Editor's note: Southern reproductive justice movements knew this day would come, when The Supreme Court would gut its 1973 ruling, Roe v. Wade, which federally protected abortion. They've been preparing for it, often shuttling clients across state lines, navigating already-eroded protections.
As the South goes, so goes the nation.
It's always important to refocus and follow the lead of abortion providers in this region, who have been on the frontlines for decades. If you're panicking, you haven't been paying attention to the Black and Brown folks who knew our freedoms could never be entrusted to this nation's court systems.
The story below is a snapshot of the work of an abortion doula inside a Georgia clinic, as we wait to see how Southern states react to the end of Roe. Here are the pathways to engage:
- A day-in-the-life account from an abortion doula at a clinic in Georgia, one of the many states with restrictive abortion bans.
- The author responds to the question we all have right now: "Will we always be able to do this work?"
- The author talks with three other Southern abortion doulas about what's next for their work.
- How you can support Southern reproductive justice funds today. (Keep your wire hangers in your closets, people.)
Plus: We kept the conversation going with this story's author and abortion workers from across the South live on Twitter Spaces on 5/19. Listen to the replay for more why abortion care is abolitionist work, what the media gets wrong in its abortion coverage, and how doulas will continue their work.
For privacy and safety concerns, this author is using a pen name.
My alarm goes off, blaring the classic iPhone alarm. This is my second arousal. My poodle has to go to the bathroom at 6 a.m. every morning, so after his potty break, I go back to sleep.
When I wake up for real, I drink a bit of water, feed the dog, and get ready for the morning. If I am smart, I laid out my scrubs and jewelry out the night before. Today, my scrubs are on top of the dryer. Jewelry is minimal. But maybe next work week I will invest in creating a more coordinated accessory look. There's always next week.
At this point, I am showered and dressed. Dog is walked and cuddled, and I head out to drive to work in my Civic. With skyrocketing gas prices, I'm lucky it's a relatively short drive—16 minutes.
I stop to grab a breakfast sandwich and vanilla latte from a café right next to the clinic. I don't do this every morning, but when I know I could use the boost, I invest in some sweet-tasting caffeine.
At the clinic now, surrounded by shops and restaurants, I park in one of the spots in the lot. I am truly lucky to work at a clinic with no protesters or nearby Crisis Pregnancy Centers (CPCs).
CPCs are organizations, often religiously-affiliated, that send people to wait outside of clinics like mine to "intercept" someone seeking an abortion. Other clinics in the South aren't so lucky, with people entering their parking lots and even their entrances. The clinic I work at is on private property, so no one can casually amble or loiter.
My shift has officially begun! I wave and say good morning to all of my coworkers and clock in. I am very fortunate to work in a clinic that is pretty well known in Georgia.
We are celebrated for our top rate facilities and commendable customer service. I have great co-workers and a pleasant work environment. The clinic itself is brightly lit and pristine. Portraits of phenomenal activists and writers like Angela Davis, bell hooks, Pearl Cleage, and Toni Morrison hang on the walls. Dozens and dozens of pilea, pothos, cacti, and other philodendrons make the space green, and we have TVs for folks to entertain themselves while they are sitting in our waiting room.
Our staff is dedicated to friendliness, answering questions, and being open to assist anyone. Our clinic offers a range of services—from STI testing, to short- and long-term options for birth control, to pregnancy testing and abortion services—and we understand when you come into our clinic, you could be experiencing a range of emotions. That's okay.
I head to the health education office and put my things down. The position I work is technically called "health educator," but I personally prefer the term abortion doula. I feel connected to serving as a support person and trusted guide.
Illustrations by Ellen O'Grady.
An abortion doula is, in a sense, a navigator. We guide each client through the procedure step by step to ensure you are empowered to make educated decisions about your body and your safety. We affirm any decisions you want to make. We prioritize your emotional well-being, reassuring our clients that they are in good medical care, whereas providers prioritize patients' physical well-being.
There are many types of doulas, including labor and childbirth doulas, postpartum doulas, and even death doulas. Some doulas are "full spectrum," supporting a person through pregnancy, delivery, and postpartum. Some, like me, are strictly abortion doulas. I work only as an abortion doula, and have done so for more than five years. In 2021, I completed an abortion doula/companion training from Chicago Women's Health Center, as well as with Dopo, an amazing doula duo. (Hey Zachi and Carly!)
