Abortion doulas: The quiet foot soldiers in the fight for reproductive rights
A room formally used as an examination room for abortions is seen at Choice Clinic, formerly Whole Woman’s Health Clinic, June 27, 2016, in Austin, Texas. Eric Gay/AP

One Saturday every month, Maris arrives at a busy abortion clinic in northern Virginia to volunteer. As she walks towards the facility, protesters carrying rosaries and placards with images of fetuses and stern biblical messages are often waiting to confront vulnerable people as they are escorted inside.

“You have options! God loves you!” they shout, keeping the minimum distance they are permitted on the sidewalk outside.

Inside, people of all ages — from teens to mothers of several children — are seeking refuge from the political commotion as they go through what is, for many, a difficult experience. It’s there that Maris, an abortion doula, offers pregnant people the kind of emotional support once reserved for childbirth.

A doula — the word comes from Greek, meaning “woman servant or caregiver” — is a there to be a soothing presence. Isolated from the roar outside, 23-year-old Maris and other doulas volunteer their time to shepherd patients through first trimester abortions with compassion, respect and without judgment.

Maris, who didn’t want to use her last name for security reasons, grew up in a conservative Catholic home in the Midwest. She says she had no political leanings when it came to reproductive rights. But today, as an abortion doula, she holds the hands of people seeking abortions, offers distracting conversation and answers nervous questions about the legal medical procedure, which has recently become increasingly vilified.

Maris is part of the D.C. Doulas for Choice Collective, which since 2011 has provided trained volunteers to this abortion clinic outside the nation’s capital. The clinic requires a background check and a TB test for each doula. Neither the collective nor the doulas receive compensation.

During her shift, Maris will tend to half a dozen pregnant people — one at a time, from their first medication, through the abortion procedure and into the recovery room. Throughout, she provides physical comfort and reassurance, and answers questions.

Some people want answers to tough concerns: Am I doing the right thing? What will others think of me? Those who believe abortion is a sin often ask doulas if God will forgive them. Some want to know, what does an abortion feel like? Will I remember this? What will happen when I get anesthesia?

“You are in good hands,” doulas are trained to say. “You won’t feel anything, and I will be right there when you fall asleep and when you wake up.”

Other patients just seek silence.

The product of conception is referred to as a “fetus” by doctors; Maris puts the patient’s beliefs first. “If they call it a baby, I call it a baby,” she told Mic. “If they call it nothing, I don’t name it. I don’t have to weigh in on what it is. As a doula, there is room for all those answers. The most important one is: Does it belong to the person carrying it? Yes, it is their body.”

Abortion doulas have become quiet foot soldiers defending people in the war against reproductive rights, supporting people through what can be the most difficult of personal choices. The Doula Project, based in New York City, was the first group to reimagine the role of a childbirth doula in 2007, but now similar organizations operate in 24 states, from Colorado to Alabama, and Washington, D.C.

“A doula isn’t a political role, because it’s about holding space and basically loving my patients, regardless of their politics,” Maris told Mic. “But I do think on a larger level, to love someone and hold space for them in a landscape that is so violent and politicized — that is a political act for me.”

In this July 19 photo, abortion opponents with a group called Operation Save America gather during a rally in downtown Louisville, Kentucky.
In this July 19 photo, abortion opponents with a group called Operation Save America gather during a rally in downtown Louisville, Kentucky. Dylan Lovan/AP

Carly Manes, a 24-year-old doula and co-chair of the D.C. collective, told Mic that “the patient, and her wants and needs, are at the center” of the experience.

On a typical Saturday, she begins her work at 7:30 a.m. in scrubs, leading patients into the doula room, a private space with a small waterfall and inspirational quotes on the wall. Just before that meeting, a nurse has given the patient misoprostol, a drug that will soften her cervix and ready it for the abortion.

“Essentially, I give the pitch: I tell them my name and that I am part of the doula program,” said Manes. “Have they heard of it? They’ve probably forgotten as they have had so much happening in the last 24 hours.”

The patient cannot bring a cell phone or friend into the procedure room, so Manes offers to be her “stand-in friend” and be present during the actual abortion. Some want that support, while others don’t. “Many have struggled with the decision,” she said. “Some are afraid they’ll never wake up when they go under general anesthesia.”

