For some women, the need for emotional support during pregnancy termination is high. Erin explained, "Even though I was very clear in my heart and mind that the abortion was exactly the right thing to do for me at that point in my life, it was nonetheless a very frightening experience. The medical staff at the hospital were not kind to me and there was no discussion about what was happening to my body, it was just a procedure that they were doing to me as coldly and clinically as possible." As the number of providers decreases (it has dropped 37% since 1982) and the number of women having abortions continues to go up, clinics and abortion providers are overextended and under-resourced. Not only are many providers not well equipped to provide adequate support, but the procedure itself can also be a painful one, during which many women are fully or at least partially conscious. Raquel Valentin, Practice Manager for the Family Planning Division at Beth Israel Hospital explained, "Many first trimester abortions are being done with local and moderate sedation. This means that the women are still awake and emotional." The decision to use moderate sedation is based on both the women's choices and the higher risks associated with full anesthesia but can result in an experience that can be both frightening and, at times, painful.
In at least one abortion provider setting, a group of women is looking to provide additional support to women during pregnancy termination. The Birth Sisters, an existing doula program at Boston Medical Center (BMC), is in the process of adding abortion to their already comprehensive list of support services offered. The program, fully funded by the hospital, provides women with support from the early stages of their pregnancy through the postpartum period, often from doulas who can provide culturally competent services to the burgeoning Latino immigrant population served by the Medical Center.
Within the Birth Sisters program, the doulas have developed specialties, which are accompanied by further training in a particular area. Some of the Birth Sisters have specialties in domestic violence, others in breastfeeding. In an effort to meet the needs of women having abortions, the program is looking to expand the program to include compañeras, doulas who would provide this abortion support. The idea is currently in the research stages, and the members of the program have developed a needs assessment that will provide data on what kind of support women who are terminating their pregnancies at BMC need. They plan on having the compañeras meet with the women before the abortion, accompany them during the procedure and then meet with them at periodic increments afterwards as well (two weeks, two months, four months, etc). This mimics the role of a birth doula, who frequently meets with women before and after the birth, and goes beyond the support that most abortion providers currently offer. Dr. Nilda Moreno, an OB/GYN and member of the Birth Sisters program, explained, "We don't only want to provide emotional support but also contraceptive support. We want them to have all the information to prevent unintended pregnancies." Dr. Moreno also explained that the training will be similar to what counselors at Planned Parenthood receive, but with a special focus on emotional support. In addition, they also plan on providing support to women having medication abortions, who usually go home and pass the pregnancy on their own.
The idea of providing a support person to women during pregnancy termination is not a new one. Planned Parenthoods, other abortion clinics and feminist health centers have a history of trying to provide support to women having abortions, in the form of options counseling and also with accompaniment during the procedure. Other abortion settings provide similar support in the form of specially trained counselors, or patient advocates. When these programs are already providing models for supporting women during abortion procedures, why doulas?
Erin explained why she would have wanted a doula at her abortion: "I feel that a doula would have helped me understand what was happening to my newly pregnant body, the process of the abortion, and the after care for my body." Doulas employ a variety of techniques with women in labor, some that help prepare her mentally for the labor, others that mediate pain, and others that focus on relaxation. Many of these techniques could have useful applications in the support of women during pregnancy terminations, as Erin describes. Explaining how the abortion procedure works is similar to visualization used by doulas during labor, when the doula helps the woman to visualize the baby moving down into the birth canal with the strength of each contraction. These visualizations can help the woman better cope with the pain of labor by enhancing her understanding of the purpose and cause of the pain she is feeling. In addition, pain mediation techniques, like massage, acupressure and breathing could all be helpful for some women during these abortion procedures.
Central to the concept of doula care for abortions is the follow up component. This is where most clinics and providers are unable to provide the longer-term support that a doula could. "I would also have welcomed their support in confirming that my body would, in the future, be ready and able to make a baby and that I would be a good mother when the time was right," Erin says. An important component of birth doula work, this follow-up allows the doula to check in with the woman throughout the months following her abortion, when additional concerns and issues may arise.
Susan Yanow, supporter of the Birth Sisters project and former director of the Abortion Access Project, explained that she sees abortion care as just another service that doulas can provide, in addition to the other areas where they already provide support. "I don't want to carve out abortion in any way that minimizes or maximizes it," she explained. Instead of implying that women who have abortions need a lot of support, this is simply another opportunity to help women within the broader context of doula care. To her it's important that women do not feel that abortion is being stigmatized and that women are not being sent the message that they need support during their abortion. "For some women," Susan reminded me, "all they feel after their abortion is relief."