Time for opening duties: Restocking gowns, sanitizing areas, and light clerical work. It's a really smooth way to transition into the working day. Sometimes, I may vibe to a podcast or a meditation as I am completing my tasks.
This is also a good time to check in with my fellow health educator(s). We usually chat about who will first go on lunch break, our caseloads, or just catch up!
These are the last quiet moments of the day.
Time to really hit the ground running! Patients are now coming into my office. I welcome them, announce my name and my pronouns, and then share what they can expect.
These sessions are completely confidential. I ask the patient how they are doing, what they are feeling, and really get a temperature check on their emotional well-being. My clients come to me after the 24-hour state-mandated waiting period that follows Georgia's required "Women's Right to Know" Act speech. My role consists of explaining the abortion procedure and their options. What they can expect in the operating room, what medicines they need to take, birth control options moving forward, as well as how their recovery might go—what's normal, what's not.
Some folks opt for surgical procedures, offered with local anesthesia or general anesthesia. Some folks opt for the abortion pill, which is really a combination of medications used to end a pregnancy and available in most Georgia clinics until 10 weeks. Some folks visit the clinic and realize they don't actually wish to continue with their procedure.
All of these choices are 100 percent valid. Our goal is to affirm and support every decision that is made.
I always let the patient lead their session, sure to follow their social cues. I pay close attention to body posture and eye contact. If folks aren't engaged, I simply tell them that we can take our time. Sometimes, we simply just pause. Health education sessions are never rushed. I want to ensure that they are choosing their procedure and are not being influenced by family, friends, or a partner. Some patients are hungry because they are not allowed to eat after 11:59 p.m the previous day for surgical abortions under anesthesia. Some sessions are relatively quick. Some sessions are lengthy.
Illustrations by Ellen O'Grady.
Sometimes, folks need a listening ear for support and guidance.
My goal is to offer support and medically accurate information to patients. I sometimes dispel misnomers and harmful myths. Some folks believe that abortion increases the likelihood of being predisposed to reproductive cancers. Not true!
Sometimes, we talk about future goals, like career and travel destinations. It truly depends on each and every patient.
I sit at a large desk to fill out paperwork, and there are about three extra chairs in the room. We have a large plexiglass piece hanging from the wall, which patients can sit behind in an office chair. This plexiglass is used to ensure that we are protected from COVID-19. Currently, also to ensure the safety and protection of staff and clients alike from COVID-19, patients cannot bring a support person into this clinic—unless they are a minor or need a translator. I believe my presence as a doula offering support has been ever more important during the pandemic.
I've seen patients sit across from my desk who are nervous or anxious to be there, worried about what family members will think. I've also seen patients who are calm and confident in their decision, already arriving with an understanding of what is best for them.
We begin the conversation around expectations.
Here's what I'd tell if you I could meet with you before you come in:
Patients at most clinics go through a series of steps. At most doctor's offices, you can expect to pay with insurance as soon as you check in, go to your appointment, and then leave with any prescriptions or medications.
In many abortion clinics, it is the complete opposite. Always expect 6-8 hours for your appointment. Most clinics in Georgia start abortions around 5 weeks, and can go up to 20-21 weeks. You will have to call each clinic to know their specific parameters.
After checking in and filling out paperwork, you step into lab and ultrasound to assess your gestation and vitals. After your lab work is completed, you head to health education—to someone like me—and then to payment. Payment for an abortion can be costly. Some insurance plans can reimburse you, but at most outpatient clinics, it is expected that you will have funds ready on a credit card or check. Your abortion fees depend on what kind of procedure you are having. Surgical abortions with anaesthesia are usually more expensive than local surgical procedures and the abortion pill. Depending on how far along you are in gestation, you can expect to spend $500-$2,000 for your procedure. This is why it is crucial to support local abortion funds to help individuals and families offset the cost of abortion care.
After finance, you will be given some medical gowns to change into and shown to the pre-op room. When it is your time for your procedure, you will be escorted to the operating room. You will be greeted by your physician and health workers. They will describe the procedure to you again and ensure that you are comfortable. You will be asked to sit on the operating table, and the CRNA will use an IV to give you medicine to help you fall asleep.
