt that tension really keenly?

LAUREN MITCHELL: We had this client who was really close to the legal limit [for abortion] of 24 weeks. Our hospital was willing to help her but they were really backed up in their operating room, so they were going to offer her what’s called an induction termination, which is to go up to labor and delivery and induce labor. For the most part if someone is having a termination for life circumstances, like it’s not the right time for whatever reason, studies have shown that induction terminations can be really emotionally hard. But this was what the hospital could offer her and that was it. Mary and I didn’t necessarily have an appreciation of all the bureaucracy that was going into making sure this person could have an abortion, we just heard that this person who has never had a baby before, who’s young, who’s scared, is going to have an induction termination with this group of anti-abortion—like, aggressively anti-abortion—labor and delivery nurses on the labor and delivery floor next to people who are having live births, and we were just sort of panicking on her behalf. And she didn’t want that either, but we spoke with her and we were like “You should advocate and see if you can go somewhere else.” Rule number one [of full spectrum doula care]: Do not advocate against the service you’re working with. We didn’t quite look at it that way, we were more concerned with her emotional well-being, which is legit; it wouldn’t have been easy on her. But we advocated for and with her to screw over the counseling staff that had worked really hard to make sure she could get a procedure. We were working with that counseling team and medical staff every day and our role at this hospital was entirely contingent on our good relationships with them, especially when it was a new and somewhat provocative abortion doula project. Luckily for us, the counselor spoke to us and she was very kind about saying, “I recognize that your intentions were really good, but you need to understand what that does to the rest of us.” It really could have thrown everybody under the bus. Luckily, it all ended up okay and the client did get the procedure that she needed, and [the staff] pretty quickly forgave us. But we offer that as a cautionary tale to new groups; please learn from our mistakes.

It seems like that’s part of the point of the book—to offer advice to new groups that are just starting out and help them learn from your experiences. I’m wondering if you can speak to that. What were your reasons for writing the book? Who are you hoping the book is going to reach and what did you want to say to them?

MARY: You really nailed it. One thing we’ve always felt is really special about our work is that we work with people who are apolitical, we work with clients who are pro-life. I’m from a very pro-life community, and I think we’re able to create a bridge between the pro-life and the pro-choice through this idea of supporting people through challenging, life-altering transitions. There was some research that came out while we were writing the book that said something like 75 percent of the American public believes that people should have support during an abortion no matter what their political beliefs are. That felt really powerful to us, so we wanted to write this book as a way of demystifying abortion. We wanted to go deep into these stories–being pregnant and deciding what you want to do and all the ambivalence that can be involved–we wanted to show that it’s okay to have feelings about your abortion. I really like to highlight the stories where it’s not a clean-cut, black and white decision, because the truth that we’ve seen with the tens of thousands of clients that we’ve worked with is that it’s a hard-fought decision, always. The procedure is five minutes long, but there’s a whole lifetime that went before that, and that’s the message we really wanted to get out there with this book: Every pregnancy has a story.

That’s from the client end of it, and from the doula end of it, there aren’t a lot of stories about what it means to a person in the trenches every day being there for another person. There are so many people who go into client care and take so much of it home with them, and where do they put it? So it was incredibly healing for us to collect these oral histories from doulas. It’s framed in the book as a mutually therapeutic practice for us to take in a part of [the clients’] stories and become a part of their stories.

Photo by Zhu (Creative Commons).

I think you did a beautiful job with that. The way that you humanized the experience of the doula was so moving and compelling; I really appreciated it. In my doula training I never read any experiences or stories like that, so it was really powerful.

MARY: We also looked at what’s missing from the conversation in the literature and what we could contribute that’s needed. There are now a lot of these great empowering stories about abortion, but there are still not [many about] people who maybe didn’t feel great about their abortion, or think about it all the time and feel sad about it and think they’re the only one who feels that way because maybe they’re pro-choice and so they don’t feel like it’s okay to have those feelings.

You mention this idea in the book—acknowledging that people who are having an abortion would need a doula implies it’s an emotionally or physically difficult procedure in a way that counters the pro-choice narrative we often feel we need for our movement to be politically strong, but that erases the abortion experiences that so many people have. You emphasize that it’s important for people to be able to tell their stories even if they might somehow undermine the pro-choice movement by acknowledging that abortion is not an easy thing for many people.

LAUREN: We came from that movement. Our perspectives when we started The Doula Project were shaped by activism because that’s what we were doing and that was and remains a strong part of our identities. It is interesting because you’re going from this meta-level policy change in activism, trying to create these broad spanning changes, and when you’re doing direct care you’re getting down and dirty in the intricacies and nuances of [the client’s] narrative. We open the book with an epigraph from a play called One Flea Spare that says, “I have loved them, and they have marked me,” and that is how you go home every day. All of these abstract, policy-based concepts are given this new life from the people that you met.

You talk a lot about understanding systemic oppression and how that’s crucial to doula work, and the fact that your clients are often people from marginalized populations but the doulas are often white and middle-class. You mention your attempts to diversify your volunteers, and I’m wondering how successful that’s been, and what that looks like?

MARY: I would say there are definitely shifts being made, but we did just have a new group of trainees come on and it’s mostly middle-class people. A huge part of it is definitely the fact that we are unable to pay people what this work should be paid. And abortions take place during the day, during the week. You have to lead a life of relative privilege to be a doula because you have to be able to drop everything. We just got our first grant to build our capacity, which is super exciting, because if we can pay people more maybe they can take a day off from what they’re doing and it’s not going to negatively impact their life. The other piece is outreach. You run into this problem when you’ve been a majority white-led, middle class organization, it keeps breeding itself as that. So part of that is an outreach issue and us becoming more intentional about where we do outreach, and not just doing it in liberal arts schools, or to people who already have bachelor’s degrees and are working in the reproductive rights and justice movement. Our application and interview process is really stringent and not everyone who wants to do this work has the perfect language to speak about abortion and birth. So we try to be very self-aware about where we’re lacking, and it’s going to take time to build a different kind of organization, but we’re definitely committed to it.

LAUREN: Our goal with this project was always to have doulas in every community and there’s been a lot of progress but there’s still a long way to go. One last thing I want to say is that I think the reason being a doula is beautiful is that we so rarely have the opportunity to be unabashedly kind to people. To be down low and vulnerable and loving toward somebody is so powerful. I know for me it’s also made it easier to ask for help myself. I think that’s the true beauty of our work. It’s an exchange of kindness that we don’t get to do as people very often.