In January, winter rains washed across the Arizona desert, obscuring the mountains around the city of Tucson. Temperatures swung from balmy 70-degree days to below freezing at night. And 19-year-old Rose* became pregnant. (She requested a pseudonym for privacy.) She was reeling from a painful breakup with a long-term boyfriend, living with her parents, and earning minimum wage part-time.
She knew immediately that she was not ready to raise a child on her own. “I never considered having it,” said Rose. “I knew.”
Soon after the pregnancy was confirmed, Rose made an appointment with a doctor for a surgical abortion a few weeks later. She felt anxious and overwhelmed by the entire experience, and did not have a support network of friends or family whom she could confide in.
An acquaintance told her about Dora Martinez, who works full-time at a local nonprofit and part-time providing physical, emotional, and informational support to people seeking abortions. Rose immediately called her. After hearing her story, Martinez, a “full-spectrum doula,” agreed to work with Rose for a nominal fee.
As her abortion doula, Martinez texted with Rose and talked to her by phone whenever Rose needed support in the days leading up to the procedure. Rose opened up about her feelings as the date drew nearer, and Martinez helped her anticipate what to expect during and after the abortion. She also agreed to accompany her to the clinic and to drive her home afterwards, fulfilling the mandatory accompaniment policy of the Tucson clinic. But the night before the procedure, Rose’s partner suddenly refused to contribute the money he had promised for the abortion.
“I thought, I can’t even support myself right now and I can’t support a kid,” said Rose, “but I can’t afford to go through with [the abortion] either. I don’t have any money.”
At six weeks pregnant, and with less money than she had expected, Rose was able to end the pregnancy with misoprostol, a medication that causes contractions of the uterus leading to a miscarriage. The medication was cheaper than the surgical abortion would have been, but it also meant a longer process and, ultimately, a home abortion. Rose procured it on her own, and after taking it, immediately called Martinez for support.
Rose called out of work for three days. She stayed in her bedroom, breathing through the cramps, and tried not to make any noise. “My family was right on the other side of the wall,” she recalled. She felt completely alone except for Martinez, who remained on the other end of the phone, texting with Rose throughout the night and into the morning.
MMartinez first trained as a doula to provide support during pregnancy and labor. Doulas provide knowledgeable emotional support and are able to advocate for their clients, especially in hospital settings where medical interventions are more likely to occur. Once she received her certification, Martinez began assisting Native women and women of color with their births around southern Arizona.
While she found her work powerful, she noticed a gap in the support available for those who miscarried or chose abortions.
“People are more excited to talk about birth,” she said, “[but] there was really no conversation around abortion. So one morning I woke up and said, ‘I’m not taking any more birth clients. I’m going to intentionally go out and promote this other side of the spectrum.’” She charges patients on a sliding scale, depending on the patient’s ability to pay and how complicated the case is.
According to Miriam Zoila Pérez, who wrote a primer about “radical doulas,” a full-spectrum doula refers to one who gives support to people during birth as well as other realities of pregnancy: miscarriage, lethal fetal anomaly, stillbirth, abortion, and even adoption. “I love the way it highlights how we provide support regardless of the pregnancy outcome,” she wrote. “It also makes sense to me because a person who starts out their pregnancy planning on a birth might instead end up with an abortion, a miscarriage, or an adoption. Why would we turn them away if the outcome changed?”
For the past decade, full-spectrum doula work has been gaining momentum in the birth worker and pro-choice communities. In 2007, Pérez and two other doulas founded The Doula Project to serve people seeking abortions. Based in New York City, they now work directly with hospitals and clinics. In northern Texas, The Cicada Collective provides lodging, transportation, and financial resources for people choosing abortion — particularly queer and transgender people of color. And in 2015, Martinez co-founded the Tucson Abortion Support Collective (TASC), with the goal of providing full spectrum doula support for people seeking abortions in southern Arizona.
For Martinez, each case and client is unique. “Some people come and they already know they want an abortion,” she said. “But others aren’t sure, and they need to hear their options. I tell them, ‘Whatever you want to do, I want to support that. If you choose abortion, you have choices. If you want to have a baby, we can explore your birth options.’”
Martinez helps her clients process their feelings and validates their experiences. She also helps clients access and understand the information about pregnancy options. If a client chooses to have an abortion, Martinez provides physical support — she might provide a heating pad for pain management, help them to stretch through the cramps, or find a way to distract them from the pain.
Ultimately, she believes being a full-spectrum doula means demonstrating human compassion during an intense time.
