Witnessing, Processing, and Holding Space: Opportunities for Abortion Doula Care Work in Prisons and Jails
by Regan Moss & Margaret Mary Downey
Abortion Access in Prisons and Jails
People who are incarcerated^1 have long faced barriers to abortion care.
They report judgement from prison-based healthcare providers and a lack of trust in medical providers. In addition, facilities have unclear or restrictive policies surrounding abortion access, changing between states or even prison to prison.
The ambiguous policy landscape is challenging for people who are incarcerated to navigate, as there are limited means to self-advocate without repercussions.
As a result, even in states where abortion remains legal, people face restrictions while incarcerated, like only being allowed abortion services in the first trimester, or having to pay for the transportation and guard overtime required to get to their appointmentIn addition, people report internalizing criminality and question their deservingness to have their own needs met.
Activists and scholars argue for a range of positions on pregnancy and incarceration.
An abolitionist framework states that no one, including pregnant people, should be incarcerated and that the current model of the US carceral system is irredeemable. Interventions should never expand the reach and authority of the carceral system.
Reformists see the current system as necessary but in need of change such as increased regulation, staffing, or programs (Institute of Medicine, National Research Council. Health and incarceration: a workshop summary. Washington (DC): National Academies Press; 2013).
Currently, abortion doulas and their patients in prisons and jails exist in this tension.
Increasing Access to Abortion Doulas
Doulas may be uniquely well-suited in the context of abortion care in prisons.
Within a traumatizing environment like a prison, doula care can holistically address pregnant people’s physical, informational, and psychosocial needs. Because they are separate from the prison staff, patients' family, and fellow inmates, they are often able to provide more non-judgemental, personalized support.
Further, barriers to care like provider trust and judgment may be offset by doulas who embrace patient advocacy and education as a part of their practice, such as those who follow the practices of Radical Doula, Birthmark Doula Collective, and Birth Advocacy Doula Training (BADT).
While abortion doula care has not been assessed in the context of US prisons, traditional (i.e, birth) doula care has. Intervention studies have found doula practice to be logistically feasible, even for those that had to adapt their practice in the context of prisons.
In fact, many prison doula programs have been established across the US.
However, such studies have also highlighted the restrictions within prisons and the impact it may have on their practice. Recognizing the value of doula care overall, we have been assessing the feasibility of abortion doula care in prisons.
Our Study
Through funding from the Society of Family Planning, we have been interviewing doulas and plan to interview formerly incarcerated individuals to better understand the role that doulas can play in improving the experience of accessing and receiving abortion care among people who are incarcerated.
There is very limited research that highlights what the experience is like when accessing an abortion within prison, since so few people have been afforded their right to access one.
We’ve also discussed how doulas navigate providing care within the prison system and considerations to sustain their work.
What have we learned?
Reproductive Justice & Doula Care
Our study findings affirm the decades-long call to recognize abolition as a core tenant of reproductive justice.
Doulas highlight the lack of agency that is inherent with the prison system, which is in direct opposition to their work. As one doula described, “I think it would be very difficult to provide the level of quality care I would want to provide because of the lack of autonomy that is inherent in being incarcerated.”
While doulas aim to provide high-quality care, their client does not have agency and cannot define care within their own terms.
As doula care is focused on autonomy, agency, and dignity of the body, doulas report a tension between the care they want to provide, with the care that they can provide.
This dilemma exists for doulas that operate in hospital settings as well. Doulas may feel distress and fatigue working within a system that ultimately undermines the wellbeing of their client. It may be especially challenging to advocate for a client, when there are limited accountability mechanisms for prisons and reporting harmful behaviors can comprise program contracts.
While reproductive justice is impossible to achieve within the confines of prisons and jails, there are many tangible actions doulas can take to help ensure that abortion does not become a point of trauma for their client, but a moment for self-care and human connection with a doula.
Our work is exploring what these tangible actions for self-care and human connection can be. One doula led us to wonder, “How do we create the things that don’t exist?”
Witnessing Trauma
Doulas who provide abortion support in prisons and jails bear witness to overlapping harms.
For example, clients who are incarcerated are far more likely than the general population to have a history of trauma, substance use, intimate partner violence, homelessness, and abuse or neglect.
Moreover, the inequities born out by policing in the US mean that Black and Indigenous women - those who are targeted by generational, structural violence constraining their choices to act on parenting desires - are also those groups who are surveilled and incarcerated more often and in more severe conditions.
Incarceration is also, in and of itself, a traumatizing and abusive experience for many.