The abortion procedure itself takes only three to five minutes. Patients are often naturally nervous, so the doula will typically ask, “How are you feeling?” “What questions do you have?” “Do you have what you need to feel comfortable?”

Statements like, “This is your right,” are unacceptable. Rather, the doula might ask as a woman walks through her decision, “Are you sure about this? Do you feel you are doing the right thing?”

Once they’ve entered a clinic, most people have made up their minds. But they still need someone to listen.

Violence, red tape and a “military strategy” against abortion

Violence at abortion clinics is at its highest level in 20 years. According to the 2016 National Clinic Violence Survey, more than one-third of U.S. abortion providers had seen “severe violence or threats of violence last year. In one incident, a gunman killed a policeman and two civilians at a Planned Parenthood clinic in Colorado Springs, Colorado, in 2015; the man had reportedly said “no more baby parts’’ to explain his actions.

An estimated 652,600 abortions were performed in the U.S. in 2014. That’s the lowest number since 1973, when abortion became legal in the U.S., according to the Guttmacher Institute. The decline is in every state and among all ethnicities.

Today, more than seven in 10 women oppose overturning Roe v Wade, the 1973 Supreme Court ruling that legalized abortion, according to the Pew Research Foundation. But abortion is still one of the most contentious political issues, and those who oppose abortion have made great strides in eroding reproductive rights at the state level — mostly “under the radar,” according to Kaylie Hanson Long, a spokeswoman for the National Association for the Repeal of Abortion Laws. The group advocates for abortion care, birth control, paid parental leave and protections from pregnancy discrimination.

Long calls anti-abortion activists a small, fringe group.

“But it’s powerful. They are finding all sorts of back-door ways to target abortion clinics … It feels like attacks on women in this country are never-ending,” Long said.

So-called Targeted Regulation of Abortion Providers, also known as TRAP laws, which are mostly in states in the Midwest and South, have restricted the time window in which pregnant people can obtain abortions, instituted mandatory wait times, and even changed smaller regulations.

Only about six states have “strongly protected” access to abortion, according to NARAL Pro-Choice America, while more than half of U.S. states have “severely restricted” access.

In Virginia, pregnant people are required to receive counseling that discourages them from obtaining an abortion, and must also undergo an ultrasound and be offered to view the image. They legally also have to wait 24 hours before the procedure. And pregnant people under 18 seeking an abortion require the permission of a parent, grandparent or adult sibling.

This year, Maris said, the clinic where she volunteers was required to change the width of its hallway — ostensibly for safety reasons. Ohio recently changed the cut-off point for a legal abortion from to 20 weeks pregnant; In 1973, Roe v Wade gives the right to have an abortion until about 24 weeks into a pregnancy.

Charmaine Yoest is an anti-abortion rights activist. Now assistant secretary for public affairs at the Department of Health and Human Services, she was formerly president of the pro-life public interest law firm and advocacy group Americans United for Life. Yoes described their legal approach as a “military strategy.”

State laws, in some instances, have been ruled unconstitutional. In Texas, for example, a state law that required abortion clinics to have surgical facilities and admitting privileges at a nearby hospital was struck down by the Supreme Court in 2016. Critics of the law had said it would force many clinics to close.

“We don’t make frontal attacks,” she told the National Catholic Register. “Never attack where the enemy is strongest.”

AUL’s biggest legal success was defending the Hyde Amendment in the Supreme Court in 1980. The Hyde Amendment bars federal funds from being used for abortion, except to save the life of the pregnant person. Since then, the organization has worked to establish fetal homicide legislation in 36 states, in addition to supporting parental involvement and informed consent laws.

Current AUL president and CEO Catherine Glenn Foster defended these laws, saying they are “about women’s health and safety” — and not aimed at shutting abortion clinics down.

“Yes, ultimately we want to overturn Roe v. Wade, and we are working state-by-state to create a culture of life,” she said.

Foster explained that it was her personal experience as a young woman that led her to the anti-abortion fight. She was pressured into an abortion, she said, and was denied her request to see a sonogram of the fetus.

“Lack of choice, lack of empowerment, lack of caring — that alone is traumatic,” she said.