“It’s being a witness, reminding them that they know their body, to trust themselves, and that they know what’s best for them,” she said. “And you have to be willing to leave your own stuff at the door. For example, I’m not religious at all, but I found myself praying with someone one time. That was really powerful.”
Like a birth doula, abortion doulas focus on the whole person, considering prior health issues, relationship dynamics, and stress when offering support. “For example, if I get cues that [a client is] physically sensitive to touch, or if they have a history of domestic violence, sexual assault, or rape, I can help them process how different procedures may be more invasive than another,” Martinez says. “The more intrusive the abortion procedure is, it can bring those things up.”
WWhile founding TASC, Martinez researched Arizona abortion resources, and she was shocked. Due to a recent uptick in Arizona’s anti-choice legislation, there were new legal barriers for clinics to be able to provide abortion services. In 2014, according to the Guttmacher Institute, 80% of Arizona counties did not have a single clinic providing abortions.
“Women in some parts of Arizona are traveling four hours, one way, to access abortion and birth control care,” said Kat Sabine, Director of NARAL Pro-Choice Arizona. “This is a tremendous burden on their ability to receive that care.”
According to Sarah Tarver-Wahlquist, who chairs Abortion Fund of Arizona, most people seeking abortions need to pay out of pocket, since the state prevents Medicaid and many private insurers from paying for abortions. “Anti-choice legislation…is especially discriminatory to low-income and rural people,” she said, “who in addition to having to pay for their abortion, also face additional costs like taking multiple days off of work, potentially finding childcare, and often traveling many miles to access a clinic.”
Just last week, Arizona Governor Doug Ducey signed into law a bill that requires doctors to use all possible methods to save a fetus or embryo delivered alive during an abortion, including those with fatal fetal anomalies (this law may represent fear-mongering over evidence; of responses from 38 attorneys general, not a single office provided evidence that it has ever had cause to prosecute a physician for delivering and then killing a viable fetus).
This new law joins a slew of bills that, in 2011 and 2012, were proposed and passed in the Arizona state legislature that placed restrictions on legal abortion. Immediately after the implementation of these laws, most of Arizona’s abortion clinics were closed. Some of those laws include:
● SB1359, which protects doctors who withhold information if they think it may lead the patient to choose abortion
● HB2416, which redefines RU-486 (The Abortion Pill) as surgical abortion, mandating extra requirements for providers. This law also requires providers to perform an ultrasound and heartbeat monitoring at least one hour before the procedure.
● Additionally, patients in Arizona must endure a 24-hour waiting period before receiving an abortion. This means that a patient must go to two appointments no closer than 24 hours apart.
“Arizona has been a hot bed for anti-choice legislation for years,” said Sabine. “In fact, most anti-choice legislation is tested in our state for passage and forces supporters of reproductive healthcare to file cases in the 9th Circuit of the Supreme Court to determine constitutionality.”
“Restricting access to reproductive healthcare does not make women more safe,” she continued, echoing an argument often made by pro-choice groups. “It makes people seek dangerous options that cause harm to our communities.”
TThrough her work with TASC, Martinez speaks to midwifery groups and family planning organizations about the importance of full-spectrum reproductive support. She says she’s received some backlash for her work. After one such presentation at a university, her car was keyed and she received a barrage of anonymous hate mail. Even within the birth worker community, there are differing perspectives on the ethics of providing support to those terminating their pregnancies.
But Martinez believes people have a right to be supported in their reproductive choices, and she won’t be deterred in offering that support. “History is filled with the repeated colonization and violence of women’s bodies, particularly women of color, by men,” she said. “And women have always helped each other birth babies and end pregnancies at home and in community. As long as birth has existed, so has abortion.”
After Rose’s abortion, Martinez stayed in touch, texting regularly to check in and offer support. Two weeks later, she sat with Rose as she waited for the results of a home pregnancy test, to ensure that the abortion had been effective. When the test was negative, Rose says she burst into relieved tears.
“Just as a laboring patient needs emotional and physical support in the delivery process, women accessing abortion care also need the same support,” said Sabine. “We consider doula services as an important component to reproductive justice.”
Rose echoes this. “I didn’t have anyone to talk to, because I didn’t tell anyone what was happening,” she said. Without [Martinez], I would have bottled up all of my feelings. I might have made desperate, irrational decisions.”
She paused. “She’s that person who is like, ‘Okay, you need somebody and you don’t have anyone. I will be that somebody.’”
