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A Great Idea

The Abortion Doula Project was a great idea.

It was one of those brilliant shining stars that catches your eye from high above, the kind you want to reach up and grab with both hands, make a wish on. And this was it in all its profound simplicity: people having abortions should have continuous and nonjudgmental physical, emotional, and educational support just like people giving birth. For one year, between the summers of 2007 and 2008, we floated on our big, beautiful idea, lifting it up bright and glowing into a cloudless sky.

The idea was conceived at the NYC Birth Coalition meeting, a local attempt to bring abortion and birth activists together in one room—something that didn’t normally happen. That day, Lauren Mitchell, Mary Mahoney, and Miriam Zoila Pérez, the Doula Project’s founders, all stood up and said, “We want to be abortion doulas.”

Words of encouragement fluttered through the air, the group nodded and smiled at each other as the idea dawned. Maybe this will be the next “big thing,” their reactions seemed to say.

The three of us circled each other curiously. We had met briefly before at some point or another—the New York repro scene was relatively small. We decided to grab lunch after the meeting. We walked to Zuccotti Park to eat our deli fare and jumped into how we might start an abortion doula program here in the city.

We had each entered the reproductive justice fold in the early to mid-2000s and were trained under its holistic justice-based framework created by women of color in the 1990s, with Loretta Ross spearheading the conversation. Often, the feminist movement of the 1960s is associated with a reproductive rights framework—the right to choose when, how, and with whom someone has children. Reproductive justice takes that movement further, bringing together intersections of identity to form a definition of social justice hinged on lived experiences—especially lived experiences of women of color. It analyzes and exposes the intersections—including gender, race, sexual orientation, and access to resources—that affect how a person makes decisions and whether that person has meaningful choices around reproductive health. Reproductive justice looks not only at the right one has to an abortion but also one’s right to have a child and to parent that child.

Connecting the right to give birth and parent to the right to an abortion was a groundbreaking concept that would greatly influence the mission of the Doula Project (which would become our official name within a year).

Full-spectrum care, the cornerstone of our organization, was a direct descendant of the reproductive justice framework and bolstered the stance that abortion should not stand alone, that it is one part of a person’s entire reproductive life. The same individual may have an abortion, give birth, and then have a miscarriage. The point we feminists wanted to make was no longer only, “I’m having an abortion.” It was now, “I am pregnant. This is what I choose to do for this pregnancy. This is what I am able to do. Next time, I might choose something different. Can I get some care and support for this pregnancy’s path?”

Full-spectrum care acknowledged the experience of being pregnant—whether for four weeks or nine months—not just the outcome of the pregnancy. Somehow this idea seemed new. Aimée Thorne-Thomsen, former executive director of the Pro-Choice Public Education Project (PEP), early advisor to the Doula Project, and current vice president for Strategic Partnerships at Advocates for Youth, remembers:

It felt like there were more conversations about the end result of pregnancy. We would talk a lot about abortion or birth control, we would talk about things around pregnancy, but not pregnancy itself. And at the point you all were going to launch, it was like, huh, there’s a process here that we skip over in the field all the time: the actual pregnancy.

We were compelled to do this work because we wanted to see and feel the changes we were trying to create. The reproductive justice movement was home to us, and we were well aware of the debt we owed to the intellectual and political framework it created, which opened the door for us to dive into this project. We were standing on the shoulders of giants, women in the field who were changing both policy and the messages being presented in media. As a result they changed the lives of countless people, who started receiving better care and more acknowledgment of the state of their care.

We also looked back to the 1960s and early 1970s, the time before Roe v. Wade was decided, when women still had to obtain abortions illegally in most states. We discovered Jane, the underground abortion network in Chicago that helped more than eleven thousand women receive safe abortions between 1969 and 1973. Jane was known for its radical feminist politics and DIY spirit. Members of Jane put together pop-up abortion clinics in whatever nice apartments they could find, they did extensive counseling and phone support, they provided post-abortion care—and often were the abortion providers. What we were most struck by, though, was how much support and care was exchanged between the members of Jane and their clients who had little to no anesthesia to offset the pain. Thinking about how this support played out, Laura Kaplan, author of The Story of Jane and one of the coordinators of the Jane Collective, reflects, “How you behave toward another person and what you do for her affects her view of herself.”

