The Boston Globe | Abortion doulas help patients navigate the fraught landscape of a post-Dobbs world

By Olivia Yarvis and Zeina Mohammed

Originally Published in the Boston Globe

When it came to the question of whether to get an abortion, Camilla Thompson didn’t feel she had much of a choice.

Her mother’s words were clear: It was something you do, move on from, and stop thinking about.

For Thompson, then 16, the procedure itself was quick. But then came the doubts. Had she squandered her chances of becoming a mother? The shame. How could she, an adoptee, terminate a pregnancy? And the residual grief that would be her shadow for years to come.

Had there been a dedicated person to confide in, to affirm her experience, Thompson said she would have “absolutely” used their help. But aside from the clinic’s standard pre-operation counseling, that option did not exist for her — not yet.

Nearly 14 years later, there is a close-knit support network of non-medical professionals across New England filling that role — and Thompson is a part of it. She is an abortion doula: a judgment-free advocate for patients as they navigate the emotional, physical, and logistical journey of terminating a pregnancy.

Doulas are careful not to impose their own beliefs on clients, instead working to validate patients’ decisions. To do this work, Thompson said, “you just have to be open-minded and you have to be able to not have a stance on the matter.”

Indeed, many doulas offer abortion support in addition to other forms of care along the reproductive spectrum, including birth, postpartum, and miscarriage support.

Like birth doulas, who provide support during pregnancy, labor, and the postpartum period, abortion doulas offer comfort and guidance that complements a patient’s medical care. That support can include raising funds, offering transportation, and providing companionship before, during, and after medication and surgical abortions.

Thompson is part of the inaugural class of 19 doulas trained by the Reproductive Freedom Fund of New Hampshire. The fund is just one of many institutions — including college reproductive health collectives and abortion clinics — integrating abortion doulas into their care models.

There is no official tally of abortion doulas, though individuals and organizations offer such support throughout the country, largely operating as a diffuse network with no universal certification requirement or training program to complete before adopting the title.

Thompson and many of her peers entered the field in the post-Dobbs era, as multiple states passed total abortion bans and restricted access to medication abortion. The changing laws have brought logistical challenges and heightened anxiety into the process for many. According to Boston-based doula Cedar Hayes, even people in New England, who enjoy broad abortion protections, aren’t insulated from the emotional effects and legal confusion produced by the reversal of Roe v. Wade nearly two years ago.

“There’s still that baseline harm,” regardless of the protections in one’s state, Hayes said. “Saying that your blanket protection is being taken away, and good luck … that’s scary.”

More people are traveling to New England for abortion care in the wake of Dobbs, but Hayes said restrictions persist in New England that complicate people’s ability to access quality care.

As of 2020, the majority of counties in Rhode Island, Vermont, and New Hampshire did not have an abortion clinic, according to a report from the Guttmacher Institute, and geography can likewise be a barrier in parts of Massachusetts and Maine. According to Reproductive Equity Now, crisis pregnancy centers, antiabortion facilities that have been accused of posing as reproductive health care clinics, outnumber legitimate providers in New England.

No two clients’ reasons for and feelings toward seeking an abortion are alike, and neither is the care they receive from doulas.

“The limit does not exist to the ways in which you can support someone,” said Portland, Maine-based abortion care worker and author Hannah Matthews.

Remembering the late nights spent ruminating over her decision, Thompson, who works remotely, makes herself available to her clients at all hours, their texts often reminiscent of her inner monologue surrounding her abortion.

I’m afraid of how I’ll feel after. I feel like I’ll be grieving this loss forever.

For Matthews, caregiving can take the form of a multi-hour drive to the nearest clinic. At times, care appears as crowdfunding on behalf of a client. In other cases, care is “verbal anesthesia” in the form of a prayer, soothing a client whose pregnancy was not necessarily unwanted, she said. Always, the authority to make decisions lies in the hands of the person seeking an abortion.

“People want to be witnessed. They want to be seen and they want to feel like there’s at least one person who isn’t trying to promote their own agenda for that person’s life and future,” said Portland, Maine-based doula Cait Vaughan, who offers abortion care as well as other reproductive support. “And sometimes we’re the only ones, you know.”

Empirical research on the benefits of abortion-specific doula care is limited, but positive health outcomes associated with birth doulas have been well documented. Particularly when there is concordance between a patient’s identity and that of the provider, doulas can be rare sources of culturally competent care for Black and Indigenous people who disproportionately face poor maternal health outcomes.

For Vaughan, who frequently works with clients with histories of incarceration and drug use, her goal is not just to support such communities, but also to one day see these clients receive training and resources to provide support to their peers.

She and many fellow doulas also believe that normalizing a wide range of client experiences means building a network trained to support diverse clientele but also to be representative of them.

“Representation matters with patients,” said Thompson, who is frequently paired with BIPOC clients through the reproductive fund. “l think that what Black women specifically face in health care is completely different than our white counterparts, so to be able to work with somebody that has a closer genetic makeup, or health history that might look the same, family values that might look the same. ... I think that’s important.”

Building a representative network of abortion doulas is still a work in progress. Some doulas have taken the initiative to serve clients with shared sexual and/or gender identities, and RFFNH recently created a stipend program to recruit BIPOC doulas.

In contrast to birth doula care, which can cost between $800 and $2,000, most abortion doulas the Globe spoke with offer their services free of charge or on a pay-what-you-can basis. MassHealth, the state’s Medicaid program, will begin allowing coverage of doula services this spring for all pregnancy outcomes.

The biggest barrier to abortion doula care, Vaughan said, is the knowledge gap.

“I still think we’re at a point where people don’t know that [abortion doulas are] an option,” said South Shore-based full-spectrum doula and childbirth educator Amber Matteson, who typically has only six to 10 abortion clients a year. “And because they don’t see us, I don’t see most of us being busy yet.”

Several doulas said social stigma is another barrier, particularly since the overturning of Roe v. Wade. Amid the difficult climate, Matteson, who uses she/they pronouns, and many of their peers have invested their energy in spreading awareness about their services.

For Thompson, who was pregnant with her daughter Ava when Roe v. Wade was overturned, the responsibility she feels as a doula to destigmatize the practice of abortion is a personal one.

While she cannot guarantee legal protection for her daughter should she one day need an abortion, she can confidently make one promise: that she will always create a space for her where abortion will not be taboo.

It’s a promise Thompson and her colleagues, like Matteson, continue to pledge to every new client.

“Underneath all of the crap that you’ll probably encounter trying to gain access to health care, I promise there’s a community here in waiting ready to support you,” Matteson said.