When it comes to reproductive health care, we tend to focus on two sets of people: the physicians and the patients. But abortion health care, especially, involves folks who move under the radar and don’t get the recognition they deserve. Even beyond recognition in terms of workers' rights, many folks don’t know what resources are available to them when it comes to seeking an abortion.
One example? Doulas. Doulas—a broad category generally understood as a person providing specific care and support to a patient—serve an under-discussed yet enormously important and beneficial role when it comes to abortion, especially in light of the U.S. Supreme Court overturning Roe v. Wade. Doulas offer care before, after, and during abortions, which can look like many things—organizing safe transportation for a patient to get to their appointments, for example, or providing emotional support during recovery.
Doulas don’t serve only folks who have abortions, either. Doulas can serve folks who are dying, giving birth, trans folks, those trying to become pregnant, and more. And as writer and abortion doula Hannah Matthews discusses with Daily Kos, doulas can truly be a lifesaving form of community care.
Matthews, a queer, chronically ill, and disabled mom whose debut book You Or Someone You Love is forthcoming with Atria Books in May 2023, sat down with Daily Kos for an email interview to break down what exactly an abortion doula does and why the role is so important, especially in a world where conservatives are fighting hard to deny reproductive health care to all folks who are or can become, pregnant.
RELATED: The real reason the dentist and eye doctor aren't covered by our health insurance plans
This interview has been edited for clarity, length, and flow.
MARISSA HIGGINS: For people not familiar with your book, You Or Someone You Love, how would you summarize it in a few sentences?
HM: You or Someone You Love is, essentially, an abortion doula in book form. It tells many abortion stories, including my own. It features the wisdom of exploring community abortion care—what it can look like and how it can be integrated into all of our lives (since each and every one of us know and love people who have had or will have abortions). It draws a star map through our vast constellations of support and care resources and invites connection, imagination, and action.
MH: Can you talk about your journey to getting this work published? What inspired the book, what obstacles (if any) did you face in getting an agent or book deal?
I've been writing for a long time, and publishing some pretty vulnerable creative nonfiction—but it's never been the main focus of my life or even my workday. A few agents and editors reached out to me about five years ago, after McSweeney's ran a humor piece of mine, but I wasn't ready (the agents who saw the proposal I threw together then, for a book of essays, would certainly agree). I was also terrified—if I tried in earnest to write a book, I would have to call myself a writer. I would have to take myself and my work seriously, promote it, and take up space. Luckily, nothing ever came of those early emails and phone calls, and sample chapters.
I kept publishing essays and features in magazines over the years, I got pregnant and had a baby, I worked in abortion care and a public library and nonprofits, and was broke and exhausted. I finally realized that writing didn't have to be in tension with my identity—doula, mother, organizer, care worker—and that the writing could be a form of care work.
In the summer of 2021, I tweeted that I was going to write a book about abortion and my wonderful agent Jade Wong-Baxter saw it and reached out to me. We spoke on the phone, I finished my proposal for YOSYL, Jade took it on submission, my incredible editor Stephanie Hitchcock at Atria bought it, and the rest is history.
MH: How has it felt in the months leading up to your debut?
HM: As I began to research and to reach out to people for interviews—people who, because they work in abortion care and reproductive justice, were and are exhausted, traumatized, overwhelmed, underpaid, and busy with matters of survival—I still felt slightly unsettled.
As a white cisgender woman, in a state with protective abortion laws and relatively high access to care, who was I to write a book? As a writer, how could I be so lucky and have such an easy road to my book deal, when so many brilliant authors have labored endlessly to craft, query, to sell their books?
I decided that I would give half of my advance, and 100% of any royalties I may end up making from the sales of the book to a handful of abortion funds operating in places to which I have personal and emotional connections. This choice—alongside the experience of having conversations with abortion doulas, providers, and advocates all over the world—was like a pressure release valve for my shame and self-doubt, and the writing started flowing.
I thought: Even if this book is bad, even if critics and readers hate it, it will have been useful in this very tangible and material way. It will have funded some abortions.
MH: Can you explain the basics of what a doula does in general terms?
HM: A doula (or, as some folks prefer to call it, a companion or a care worker) is someone who provides physical, emotional, logistical, and spiritual support. Most people are familiar with the job in the context of childbirth, but there are death doulas, postpartum doulas, full-spectrum doulas (who support any and every pregnancy or fertility outcome), and abortion doulas.
