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      “ I can be pro-abortion and pro-birth”: Opportunities and challenges for full spectrum care among doulas in Georgia

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          Abstract

          Background

          The work of full spectrum doulas (i.e., non-medically trained care workers offering support before, during, and after pregnancy including abortion)—is increasingly important as abortion access decreases across the U.S. Few studies have examined the work of community-based doulas in restrictive abortion settings or how they might further incorporate full spectrum care. As part of the community-engaged mixed methods Georgia Doula Study, this analysis examines the scope of work of community-based doulas regarding full spectrum and abortion services, doula opinions on full spectrum and abortion work, and potential barriers and facilitators for full spectrum doula care in metro-Atlanta, Georgia.

          Methods

          From October 2020 to February 2022, the team recruited 20 community-based doulas with 8 who provide full spectrum services including abortion. Surveys covered demographics, doula scope of work, family planning attitudes, and abortion stigma. Survey data were analyzed using descriptive and bivariate statistics. In-depth interviews further explored those topics. They were de-identified and thematically analyzed using a semi-deductive approach.

          Results

          The findings are organized around five themes: (1) doulas of all kinds center reproductive autonomy; (2) abortion doulas play important roles in reproductive autonomy; (3) doulas have mixed feelings about contraceptive counseling; (4) abortion doulas provide diverse services carrying numerous benefits in a stigmatized environment; and (5) abortion doulas experience challenges including stigma but they offer solutions. All but two doulas in this study were interested in learning how to incorporate contraception and abortion services in their current scope of work, and most participants supported the role of full spectrum doulas.

          Conclusion

          This analysis highlights the experiences of abortion and full spectrum doulas, reactions of the larger doula community to those services, and facilitators and barriers to full spectrum doula care in a restrictive abortion setting. There are urgent needs and opportunities for full spectrum doulas to offer life-protecting services to pregnant people across the U.S. and globally. Coordination efforts for U.S. abortion care post- Roe v. Wade must include community-based doulas, who are largely open to aiding abortion clients through education, connection to care, and emotional support.

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          Most cited references36

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          Conceptualising abortion stigma.

          Leila Hessini, Anuradha Kumar, Patrick Mitchell (2009)
          Abortion stigma is widely acknowledged in many countries, but poorly theorised. Although media accounts often evoke abortion stigma as a universal social fact, we suggest that the social production of abortion stigma is profoundly local. Abortion stigma is neither natural nor 'essential' and relies upon power disparities and inequalities for its formation. In this paper, we identify social and political processes that favour the emergence, perpetuation and normalisation of abortion stigma. We hypothesise that abortion transgresses three cherished 'feminine' ideals: perpetual fecundity; the inevitability of motherhood; and instinctive nurturing. We offer examples of how abortion stigma is generated through popular and medical discourses, government and political structures, institutions, communities and via personal interactions. Finally, we propose a research agenda to reveal, measure and map the diverse manifestations of abortion stigma and its impact on women's health.
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            Stata Statistical Software: Release 16

            Statacorp, LLC StataCorp, L StataCorp (2019)
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              Self-managed abortion: a systematic scoping review

              Heidi Moseson, Steph Herold, Sofia Filippa … (2019)
              Self-managed abortion, when a person performs their own abortion without clinical supervision, is a model of abortion care used across a range of settings. To provide a comprehensive synthesis of the available literature on self-managed abortion, we conducted a systematic search for peer-reviewed research in April 2019 in PubMed, Embase, Web of Science, Popline, PsycINFO, Google Scholar, Scielo, and Redalyc. We included studies that had a research question focused on self-managed abortion; and were published in English or Spanish. The combined search returned 7167 studies; after screening, 99 studies were included in the analysis. Included studies reported on methods, procurement, characteristics of those who self-managed, effectiveness, safety, reasons for self-managed abortion, and emotional and physical experiences. Numerous abortion methods were reported, most frequently abortion with pills and herbs. Studies reporting on self-managed medication abortion reported high-levels of effectiveness. We identify gaps in the research, and make recommendations to address those gaps.
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                Author and article information

                Contributors
                Journal
                Journal ID (nlm-ta): Front Glob Womens Health
                Journal ID (iso-abbrev): Front Glob Womens Health
                Journal ID (publisher-id): Front. Glob. Womens Health
                Title: Frontiers in Global Women's Health
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 2673-5059
                Publication date (Electronic): 01 March 2023
                Publication date Collection: 2023
                Volume: 4
                Electronic Location Identifier: 966208
                Affiliations
                [ 1 ]Rollins School of Public Health, Emory University , Atlanta, GA, United States
                [ 2 ]The Center for Reproductive Health Research in the Southeast, Emory University , Atlanta, GA, United States
                [ 3 ]Department of Health Policy and Behavioral Sciences, Georgia State University , Atlanta, GA, United States
                [ 4 ]Division of General Internal Medicine, Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh School of Medicine , Pittsburgh, PA, United States
                Author notes

                Edited by: Summer Martins, Allina Health, United States

                Reviewed by: Charlotte Hord Smith, Independent Researcher, Carrboro, NC, United States Jaime Cidro, University of Winnipeg, Canada Sarah Baum, Ibis Reproductive Health, United States Zoe Josephine Darwin, University of Huddersfield, United Kingdom

                [* ] Correspondence: Alyssa Lindsey alindsey72@ 123456gmail.com

                Specialty Section: This article was submitted to Contraception and Family Planning, a section of the journal Frontiers in Global Women’s Health

                Article
                DOI: 10.3389/fgwh.2023.966208
                PMC ID: 10014539
                PubMed ID: 36937040
                SO-VID: 55f2ab77-5fe1-44e0-a397-555bc7d6b320
                Copyright © © 2023 Lindsey, Narasimhan, Sayyad, Turner and Mosley.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 10 June 2022
                Date accepted : 02 January 2023
                Page count
                Figures: 0, Tables: 4, Equations: 0, References: 42, Pages: 0, Words: 0
                Funding
                Funded by: Center for Reproductive Health Research in the Southeast through grants from an Anonymous Foundation and the Collaborative for Gender and Reproductive Equity, a sponsored project of Rockefeller Philanthropy Advisors.
                Center for Reproductive Health Research in the Southeast through grants from an Anonymous Foundation and the Collaborative for Gender and Reproductive Equity, a sponsored project of Rockefeller Philanthropy Advisors.
                Categories
                Subject: Global Women's Health
                Subject: Original Research

                Keywords: abortion,contraception,doula,birth worker,stigma,family planning,full spectrum doula,abortion doula
                Data availability:
                Keywords: abortion, contraception, doula, birth worker, stigma, family planning, full spectrum doula, abortion doula

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