The following article was originally published in the Ohio Capital Journal and published on News5Cleveland.com under a content-sharing agreement.
Even as a decision on Roe v. Wade approaches, those that help abortion patients through the process say it will not spell the end of abortion care, just a change in the way it’s done.
“I don’t want Ohio to become one giant health care desert in terms of abortion access, but that looks like it’s going to happen,” said Andrea Johnson.
Johnson lives in Cincinnati. By day she’s a clinical psychologist, which she says helps her when she volunteers as abortion doula for Planned Parenthood’s Southwest Ohio clinic.
Doulas are non-medical companions who can help with everything from talking through the options of keeping or not keeping a pregnancy to distracting from protesters attempting to intervene as the patient walks into a clinic, and holding hands with the person as they sit in a procedure room. Doulas are used in a birth and end-of-life care, along with in the abortion field.
“I’ve had specific conversations about the protests, specific conversations about the pictures they’ve seen,” Johnson said, referring to graphic pictures anti-abortion groups display, purporting to show dead fetuses. “But none of the women that I’ve ever sat with have ever said ‘I’ve changed my mind.’ They’re just dealing with the enormity of it.”
Training for abortion doulas can vary depending on the source, but usually includes lessons on patient barriers that contribute to a lack of access to health care, the stigma surrounding abortion, impactful legislation, and skills needed to help patients.
“Nobody is pushing people to have abortions,” said Lindsay Laubenstein, who works in Ohio and Kentucky. “We want people to be informed; we want people to have the information they need for that specific pregnancy.”
Part of informing patients about their options includes debunking information they may have been given by religious groups opposed to abortion, or even “crisis pregnancy centers,” some of which are state-funded clinics under the Parenting and Pregnancy Program and act as counseling and resource centers for pregnant people, but stand against abortion as an option.
“(Society has) stigmatized the word abortion so much that we don’t even realize that it’s been built into the medical profession,” Laubenstein said.
In the medical world, an abortion can be “elective” or “spontaneous.” Some abortions can be categorized as “incomplete” as well, better known outside of the medical field as miscarriages, according to Dr. Anita Somani, a Columbus-area OB/GYN.
Legislation seeking to ban abortions doesn’t address potential nuances in medical care, including the idea that some abortions are medically necessary, in the case of ectopic pregnancies that can’t result in a viable pregnancy, along with miscarriages.
“Nobody wants to deal in nuances,” Somani said. “These are not bills and legislation created to improve the health of Ohioans.”
The trigger ban that would ban abortions within six weeks gestation asks patients to consider their options before they may even know they’re pregnant, reducing their options from the state, according to Somani.
“If you don’t know you’re six-weeks pregnant, and you find out at eight or 10 weeks, there’s already a barrier,” Somani said.
Creating barriers, including completely removing abortion as an option in the state, will only create more problems, including increasing costs for care and transportation concerns in an already bleak landscape for those who need care.
“You have to have time, you have to have money, and as a patient, you may have other children to think about,” Somani said.
Having the knowledge of what goes into an abortion – which is currently still legal in Ohio up to 22 weeks gestation – and how that might change is exactly the reason abortion doulas can have a positive impact for patients, according to Kimberly Mason, another Cincinnati-area doula.
When Mason went through her own abortion as a college student without the financial or emotional ability or desire to go through a pregnancy, she said she definitely would have chosen to have someone sit by her while she weighed her options.
When she came to Ohio to pursue her Master’s degree, she researched abortion stigmas and noted the presence of doulas in labor and postpartum care. From there, her focus moved to creating training that would blossom into a network of doulas able to walk abortion patients through their own experience.
“I didn’t know anyone who had had an abortion until I had an abortion, and I realized there was this community,” Mason said. “I thought about how important it would be to have someone to talk to about it.”
Studies have shown doulas are well-received in the abortion process, just as they are in birth and end-of life care. One by a group from the University of Chicago studied first-trimester surgical abortions conducted with or without a doula by the patient’s side.
“Women who received doula support universally reported positive experiences with the verbal and physical techniques used by doulas during the procedure and most women who declined doula support subsequently regretted not having a doula,” the study stated.
For Johnson, she’s imagined different scenarios for her role as a doula if abortion is made illegal in Ohio. None of the options include stopping her work.
“I think to myself,” Johnson said. “Can the role of a doula be driving them somewhere, can the role of a doula be an information gatherer?”
Though Ohio may not be an option for those in need of abortion care, Johnson said she’ll be ready with the options to keep access to it available to those looking for it. That could include knowing the surrounding states where abortion is legal, or just talking with a patient about what to do next.
With the potential for unsafe abortions and non-regulated methods to increase as legalization decreases, Johnson said it’s important that resources still be there.
“Just like if you were to buy Xanax on the street, you don’t know what’s in there,” Johnson said. “I worry about women if they aren’t able to talk to someone.”
Reducing the need for abortion can easily be done without state government intervention, according to Somani.
All that’s needed, Somani said, is easily accessed health care and contraception.
“If you want to reduce abortion you need to improve contraceptive access,” Somani said.
Somani is part of a nationwide “Reproductive Freedom Taskforce” as part of the Committee to Protect Health Care, which has created a petition urging the U.S. Supreme Court to uphold Roe v. Wade.
“The goal is to start talking about abortion more from the perspective of physicians,” she said. “How we can get people to other places and create a network of support.”
Mason fears some of the same misinformation already present in anti-abortion messaging will become even more alarming if abortion is made illegal, making education about abortion even more important.
“There’s an automatic jump to genuine fear of not being able to access the procedure,” Mason said. “Utilizing our doulas to be out in the community to talk to people about whether it’s legal and if it is made illegal in Ohio is going to be really important.”