I like to think of a doula as a partner or collaborator—working with someone to protect their autonomy, their health, and their joy, and often acting as a barrier between a person and our violent, racist, capitalist medical and legal systems.
Ideally, when possible, an abortion doula helps to create safety and abundance, and space for not just the abortion experience that someone needs, but the abortion experience that someone dreams of.
MH: What qualifications are needed for being a doula? What's the career path like? How do folks get into it?
HM: This is complicated! Though I have taken courses and trainings and also learned from mentors in my community, I firmly believe that you become a doula by doing it. Nothing and no one has taught me more than the actual people I've supported through their abortions--whether remotely or in intimate physical proximity.
Many, many doulas get into the work after their own abortion experiences, or after accompanying someone they love through an abortion. Others come to it from community organizing, mutual aid, and harm reduction circles, a calling to mitigate the injustices and abuses they see or know are happening to birthing people and families, and a general love for human bodies and minds and lives.
There are many local and online trainings and knowledge shares organized by collectives all over the world, and many abortion clinics are currently in desperate need of support workers and volunteers in various roles that can overlap with, or feed into, doula work. Anyone can be a doula. It's a matter of curiosity, of working always from a learning stance, and of just becoming aware of and plugging into the reproductive justice needs of your own community.
MH: Can you break down a "day in the life" of an abortion doula?
HM: Doula work can look like so many things, and it varies so widely from community to community, person to person, context to context. Each and every abortion is completely unique, and no abortion is sought in a vacuum.
My own "day in the life" as a doula has looked like, on different days: calling to set up someone's appointments and procure funding and transportation; providing emotional support remotely, via text and phone, on an anonymous and secure hotline; holding someone's hand and rubbing their back and providing verbal anesthesia through their in-clinic procedure; going to someone's home and talking them through their medication abortion (while playing with their very cute baby); making food for someone's family; and so many other days.
MH: What sort of scenarios might you help patients tackle in a day’s work?
HM: Can the person afford their care? Do they need funds for the medicine, the procedure, the travel, the time off work, the childcare, the heating pad and ibuprofen, and the hotel room? Do they need resources related to sexual assault, intimate partner violence, coercion, religion, transphobia, houselessness, etc.? Do they need spiritual or religious support? Do they need legal resources, or help with privacy and safety? What are your limitations and your abilities, where are your resources to share and your networks of support in your communities? What can you afford to do and what is safe for you to do, when it comes to your own risk for criminalization, your own marginalized identities, and your own lived experiences?
MH: What's the biggest misconception about abortion you'd like to correct?
HM: In reality, abortion is just a form of health care that exists on the same spectrum as childbirth, miscarriage, fertility issues, etc. It is just another very common, natural, and normal part of someone's reproductive life.
There are so many misconceptions I will be working to correct for the rest of my life: that abortion is the opposite of parenthood (I, like most other Americans who have abortions, am a parent, and abortion is often an incredibly integral part of a family's origin story or a powerfully loving act of parenting one's existing children). That abortion is dangerous (it is safer than taking Tylenol, antibiotics, or Viagra, and 14 times safer than childbirth). That adoption is an alternative to abortion (adoption is an alternative to parenting, but it still requires someone to carry a pregnancy, give birth, and undergo what is often an indescribably traumatic life experience).
But probably the biggest is just that "abortion" is one thing—and thus we can debate it, define it, legislate it, and police it. Every abortion is different, and the only "expert" on a given abortion is the person having it. Period.
MH: What can reproductive care providers do to be more inclusive to folks who can become pregnant but are not cis women (for example non-binary folks, trans men, etc)?
HM: I am a cis woman, so much of reproductive health care—the language we use, the considerations of what patients' lives and family structures and identities might look like—is tailored to me and my body.
Saying "pregnant people" in no way erases me, a woman who has at one point been pregnant--it includes me! But saying "pregnant women," in the context of sexual and reproductive rights, health care, and justice, does exclude many people—all the women who are not currently or cannot become pregnant, and all the people who are not women who can become pregnant, or who are affected by violent and oppressive state control of bodies, sex, parenting, and lives.
MH: Has the Supreme Court overturning Roe impacted your services at all at this point in time? Are you preparing for possible changes related to it in the future?