Kaplan describes the Jane Collective as mixing abundant idealism and social responsibility. They were responding to a pressing need in the community, saying, “We saw all of these problems, and we felt like abortion access was something we could actually do something about.” They learned quickly what we would also learn quickly: that direct care means you do not put good against perfect. “We were very focused on the here and now,” she says. People would call needing abortions and needing them fast. Most of the time, they weren’t able to pay much, if anything at all, so Jane worked through the energy of volunteers, with a handful of paid staff who were doing the heavy lifting of coordination and procedures. An elaborate yet flexible process was set up to ensure that Jane would be able to operate efficiently and under the radar of the law. But doing this work on the fringes of legal and medical systems highlighted that no amount of planning and theorizing would be able to anticipate the messy reality of working with people during abortions.

We set out to translate the reproductive justice framework into a more direct-care-oriented approach, using pieces of what Jane did as a model. The reproductive justice movement promotes the idea that, in a lifetime, a person might experience the full spectrum of reproductive health decisions, that these decisions are linked to other intersecting factors in their life, and that any decision made should be respected and protected. So what did this actually look like on the ground for pregnant people? How was this lived out during their pregnancies?

Cofounder Miriam Zoila Pérez (who goes by Pérez), founded the blog Radical Doula and wrote The Radical Doula Guide: A Political Primer for Full-Spectrum Pregnancy and Birth Support. Pérez reflects:

Starting a program to support people during abortions just made so much sense to me. Of course doulas can and should use their skills during a different pregnancy outcome. Why wouldn’t we? I also appreciated the potential political impacts of even the phrase “abortion doula.” I knew that it would push at the silos between abortion and birth, and hopefully push the birth activist world to talk about abortion and miscarriage.

As we laid down the bones of our mission, a simple but strong skeleton formed, built largely on our own personal value systems and what we had uncovered fighting for reproductive equality over the years. We quickly agreed that the clients we most wanted to serve were the ones who may not have easy access to social support during pregnancy or who could not afford to go to the private clinics or fancy hospitals with the most resources. Because New York is a very culturally diverse city with enormous disparities in wealth and class status often based on the color of a person’s skin, primary language, or age, we knew we would primarily be serving women of color, immigrants, and young people.

We wanted our service to be free to all people who needed it, something we would become known for throughout the doula world. Doulas are often reserved for a more affluent crowd—their service isn’t cheap and is not typically covered by health insurance. We believed all pregnant people deserved this kind of support regardless of their financial status. In order to do this with little to no funding of our own, we, like the Jane Collective before us, decided we would create a volunteer network. Lauren and Pérez had already attended numerous volunteer births as doulas, and Mary had been an AmeriCorps VISTA. We all felt passionate about the power of volunteerism, of the emotional intimacy that arises from our work when it’s based on a fiery commitment to the cause rather than on compensation.

As the years went on, however, we would learn that in New York City “volunteerism” often equated itself to “middle class” and even more often to “white middle class.” Abortions typically took place during the day, during the week, when many people could not afford to miss work. Though we were and continue to be in awe of the incredible caring capacity of the doulas who joined, we cringed at the thought of creating another racialized, class-based hierarchy in medicine. We would struggle to diversify our base in the face of a meager budget and ever-growing client and clinic needs. (As this book is being written, we have passed our first budget to pay abortion doulas a small stipend.)

As we were coming together in 2007, the birth doula community in New York City was at the cusp of an explosion of a new generation of doulas. In addition to the ongoing abortion debate, the heat of the “home vs. hospital” birth argument was at its zenith. Maternal mortality and C-section rates were on the rise and people were speaking up. Abby Epstein’s eye-opening documentary The Business of Being Born was released soon after we became birth doulas. Suddenly, it seemed that everyone had a “birth plan” and everything was “natural”—natural products, natural labors, and natural approaches to parenting.

Meanwhile, a few months prior to the NYC Birth Coalition meeting, National Advocates for Pregnant Women (NAPW) convened a conference that brought birth and abortion activists together in one room for the first time in most of our memories. The NAPW’s 2007 National Summit to Ensure Health and Humanity of Pregnant and Birthing Women offered a crucial platform for activists and was in some ways iconoclastic: it engaged with reproductive justice activists as well as with staunchly anti-abortion birth activists. It was trying to build alliances across political dominions in a way we hadn’t seen before—for example, it created contact between abortion providers and birth activists who feared that they would go to hell for sharing space with them. But as Lynn Paltrow, founder and executive director of NAPW, discussed at length with both communities, the “justification for locking women up and forcing them to have court-ordered C-sections stems from the same legal justifications developed for restricting abortions. [In other words] there is no difference in the legal theories used to restrict abortion and those used to justify forcing a woman to have cesarean surgery.”

