But the disconnect between direct care and policy advocacy was real. As we were conceptualizing the Doula Project we experienced this ourselves. We went into the clinic with our own baggage from the advocacy world, our own assumptions. For one, we assumed all of our clients would identify with the word “abortion.” We quickly met people having miscarriages and those who felt unsafe using that word, so we starting saying “procedure” instead, or reflecting whatever language our clients used. We also met clients who didn’t identify as women, and so we became more intentional about using the term “pregnant people.” Additionally, we had assumed we would be engaging in tons of postabortion care—as it turned out that need was never expressed by our clients. Pérez reflects, “I think advocates often make the mistake of assuming they know what the people they are trying to advocate for need. Direct care offers an opportunity to put those assumptions aside and actually listen to the needs of the person.”
While understanding the important macro connections and implications of direct care, its primary goal was individual support. The policy world didn’t necessarily want to silence abortion stories, but they were selective about the ones that should be shared: their primary goal was to protect the legal right to an abortion. For example, we were much more likely to hear a story of late-term abortion that focused on the health of the mother or the baby than we were to hear about a woman who didn’t know whether she wanted an abortion until later in her term or found out she was pregnant during her twentieth week. We were also more likely to hear a story of a woman who felt empowered by her abortion than one who felt ambivalent or regretful about it.
We would learn that the two factions of the work would sometimes rub against each other. People have emotions about their abortions, and they aren’t always what political movements want to hear. To this end, Baker notes that we should focus on caring about women, not just about abortion:
When someone truly cares about women they are open to hearing what women want to say about their own abortions (whether they are pro-choice or pro-life or neither), but when the care is primarily about securing or ending the legal right to abortion then there is great concern about what women say about their own abortions. If we stick with caring about women and we commit to doing it fiercely and publicly, with respect for their unique differences, faults and imperfections, then we don’t have to make choices about the political relevancy of their story or their feelings. We don’t have to edit and rework. We can just accept.
Many beyond the abortion rights movement were not prepared for the paradigm shift that was happening, particularly our closest critics: medical staff. They were about to let another person into the room, and to what end? Who were these abortion doulas anyway? Nurses and counselors held pieces of the doula role, with other tasks that usually took priority, and from the start we had to distinguish our role from theirs and make sure we did not take the joy of client care away from them. We learned much of how to become abortion doulas by observing nurses and counselors in action. We shared intimate space with them and witnessed the same procedures, the same client responses. We ultimately would form a community of care with them in which we all supported each other through our primary tasks.
The pro-choice and medical communities were kind in comparison to the birth community. We thought everyone was “progressive” like us—by which we meant quite simply “pro-choice.” We were wrong. Many in the birth community were affronted not only by the abortion work we were doing but by the very idea that we would expand the doula name in this way. There were those who were skeptical—“You’re not really doulas,” as that birth and abortion activist famously told us at our first training—and those who outright opposed us, mostly the pro-life birth community contingent.
Lauren, Pérez, and Aimee Thorne-Thomsen had been to the NAPW conference in Atlanta that winter and had seen this tension firsthand. Thorne-Thomsen remembers, “You were either an abortion rights activist or a birth activist, and we are not the same; we are not community. Even as an abortion activist I remember feeling completely alienated from the birth rights people, and I couldn’t believe this chasm exists, but it does.” As a full-spectrum doula organization, we would find ourselves managing either side of this equation throughout our existence.
Today
So much of how we started was about being in the right place at the right time. Once we got the go-ahead to be in our first clinic, we spent a lot of energy sprinting from one end of the hospital to the other. We followed doctors through crowds, trying to figure out where and when we would meet our clients on any given day. We had to stick to our clients like glue, or else they would be called into a procedure and the clinic staff would forget that a doula was wandering the halls, looking for her client. We knew we had turned a corner the day we got an annoyed phone call from a clinic nurse who said, “We can’t start the procedure because the doula is running late. Where is she?”
Having a doula present during an abortion is no longer “icing on the cake”—our clinics consider us an important part of their infrastructure. There is now an institutional acknowledgement that having a doula is part of a standard of care for many pregnant people, which is underscored by the fact that the doulas have been present in our clinics since before many of the doctors we work with were hired. Residents and medical students are regularly trained to do procedures with a doula in the room.
Nearly a decade later, we have served tens of thousands of clients and trained close to a thousand abortion doulas around the country. Today, it’s hard to find anyone on the pro-choice spectrum opposed to abortion doulas. Baker says:
The Doula Project is unique in that it has a record of real success. You have done more than just talk about change, you have created real change in women’s lives and in the lives of people who work at clinics. It’s amazing that it has been done by volunteers, and that alone is something tremendous to offer the world as a message. It is absolutely the kind of culture that we can and should create.
Pérez expands on this:
I think there has been a tectonic shift in both [birth and abortion] movements, which full-spectrum doulas definitely get some credit for. Both movements are talking about birth and abortion in ways they weren’t before. Both movements are being pushed to see the full spectrum of our reproductive lives. I see [full-spectrum] doulas as an incredible bridge, and I think we’ve been able to practice direct care while also [pushing] advocacy movements to broaden their lens.
On a national level, we have supported dozens of groups interested in doing full-spectrum doula work, and trained hundreds of activists. The “rise of the doula” is present in reproductive justice everywhere. Marlene Gerber Fried, who teaches at Hampshire College in addition to her work at the Civil Liberties and Public Policy program, remarks that she is “really struck by the heightened interest of younger advocates in doula work. Even among the cohort of students I’ve been working with, many want to be doulas. They’re coming into a class about abortion but they all want to be doing birth work. This is new. And it has a lot to do with the advocacy in the birth justice movement such as the Doula Project. It’s made a huge difference in drawing new energy to that work.”
Fried continues, “The spectrum idea is just perfect because it forces the erasure of the bright line that divides the women who have abortions and the women who have babies. Anything that can undermine that misconception is important to the reproductive justice movement.” Direct service work can provide young activists with plenty of gratification, as well. “Policy change is such a long road to walk,” Fried acknowledges. “At the end of the day, seeing something through like a birth allows a young idealist to hang in there for the work that is the longer haul, and that’s what I think is really great.”
Those first years, we took missteps. We tripped and fell down, bruised our knees, scratched our elbows. We got back up. We learned how to frame our work in ways that were responsible to our clients, clinics, and the world of policy advocacy. We learned to appreciate that we would not be the first or last people to do this work. We created a purposeful position and named it, giving people something to hold on to. But mostly, we kept our heads down and served