However, the role of the doula “inspires” her work to keep abortion clinics well-regulated and to protect people from what AUL alleges are unsanitary and unsafe conditions, she told Mic. Foster said she had never met an abortion doula or doula organization, but stressed the importance of protecting the physical safety and mental health of the person seeking an abortion.

“The abortion doula movement is right to recognize that abortion is not simple or easy, and that women in abortion centers are in need of care and support,” she said. “But many women experience real doubt, real coercion and even abuse; their inner voice that is calling on them to choose life, that is bolstering their confidence that they are strong enough and can handle what life is throwing at them, should be affirmed rather than stifled.”

AUL president and CEO Catherine Glenn Foster.
AUL president and CEO Catherine Glenn Foster. Americans United for Life

Abortion doulas help people seeking abortions with their “informational and emotional needs,” according to a small University of Chicago study that was published in 2016 in the journal Contraception, particularly because clinics do not allow other support in the procedure room.

Phoebe Lyman, one of the study authors and director of the full-spectrum program at the LA Doula Project, said 56 abortion doulas were trained this year.

The doula-patient relationship is “kind of like a blind date,” Lyman told Mic. “There is something really special about the anonymity. I don’t know you, and you don’t know me, but I am here to support you and make an experience that can be dehumanizing more human.”

Such was the case with Jane (not her real name) who Lyman said made the excruciating decision to have an abortion at 22 weeks, after an ultrasound revealed a brain abnormality in the fetus.

Jane, a third-grade teacher with a 3-year-old, was alone and in crisis, because her husband disagreed with her decision to have an abortion, Lyman said. The doula at her clinic listened as Jane struggled with her choice. In the end, she thanked and hugged her doula.

“It takes a really flexible and compassionate person to be a doula,” Lyman said. “A lot of people are called to this work and have a natural inclination to support women in whatever decision they make.”

“It’s about the mother”

People who seek abortion come from all backgrounds: An estimated 60% are in their 20s, according to the Guttmacher Institute, while about 86% are unmarried and 75% are economically disadvantaged. Just under two-thirds of women who have an abortion report a religious affiliation.

About 59% have had one or more children, a number that doesn’t surprise Manes, from the Washington collective.

“As doulas, we find most people want to talk about their children,” Manes said. “It makes total, logical sense, and feels absolutely right. They know they cannot afford to bring another child into the world, or they don’t have the financial, emotional or familial support to raise another child. It’s wildly selfless and a testament to their children.”

Both Manes and Maris say they see a surprising number of people who, for religious reasons, oppose abortion, but see their own circumstances as an “acceptable reason” to have one.

“When we see patients who really, really want a pregnancy and can’t because of larger circumstances, my heart breaks for them,” Maris said. “We say we are pro-choice, but it isn’t a choice.”

In training, doulas must dig deep into their values so their own opinions don’t get in the way. Would it be OK to get an abortion if the child will have Down syndrome or another disability?

The Washington collective receives about 60 applications a year for doula positions. That number is narrowed after informational interviews determine whether the applicant understands the gravity of the work.

Not every applicant is a good fit, according to Maris. Some are adamantly pro-choice and see being a doula as a form of activism. Others say they think they would have a hard time being sympathetic with a patient who believed abortion was wrong.

“We’ve had people in training, and their heart is in the right place, but they can’t hold space and mirror the patient,” Maris said.

Role-playing is a key tool in training. Doulas act out common scenarios as more experienced ones play patients. Another exercise helps doulas examine their biases: Do you believe a person is justified in having an abortion under any circumstance? What about choosing the gender?

After training those who are new shadow older doulas in the clinic before volunteering on their own.

A patient’s circumstances must stay in the strictest confidence. When people leave the clinic and go back to their sometimes complicated lives, a doula’s work is done.

But Manes said she carries their pain. “There’s emotional exhaustion and logistics,” she said. “Not everyone has someone to support them. They fight with the insurance company and worry about childcare. They can’t drive for 24 hours.”

As for Maris, who hopes to have children one day, working as a doula has changed her view of abortion, an issue she once saw in “shades of gray.” Now, she said, she’s clear on whose humanity comes first.

“It’s about the mother,” she said, and supporting her. “Fiercely.”