Loss of autonomy, unsafe living conditions, and mental, physical, and sexual abuse by prison staff are just some of the things people face while in incarcerated.
Abortion doulas for those who are incarcerated are intervening in a space that is both full of trauma and traumatizing, where incarcerated clients’ current and former mental health needs converge in the doula-client relationship, which is just a moment in time compared to all that comes before and after.
Doulas found value in peer support and creating formal and informal spaces to process their experiences with other doulas who understood the dilemmas and challenges of providing care in harmful spaces. “So much of doing this work is really witnessing trauma and witnessing people being traumatized which is hard to do. […] One thing that I think would be ideal would be to have a group of people who are doing this work together that have time and space to regularly meet and process their experiences.”
Doulas described how they hold space for their clients to process the health event. Even when resources are limited, emotional support is possible.
“Being a soundboard. Being a listening ear and helping them process different things – that's really important and mostly letting them know they’re not alone where they are because I’m sure many of them feel very isolated and rejected. Just having that connection can be helpful too.”
The Need to Centralize Abortion Care
Doula trainers and managers can support the abortion-prison doula workforce by expanding on current training programs to centralize abortion care.
Abortion doula care has been on the fringes of birth work.
While models of doula-care such as full-spectrum doula care or pregnancy loss doula exist, not all doulas have had access to abortion doula training. Abortion care must be centralized in all birth work, as abortion is foundational to maternal health.
The exclusion of abortion care from mainstream doula care has led to inadequate training, leaving doulas to learn on the spot to provide care; especially, when they are only one of a couple of doulas providing care within the prison setting. In addition to not having access to abortion doula training, doulas report not having adequate education on the complex policy landscape impacting incarcerated clients.
In the fast-paced policy climate, this can be particularly challenging for anyone, including doulas, to navigate.
Prison policies surrounding abortion access and pathways to care are also difficult to understand for many professionals. Our study board of doulas and community-based reproductive justice organizations, the Prison Abortion Access Advisory Group, has been working to co-create guidance for doulas to navigate the complex policy landscape.
Collaboration and Collective Care
Doulas underscored the value of collaboration and collective care. Working in isolation, against broken systems, will inevitably lead to burnout and moral injury.
Audre Lorde reminds us of the value of self care within coercive systems: “Caring for myself is not self-indulgence, it is self-preservation and that is an act of political warfare.”
Doulas reflected on the necessity of collaboration in birth work: “Definitely the collaborative collective element I think is one of the most foundational pieces to making all birth work possible but particularly birth work where we are trying to support folks in really hard conditions.”
The collective nature of doula work is not isolated to doulas and doula managers.
Many doulas felt a moral imperative to provide their work for free since they saw abortion as a right and prisons as an injustice.
Community members, who are not doulas or involved in the doula workforce, can invest in their local doula organizations so that clients do not have to pay but in turn, doulas do not face emotional or financial hardship.
Advocacy organizations should ensure that policy changes that aim to support the doula workforce will reach all doulas - including those working within prisons.
Without these changes, doula care may diminish or become a path solely for those with racial, class, educational, and other forms of privilege.
Mental Health Needs
Communities and doula collectives can prioritize (peer) mental health support so that doulas can process their experiences with others who understand.
Regular peer support groups, whether in-person or online, facilitated by experienced doulas, offer a place for doulas to process their experiences and build empowering relationships.
National, international, and local doula organizations create and share resources that a) build general awareness about prison and jail abortion doula care or b) provide strategies for navigating the logistical, legal, and interpersonal issues specific to providing abortion support in the carceral system.
Looking forward, doulas could regularly collaborate with other supportive health and wellness providers on trainings and practices for self-regulation, de-escalation, and self-care in the face of harm.
For example, there is a small yet mighty movement within physicians, nurses, social workers, and public health professionals to practice self-care while seeking collective liberation, so that self-care does not become an individual, expensive, and private problem to solve. This movement emphasizes adequate compensation, fair working conditions, and fighting both burnout (overwork) and moral injury (being forced or coerced into making decisions that go against your own sense of right and wrong).
In the prison system, abortion doulas face unique forms of both burnout and moral injury, like the trauma discussed above.
Common cause with other providers caught in similar systems offers reprieve and solidarity.
Moreover, common cause also helps doulas push for the resources that help them afford quality health and wellness services, mental health care, time off, and personal and professional development.
For simplicity, we use the terms “incarcerated” and “prison” to describe conditions in which people are detained in the US carceral system. This is not to exclude other places where abortion doulas are needed like jails, Immigration and Customs Enforcement Detention, etc.