HM: The Dobbs ruling, and its subsequent abortion bans and restrictions, have forced people from other states to seek care in my state, where clinics were already struggling to meet the need. It has also created more suffering for patients and their families, more distress, and more need for community support.
I don't know what will come—so much depends on local and state politics, on governors' races, and on control of the courts. But what I do know, from the last 5+ years of working in abortion care and support communities, with doulas and providers, with chaplains and clergy members, with clinic escorts and security guards and lawyers and advocates, is that we will never abandon each other.
The day that Dobbs came down, I cried for a few minutes, and then I went right back to the dozens of people seeking abortion care and support from me and my colleagues. I texted a comrade, We'll keep fighting, and she texted back: No choice but to. I think that's the general sentiment. We keep going. We don't have a choice.
MH: What would you tell folks who believe abortion is a state rights issue?
HM: I think this argument really lays bare the cultural misunderstanding of what abortion actually is, and how intertwined it is with other forms of health care. If your child (or sibling, or partner, or other loved one) is pregnant, and a complication develops that threatens their life and/or has the potential to cause them suffering, injury, illness, etc., can you really honestly say that you would feel ok with them dying because they weren't able to cross state lines in time, or couldn't afford to travel, to get the care they need? Or that you would find it acceptable for them to be forced to pay thousands of dollars and travel thousands of miles in order to survive, or to save their children/family from untold suffering? Of course not.
This isn't a zoning law or traffic regulation we're talking about. States shouldn't be deciding their citizens' basic civil rights.
MH: Have you faced any right-wing or alt-right harassment or abuse because of the services you provide? Do you have guidelines in place to protect yourselves/patients from this possibility? What about the clinic?
HM: My clinic, like all places that provide abortion care, has a robust security team and protocols in place. And as an individual, I have definitely gotten some support around my own privacy and security in the lead-up to my publication date. The Digital Defense Fund is a really incredible resource, and there are so many organizations and collectives working to keep us all safe to tell our stories and care for one another. None of this infrastructure should have to exist, but it's really beautiful that we've built it, together, from the ground up, in our own communities.
I have definitely gotten some really disgusting messages and harassment but, again, as a white cis woman (and as someone with a burly male partner and lots of community in physical proximity), I have a lot more relative power and safety than many.
You can pre-order You or Someone You Love here, here, or from your local library.
One example? Doulas. Doulas—a broad category generally understood as a person providing specific care and support to a patient—serve an under-discussed yet enormously important and beneficial role when it comes to abortion, especially in light of the U.S. Supreme Court overturning Roe v. Wade. Doulas offer care before, after, and during abortions, which can look like many things—organizing safe transportation for a patient to get to their appointments, for example, or providing emotional support during recovery.
Doulas don’t serve only folks who have abortions, either. Doulas can serve folks who are dying, giving birth, trans folks, those trying to become pregnant, and more. And as writer and abortion doula Hannah Matthews discusses with Daily Kos, doulas can truly be a lifesaving form of community care.
Matthews, a queer, chronically ill, and disabled mom whose debut book You Or Someone You Love is forthcoming with Atria Books in May 2023, sat down with Daily Kos for an email interview to break down what exactly an abortion doula does and why the role is so important, especially in a world where conservatives are fighting hard to deny reproductive health care to all folks who are or can become, pregnant.
RELATED: The real reason the dentist and eye doctor aren't covered by our health insurance plans
This interview has been edited for clarity, length, and flow.
MARISSA HIGGINS: For people not familiar with your book, You Or Someone You Love, how would you summarize it in a few sentences?
HM: You or Someone You Love is, essentially, an abortion doula in book form. It tells many abortion stories, including my own. It features the wisdom of exploring community abortion care—what it can look like and how it can be integrated into all of our lives (since each and every one of us know and love people who have had or will have abortions). It draws a star map through our vast constellations of support and care resources and invites connection, imagination, and action.
MH: Can you talk about your journey to getting this work published? What inspired the book, what obstacles (if any) did you face in getting an agent or book deal?
I've been writing for a long time, and publishing some pretty vulnerable creative nonfiction—but it's never been the main focus of my life or even my workday. A few agents and editors reached out to me about five years ago, after McSweeney's ran a humor piece of mine, but I wasn't ready (the agents who saw the proposal I threw together then, for a book of essays, would certainly agree). I was also terrified—if I tried in earnest to write a book, I would have to call myself a writer. I would have to take myself and my work seriously, promote it, and take up space. Luckily, nothing ever came of those early emails and phone calls, and sample chapters.