In trying to connect both communities, Lynn describes the work of the NAPW conference as “pragmatic” because both communities were advocating for the same women—just at different points in their reproductive lives. She also hoped that bringing the two activist communities together would “detoxify the abortion debate by making it richer and more complex [and] by saying, you can’t just talk about ending a pregnancy.”

According to activist and scholar Marlene Gerber Fried, director of the Civil Liberties and Public Policy program (CLPP) at Hampshire College, “Historically, the frame of choice wasn’t about having children, but rather the choice not to. And while there was much overlap in individual players and organizations who worked between the two worlds, for decades they were usually very siloed.”

CLPP was also instrumental in bringing together voices from both movements at their annual conference. The CLPP Conference facilitates one of the largest platforms for activists, especially young activists, in the country, often influencing themes and ideas among organizers for the year to come. In 2007 a number of doulas were invited to speak at CLPP. Those talks followed the conference’s Abortion Speak-Out, a night where people share stories about their own abortions. The Speak-Out is known for being a beautiful space for those who come to listen and those who come to share. The Speak-Out would be a huge inspiration to us, in many ways a cornerstone of our compassionate practice, as we developed as an organization.

Between the burgeoning success of The Business of Being Born, the connection reproductive justice advocates were facilitating between birth and abortion, and a new activist-flavored onslaught of birth doulas saturating New York City, the timing for the Abortion Doula Project seemed perfect. We continued to formulate our mission.

Pérez says now:

In that first year of creating [the Doula Project], I remember a lot of exploring what it would look like to take the skills and role of a birth doula and apply it to the abortion context. I remember a lot of hypothesizing about what someone having an abortion would want from a doula. We were wrong about a lot of the assumptions we made, but it makes sense that we were wrong. We were really charting new territory.

With this new territory came several months of starts and stops. We were all young, busting our asses at our full-time jobs, navigating a city that left us worn to the bone at each day’s end. Weeks would pass, and the Abortion Doula Project would feel like nothing but a misty memory. One day, Pérez announced she was moving to Washington, DC, to pursue new personal and professional opportunities. Unsure of whether to proceed without her, the two of us (Lauren and Mary) met up to determine the fate of the organization. We decided that we were finally “gonna do this,” although we would now approach it as a duo.

To us, and to many others, the idea of providing compassionate emotional, physical, informational support was intuitive, whether we called it “doula care” or any other name. We knew that there were social workers, counselors, nurses, doctors, clinic escorts, and many others who were providing this care before “abortion doulas” became an official concept. In fact, there are some clinics like Preterm in Cleveland, Ohio, and Choices in Memphis, Tennessee, that hired patient support people as soon as they opened. But we also knew that at many clinics, offering adequate support at the time of an abortion could be a matter of luck and timing—whoever happens to be working that day, and whoever happens to have time.

So we figured the best way to support clinics and reach the most clients would be to partner with a clinic itself. Typically, in a traditional relationship between birth doula and client, a doula would meet a client outside the confines of a hospital and accompany her into the labor and delivery room without any official volunteer or staff status within that hospital. Abortion clinics, however, usually prohibit friends or family from joining clients in their exam rooms for procedures to ensure the safety of clients and staff alike. Moreover, we did not expect that an individual seeking a pregnancy termination would ask for this type of support given the stigma attached to abortion and the limited time period involved. Not to mention, people were barely even familiar with doulas for birth, let alone this totally new concept—how would they even know to ask?

We went in search of a clinic to pilot our project. We weren’t exactly sure where to start. We cold-called a few local facilities, sent some letters. No response. We spoke to midwives and obstetricians who tepidly expressed support but didn’t offer abortion services at their practices. We went back to what we knew—the reproductive justice movement. We traveled the country, speaking about abortion doulas at meetings and conferences, often connecting with Pérez along the way. As the months rolled on, it seemed that the Abortion Doula Project was destined to remain only “a great idea.”