"The reasons a woman decides to have an abortion are complicated, and her feelings are really complicated. We need to take care of all of it." Susan explained that what she doesn't want to do is send the message that all women need support; and she worries that it will simply add to the stigma that women already feel around abortion. Some women have social networks, family members and friend who will be there for her; some don't need any special attention at all. But for the women who do need it, Susan agrees that it should be available to them. At the Birth Sisters program, a large majority of the women they serve are immigrants from Latin America, many of who are terminating pregnancies that they acquired while crossing the US-Mexico border. These pregnancies can be a result of rapes that are not an uncommon occurrence for immigrants who come into the United States without documents.
For many in the midwifery and doula community, the idea of a doula offering her services to a woman terminating a pregnancy is controversial. Abortion is a topic that is rarely breached at midwifery and doula meetings and conferences, and in many ways has become the elephant in the room of the birthing rights movement. The reasons for this are varied, from a strong religious contingent within doula and midwifery communities to women who feel strongly that they are working on behalf of mothers and babies. A thread in reaction to an article I wrote for Campus Progress about being a radical doula on the site Alldoulas.com provoked an interesting discussion about this issue. One poster explained, "I am an advocate for moms and babies. Aborting babies is totally opposite from that in my view. As much as I believe in a mothers right to choose how she will give birth, I also strongly believe in the baby's right to live. When I was new in this doula work, I started out assuming that most in the childbirth field would naturally be pro-life. It was very hard for me to comprehend how doulas and midwives could be pro-abortion."
One woman and advocate who is working to force abortion advocates and birth activists to dialogue with one another is Lynn Paltrow. Executive Director of the National Advocates for Pregnant Women (NAPW), Lynn has been advocating on behalf of pregnant women for most of her career. Last Spring, Lynn and NAPW hosted the Summit for Health and Humanity of Pregnant and Birthing Women in Atlanta, Georgia. What transpired was a gathering of abortion advocates, reproductive rights activists, midwives, doulas and birthing rights academics. Not everyone in the room was in support of abortion. Not everyone in the room understood the benefits of natural childbirth. Lynn explained in her article on TomPaine.com, "Participants moved beyond the divisive abortion debate to find common ground in the experiences of pregnancy and the increasing limitations to care and support that all pregnant and birthing women face." The Birth Sister's Compañera project, along with two other similar abortion doula projects (one in New York City and another in Washington State) arose from conversations that began at the summit.
In the last few years, we have seen the abortion climate in the United States become increasingly hostile. The current administration, including its newly appointed Supreme Court, seems adamant about limiting women's access to abortion procedures. Medical students aren't being trained to do the procedure, yet the need for abortion services remains steady. Some women make the decision to have an abortion within a supportive and loving environment, and they are able to cope well with the emotions that can come along with terminating a pregnancy. But other women make the decision alone, or without the support of a partner or families. It's these women who will benefit the most from having a doula at her side-someone who has no investment in her pregnancy, and simply wants to hold her hand, distract her, make her laugh or explain the procedure to her. But it's also about more than just helping a woman survive that one procedure, it's also about trying to mediate the impact it has on the rest of her reproductive life. "I had a hard first labor," Erin recounted. "I wonder if I had trouble connecting to my birthing body as a result of the abortion experience. Once I worked with a doula for the birth of my two very much wanted and planned children, I could imagine what it would have been like to have a doula at the abortion."
]]>Lisa, a first time mother, touchingly recounts her story to a stand-alone camera, her image projected onto the wall behind the stage. The other seven cast members sit in two rows of chairs facing one another, alternately playing the roles of support people, mothers, nurses and obstetricians. Lisa's story is one of eight told in Birth, a play by Karen Brody, written in the style of the Vagina Monologues and based on her experiences interviewing women across the United States about their birth stories. The play is being performed around the world this month (from small towns in Arizona to as far away as Uganda) in honor of Labor Day and the BOLD (Birth On Labor Day) campaign. BOLD's mission is to use theatre as a vehicle for social change, and is part of "a global movement to make maternity care mother friendly."