I kept publishing essays and features in magazines over the years, I got pregnant and had a baby, I worked in abortion care and a public library and nonprofits, and was broke and exhausted. I finally realized that writing didn't have to be in tension with my identity—doula, mother, organizer, care worker—and that the writing could be a form of care work.
In the summer of 2021, I tweeted that I was going to write a book about abortion and my wonderful agent Jade Wong-Baxter saw it and reached out to me. We spoke on the phone, I finished my proposal for YOSYL, Jade took it on submission, my incredible editor Stephanie Hitchcock at Atria bought it, and the rest is history.
MH: How has it felt in the months leading up to your debut?
HM: As I began to research and to reach out to people for interviews—people who, because they work in abortion care and reproductive justice, were and are exhausted, traumatized, overwhelmed, underpaid, and busy with matters of survival—I still felt slightly unsettled.
As a white cisgender woman, in a state with protective abortion laws and relatively high access to care, who was I to write a book? As a writer, how could I be so lucky and have such an easy road to my book deal, when so many brilliant authors have labored endlessly to craft, query, to sell their books?
I decided that I would give half of my advance, and 100% of any royalties I may end up making from the sales of the book to a handful of abortion funds operating in places to which I have personal and emotional connections. This choice—alongside the experience of having conversations with abortion doulas, providers, and advocates all over the world—was like a pressure release valve for my shame and self-doubt, and the writing started flowing.
I thought: Even if this book is bad, even if critics and readers hate it, it will have been useful in this very tangible and material way. It will have funded some abortions.
MH: Can you explain the basics of what a doula does in general terms?
HM: A doula (or, as some folks prefer to call it, a companion or a care worker) is someone who provides physical, emotional, logistical, and spiritual support. Most people are familiar with the job in the context of childbirth, but there are death doulas, postpartum doulas, full-spectrum doulas (who support any and every pregnancy or fertility outcome), and abortion doulas.
I like to think of a doula as a partner or collaborator—working with someone to protect their autonomy, their health, and their joy, and often acting as a barrier between a person and our violent, racist, capitalist medical and legal systems.
Ideally, when possible, an abortion doula helps to create safety and abundance, and space for not just the abortion experience that someone needs, but the abortion experience that someone dreams of.
MH: What qualifications are needed for being a doula? What's the career path like? How do folks get into it?
HM: This is complicated! Though I have taken courses and trainings and also learned from mentors in my community, I firmly believe that you become a doula by doing it. Nothing and no one has taught me more than the actual people I've supported through their abortions--whether remotely or in intimate physical proximity.
Many, many doulas get into the work after their own abortion experiences, or after accompanying someone they love through an abortion. Others come to it from community organizing, mutual aid, and harm reduction circles, a calling to mitigate the injustices and abuses they see or know are happening to birthing people and families, and a general love for human bodies and minds and lives.
There are many local and online trainings and knowledge shares organized by collectives all over the world, and many abortion clinics are currently in desperate need of support workers and volunteers in various roles that can overlap with, or feed into, doula work. Anyone can be a doula. It's a matter of curiosity, of working always from a learning stance, and of just becoming aware of and plugging into the reproductive justice needs of your own community.
MH: Can you break down a "day in the life" of an abortion doula?
HM: Doula work can look like so many things, and it varies so widely from community to community, person to person, context to context. Each and every abortion is completely unique, and no abortion is sought in a vacuum.
My own "day in the life" as a doula has looked like, on different days: calling to set up someone's appointments and procure funding and transportation; providing emotional support remotely, via text and phone, on an anonymous and secure hotline; holding someone's hand and rubbing their back and providing verbal anesthesia through their in-clinic procedure; going to someone's home and talking them through their medication abortion (while playing with their very cute baby); making food for someone's family; and so many other days.
MH: What sort of scenarios might you help patients tackle in a day’s work?
HM: Can the person afford their care? Do they need funds for the medicine, the procedure, the travel, the time off work, the childcare, the heating pad and ibuprofen, and the hotel room? Do they need resources related to sexual assault, intimate partner violence, coercion, religion, transphobia, houselessness, etc.? Do they need spiritual or religious support? Do they need legal resources, or help with privacy and safety? What are your limitations and your abilities, where are your resources to share and your networks of support in your communities? What can you afford to do and what is safe for you to do, when it comes to your own risk for criminalization, your own marginalized identities, and your own lived experiences?