Though not totally defeated, we were officially frustrated.

We knew feminist leaders, young and old. We had all the right connections in our field. Why were we turned away? Why couldn’t we find anyone to partner with? Why couldn’t we connect with the people inside the clinic walls?

This is when we first started to see the disconnect that often exists between the advocacy and direct-care worlds. Sure, we knew the executive director of Advocates for Youth in Washington, DC. That didn’t mean we knew the local abortion provider practicing in our neighborhood clinic in New York City. On top of that, we realized that even though politically “birthing justice” was under the umbrella of “reproductive justice,” birth and abortion were often clinically separated from one another.

Fortunately for us, there were a handful of other activists and national groups walking the line between advocacy and direct care. We discovered groups that, for years, had been promoting a message of care similar to ours. We began to connect with them.

Aspen Baker was a big supporter of ours from the start. As founder and executive director of Exhale, a postabortion hotline that promoted a “pro-voice” framework, Baker had spent years listening to the stories of people who had abortions and bringing those stories into the public sphere. In the summer of 2008, she asked Mary to speak about the abortion doula philosophy of care at a pro-voice event at the Guttmacher Institute in Manhattan. When Exhale was being developed, the founders had briefly considered training doulas before deciding on a talk-line. Baker remembers “feeling really excited and really proud and really supportive of the idea [of abortion doulas] and glad that someone else was going to make something real and tangible and needed for women.”

During her presentation, Mary announced that the Abortion Doula Project was looking for a clinic to partner with, as she often did when she spoke in public. Normally, nothing came of the announcement other than some much-appreciated words of encouragement. But at the end of the meeting that day, two young women approached Mary. Their names were Dahlia and Sarah, and they were the interns of Dr. B. Dahlia came from CLPP’s intern program, and, together, she and Sarah were invested in finding creative approaches to improving reproductive health outcomes for women. They thought Dr. B might want to meet the founders of the Abortion Doula Project. She was the director of the Reproductive Choices clinic at City Hospital, and this was exactly the project she had been looking for.

City Hospital ran a small abortion service that focused on complicated cases, either medically or financially speaking. Pregnant people were referred there if they had a high-risk pregnancy that a freestanding clinic could not manage or if they were unable to pay full price for their abortions or qualify for Medicaid. At the point when we were introduced to the clinic they were expanding their service and looking for greater support systems for their clients.

The clinical coordinators, who served as the primary abortion counselors, were typically responsible for attending procedures with clients at City Hospital; Dr. B wanted to make sure someone was always there. But as their workload increased, the clinic realized they needed someone else to fill that gap. Dr. B remembers, “Before [the doulas] it was fine, but [the counselors] were just really busy because there’s such a high demand for services. [The doulas] took a huge burden off of them.”

The day we entered City Hospital for our first meeting, we were beyond nervous. Mary had a terrible headache. Lauren, who had woken up at three in the morning for no good reason, mulled over her second cup of coffee and prayed she wouldn’t pass out at random. We were both wearing khakis and button-downs for probably the first time in our lives. We looked like 1990s Gap clerks. It was our first big chance to be abortion doulas: we couldn’t blow it.

Little did we know, Dr. B had already green-lighted the project on the recommendation of Dahlia and Sarah. As long as Melissa, the clinic coordinator agreed, we were in. This would be our first lesson in the power the abortion counselor has in the clinic, the way in which they hold the service together.

We met Melissa, Sarah, and Dahlia in an exam room, one that would become the site of hundreds of meetings with our clients. Both parties tittered with excitement, the energy crackled, electric. It was like the beginning of a great first date. We all knew immediately we had found “the one.”

Within ten minutes Melissa was handing us the clinic schedule for the following week. We blinked. After a year of trying, our work finally began.

Dr. B says today that the clinic was “really the ideal situation” for introducing doulas. She reflects:

Dr. M, the previous clinic director, had started a clinic [through the hospital] that was kind of a freestanding unit, and we didn’t have anesthesia. So we just had ourselves, who were trained to offer conscious sedation, but nobody was completely asleep. The nurse was also super busy getting all the details medically done so having an extra support person for the patient was just really phenomenal. It made things better for all of us. You were so incredibly dedicated. There were [patients] who were coming from far away, some with absolutely no support people, so having that support was amazing.