The run in New York City includes three performances in the month of September and will raise funds for the Friends of the Birth Center, a group trying to open a Birthing Center in Manhattan since the close of the Elizabeth Seton Childbearing Center in 2003. Heidi Miami Marshall, director of the New York performance, recruited doulas to attend each rehearsal in the final week, to insure that an "expert" could give the actresses feedback. They asked questions about noises (have you ever heard a woman wahoo?), signs of nervousness in a birthing mother, and more complex questions about the political context of birth. The play touches on the many facets of maternity care in the United States today, from elective cesarean sections to home births and everything in between. Its conversational tone invites you in to experience each woman's story and feel the pain, joy, excitement and fear along with her as she deals with the cacophony of emotions surrounding childbirth and pregnancy.
At the opening New York performance at a small sold-out theatre in the West Village, the pre-play audience chatter was not your typical theatre conversation. In an audience with a higher than usual proportion of midwives, doulas and childbirth educators, the conversations instead tuned in on relevant issues like hospitals, inductions, epidurals and birth stories. As the play began, a black screen on the stage posed the question, "Do you know your birth story?" The actresses launch into their stories, through which the play made an obvious attempt not to make any woman's choice,(even an elective cesarean section), seem wrong. Instead each woman grapples with the consequences of her decision, her struggle to get what she wanted from her birth and how these decisions were affected by the people around her.
In a panel following the play, audience members hit on the difficult issues at hand-how do you know when to trust a woman's intuition and when to trust her medical provider? What about low-income women and immigrants, whose voices were absent from the play? What is a normal birth anyway? Each performance this month is followed by a Talk Back-a way for the audience to engage with the issues brought up by the play and it provides a forum for members of the local birth community.
Karen Brody's innovative play will continue to open up the dialogue about women's birthing environments, in the United States and abroad, encouraging women to process their own experiences and share their stories. As the author herself explains on the BOLD website, "One woman dies every minute throughout the world from a pregnancy or childbirth-related cause. As a writer I wondered, why are we not telling this story? And as an activist I wondered, how can we tell this story in a way that will make a difference, that will shift the model of maternity care for women to the mother's needs?"
]]>As a queer Latina working for an abortion rights organization, I can attest to that fact that Kirchick is wrong—and the only thing divisive about LGBT groups and reproductive rights advocacy is the insistence on keeping them apart. Kirchick implies that abortion should not be a concern of LGBT organizations because "'Oops babies' are simply not a phenomenon common to gay life." The ignorance behind this statement is vast, but to sum up a few of the things this author neglects:
LGBT people come to the community from a diversity of backgrounds including, for many, significant time spent in the closet, and very often partnering with folks of the opposite sex. Sexual assault and rape are unfortunately still a reality, both for heterosexual women and queer women. Kirchick is also obviously leaving out the "B" and "T" in his discussion, because bisexual and transgender members of our community are by no means excluded from the possibilities of pregnancy.
Regardless of all of these exceptions to the crux of his argument—that abortion is not an issue that affects the LGBT community—the most important evidence that I have to the contrary are the activists that I work with. At the National Latina Institute for Reproductive Health, we bring together groups of like-minded Latina/os with a passion for reproductive justice through our Latinas Organizing for Leadership and Advocacy trainings. A large number of these men and women identify with queer communities, and this isn't a coincidence. Even though our work does not focus explicitly on LGBT issues, these activists see the connections clearly and resonantly enough to devote a significant portion of their time to reproductive justice activism and advocacy.
As a member of the steering committee of Causes in Common, a coalition that works to make the connection between LGBT and reproductive justice movements and build cross-movement collaboration, I see how these connections can be fostered and put to good use. People of color, particularly women of color, are familiar with the tensions that arise when one segment of an oppressed group's interests are seen to be at odds with the agenda of the group as a whole. In the past, women of color have been at odds over feminist struggles within their national and ethnic movements. The lesson learned from this history? Solidarity is the only thing that can really bring about widespread change.
Reproductive justice is not just about one's ability to reproduce. It's about autonomy, its about respect, its about shared principles based in the human right to health and a desire for real social change. If members of the LGBT community can't understand this, how can we expect to find allies in other movements? This isn't about feminists versus abortion advocates versus queer people; this is about building a movement within which we can all find a space. The other side has mastered this. It only takes a quick look at the common denominator between anti-choice and anti-gay legislators and activists to see it. They are one in the same. We need to be as well.
]]>