MH: What's the biggest misconception about abortion you'd like to correct?
HM: In reality, abortion is just a form of health care that exists on the same spectrum as childbirth, miscarriage, fertility issues, etc. It is just another very common, natural, and normal part of someone's reproductive life.
There are so many misconceptions I will be working to correct for the rest of my life: that abortion is the opposite of parenthood (I, like most other Americans who have abortions, am a parent, and abortion is often an incredibly integral part of a family's origin story or a powerfully loving act of parenting one's existing children). That abortion is dangerous (it is safer than taking Tylenol, antibiotics, or Viagra, and 14 times safer than childbirth). That adoption is an alternative to abortion (adoption is an alternative to parenting, but it still requires someone to carry a pregnancy, give birth, and undergo what is often an indescribably traumatic life experience).
But probably the biggest is just that "abortion" is one thing—and thus we can debate it, define it, legislate it, and police it. Every abortion is different, and the only "expert" on a given abortion is the person having it. Period.
MH: What can reproductive care providers do to be more inclusive to folks who can become pregnant but are not cis women (for example non-binary folks, trans men, etc)?
HM: I am a cis woman, so much of reproductive health care—the language we use, the considerations of what patients' lives and family structures and identities might look like—is tailored to me and my body.
Saying "pregnant people" in no way erases me, a woman who has at one point been pregnant--it includes me! But saying "pregnant women," in the context of sexual and reproductive rights, health care, and justice, does exclude many people—all the women who are not currently or cannot become pregnant, and all the people who are not women who can become pregnant, or who are affected by violent and oppressive state control of bodies, sex, parenting, and lives.
MH: Has the Supreme Court overturning Roe impacted your services at all at this point in time? Are you preparing for possible changes related to it in the future?
HM: The Dobbs ruling, and its subsequent abortion bans and restrictions, have forced people from other states to seek care in my state, where clinics were already struggling to meet the need. It has also created more suffering for patients and their families, more distress, and more need for community support.
I don't know what will come—so much depends on local and state politics, on governors' races, and on control of the courts. But what I do know, from the last 5+ years of working in abortion care and support communities, with doulas and providers, with chaplains and clergy members, with clinic escorts and security guards and lawyers and advocates, is that we will never abandon each other.
The day that Dobbs came down, I cried for a few minutes, and then I went right back to the dozens of people seeking abortion care and support from me and my colleagues. I texted a comrade, We'll keep fighting, and she texted back: No choice but to. I think that's the general sentiment. We keep going. We don't have a choice.
MH: What would you tell folks who believe abortion is a state rights issue?
HM: I think this argument really lays bare the cultural misunderstanding of what abortion actually is, and how intertwined it is with other forms of health care. If your child (or sibling, or partner, or other loved one) is pregnant, and a complication develops that threatens their life and/or has the potential to cause them suffering, injury, illness, etc., can you really honestly say that you would feel ok with them dying because they weren't able to cross state lines in time, or couldn't afford to travel, to get the care they need? Or that you would find it acceptable for them to be forced to pay thousands of dollars and travel thousands of miles in order to survive, or to save their children/family from untold suffering? Of course not.
This isn't a zoning law or traffic regulation we're talking about. States shouldn't be deciding their citizens' basic civil rights.
MH: Have you faced any right-wing or alt-right harassment or abuse because of the services you provide? Do you have guidelines in place to protect yourselves/patients from this possibility? What about the clinic?
HM: My clinic, like all places that provide abortion care, has a robust security team and protocols in place. And as an individual, I have definitely gotten some support around my own privacy and security in the lead-up to my publication date. The Digital Defense Fund is a really incredible resource, and there are so many organizations and collectives working to keep us all safe to tell our stories and care for one another. None of this infrastructure should have to exist, but it's really beautiful that we've built it, together, from the ground up, in our own communities.
I have definitely gotten some really disgusting messages and harassment but, again, as a white cis woman (and as someone with a burly male partner and lots of community in physical proximity), I have a lot more relative power and safety than many.
You can pre-order You or Someone You Love here, here, or from your local library.