Those early years of existence would test us beyond what we could imagine, in the most wonderful ways as well as the most challenging. “I remember how excited and nervous you all were,” Thorne-Thomsen says today. “You already realized you were gonna hit some bumps. You were breaking orthodoxies, and I think you knew that. And so there was an excitement, but also, like, ‘How are people gonna receive this? How is this gonna go down?’”

Pushback

In a 2010 Slate article entitled “What’s An Abortion Doula?” writer Marisa Meltzer opined that abortion doulas “seemed unnecessary” and that they “don’t do anything during an abortion that a friend or clinic worker couldn’t do.” The piece went on to question whether women were “so fragile that they need to hire a complete stranger to hold their hand at the doctor’s.”

When we created the Abortion Doula Project, we understood that the “abortion doula” was a provocative idea. We knew that we would face pushback, that the world might not “get it” right away. “Any new or different idea takes some time to get used to,” we comforted ourselves.

There were those who didn’t see the distinction between us and a clinic escort or recovery volunteer, between a counselor or someone who “just stands there and holds a hand.” There were the more traditional pro-choice groups and activists who would express concern about our acknowledgment of the emotion that accompanies an abortion. We had been fed narratives through our activist work that many people felt “empowered” by their abortions. But our very presence in the procedure room undermined that message by hinting that abortion might be physically painful or people might have complicated feelings about it. Mostly what we saw from people having abortions was a nuanced mix of mourning and relief. We would rarely hear that our clients regretted their procedures, nor would we hear them speak of it in empowering terms. But when we talked about all of this, it often wasn’t received by the pro-choice community the way we expected it to be.

Supporting a client before, during, and after an abortion, being a nonjudgmental presence and having no agenda other than that, was a departure from the standard pro-choice framework. We were coming from advocacy and policy backgrounds, connected to the people creating the abortion rights messages in the United States. We knew that acknowledging complicated feelings about abortion was going to be a delicate task and that being real about what an abortion actually looked like would be even more delicate. Asserting that someone might need support during an abortion? Forget it. Those were acknowledgments that many felt could be dangerous to the policies and laws in place that protect our right to choose.

Frequently, there was concern that we could be feeding the antichoice movement with our perspectives. Baker reflects on this sentiment, “Before Exhale started, the most prominent people who were talking about post-abortion feelings were pro-life.” There had been a few pro-choice projects here and there that had considered this perspective—such as the books Peace after Abortion (1996) and The Healing Choice (1997), the November Gang, and Anne Baker’s work at the Hope Clinic in St. Louis—but these were “few and far between and did not have wide pro-choice support.”

The common pro-choice refrain was “most women feel relief “—and nothing else—and pro-choice advocates rejected the idea of a “postabortion syndrome” (characterized by stress, anxiety, and depression) that had been coined by pro-life organizations. It was assumed that anyone who talked about abortion feelings, especially difficult ones like sadness or grief, had been bamboozled by pro-life extremists. In truth, a political strategy had been developed to make abortion an unthinkable option for women. Part of making it unthinkable was to say that it was something women might regret, and to save women from the pain of regret, they should not have the choice.

Today, we have organizations like the I Had an Abortion Project, the Abortion Conversation Project, and Sea Change. We have films like I Had an Abortion and Silent Choices. We have innovations such as the 1 in 3 Campaign, The Abortion Diary Podcast, and Angie Jackson live-tweeting her procedure. We have abortion speak-outs happening all over the country. Because of this, it may seem obvious that acknowledging the complexities of abortion is the direction the movement should head in—in fact, it is already headed there. Ten years ago, creating direct service work within this nuance was more complicated. Thorne-Thomsen reflects, “In some ways, the movement either moves glacially or at the speed of light, sometimes both, so it feels like nothing’s changing, nothing’s changing, and then overnight everything has changed at once. And I think storytelling, narrative, and putting out a broader idea of what an abortion experience is looks dramatically different since the Doula Project started.”

Each time an article diminishing us was published, we were surprised. Wouldn’t acknowledging the human element in abortion reduce the stigma of the procedure? Wasn’t our mutual goal to make it less shameful and secretive? Wouldn’t sharing the individual reality of abortion serve to uphold the value and safety of the procedure? How could there be such disconnect between real people’s lived experiences and the pro-choice messages coming from the media and major pro-choice organizations?

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 our clients. That’s what this work is all about.