If you are using local anesthesia, an abortion doula, like myself, will guide you through your procedure while you are awake. We hold your hand, make sure you are comfortable, and give you some pointers for breathing techniques. Most surgical procedures 12 weeks and under last about 10 minutes. The physician usually plays music during surgery to relax the patient. I've heard everything from The Supremes, to Wham!, to Jhené Aiko.
Illustrations by Ellen O'Grady.
After your procedure, you are taken to the nurse's station, where you are given snacks and juice, along with instructions for discharge and post-op care. Your driver will be called to retrieve you about one hour after your surgery. Later, if you have questions or a copy of your medical records, you can call us.
This is usually when we break for lunch. I may walk to a grocery store nearby for a snack. Sometimes I may have yogurt, or some sort of light snack. The afternoon will be just as busy as the morning.
This is also when we usually take an assessment of how many charts we have left for the day.
After lunch, I'm either seeing patients or accompanying them in their procedures. (We call them locals).
When I go to the operating room with someone, it's my role to be the advocate for the patient, making sure every decision is one he/she/they understand(s) and feel(s) in control of. If the person is nervous about the medical aspects of the procedure, I make sure they feel safe to ask questions. If they're antsy, I remind them to breathe, and that the entire surgery is brief. If they're feeling sad, I give them space to express their emotions. If they're chatty, I'm there to listen and converse. Sometimes we talk about new Netflix shows, or recent albums that have dropped.
This is usually when we see the last patients. Typically, these are medical abortion pill patients. Check-in for surgical appointments ends around 9:30 a.m. For MAB (medically induced abortion) patients, it's 10:30 a.m.
It is important to know that the health educators leave when the last MAB or local procedures leave. This could be 3 p.m., or at the latest 4:30 p.m. Surgical abortions can start at 10 a.m., and the last of the day end at 6 p.m. It depends on the patient load and staff scheduling.
We clean the shared spaces. We finish with some light office duties to prepare for the next day. I shut the light off in the room, and head towards the break room.
I love talking to people. I love hearing their stories. I enjoy what I do immensely.
I clock out, check the schedule for the next week, and drive home. I park and walk towards my apartment. I open the door, and my pup is excited to see me return.
Will we always be able to do this work?
I love what I do. This is sacred work. I believe fully in bodily autonomy and self-determination. I have been doing this work for more than five years. However, abortion doulas and reproductive movement folks across the country are preparing for what feels like an inevitable reality: The overturning of Roe v. Wade.
If that happens, abortion in Georgia will be no more. Clinic workers like me will likely be unemployed. Many will have to rely on support to travel to states (and possibly other countries) to have legal abortions. Abortion funds will need even more donors and resources.
Roe v. Wade was the 1973 landmark decision in which the Supreme Court ruled that the U.S. constitution allows for pregnant folks to choose to have an abortion. This summer of 2022, the Supreme Court will issue a decision on a case out of Mississippi (Thomas E. Dobbs, State Health Officer of the Mississippi Department of Health v. Jackson Women's Health Organization) concerning the constitutionality of banning abortions after 15 weeks, creating near-total abortion ban.
Dobbs v. Jackson is explicitly seeking to reverse Roe, and without it, Georgia will (most likely) immediately shutter abortion clinics. Many of the other states with trigger laws, or legislation designed to immediately ban abortion should Roe ever be overturned, are also in the South, including Arkansas, Kentucky, Louisiana, Mississippi, Oklahoma, Tennessee, and Texas.
According to the Guttmacher Institute, it is estimated that a total of 26 states will or likely will ban or restrict abortion if the Supreme Court overturns Roe, and 12 of these states are in the South: Alabama, Arkansas, Georgia, Florida, Kentucky, Louisiana, Mississippi, Oklahoma, South Carolina, Texas, Tennessee, and West Virginia.
But even as we await the official Supreme Court ruling, some states have passed more restrictive legislation, or are actively considering it.
Oklahoma's governor recently signed a total abortion ban—where the procedure is prohibited after six weeks, which is usually before most people know they are pregnant—that criminalizes anyone involved in performing an abortion. This means the providers who work at a clinic like mine in Oklahoma will now face 10 years of prison and up to $100,000 in fines. This law is modeled after a contested Texas law from 2021, which prohibits abortions after a fetal heartbeat could be detected around six weeks, and allows people to sue anyone aiding or abetting an abortion, from the doctor to a friend offering a ride to the clinic.
A recent example of the Texas criminalizing pregnancy came when Lizelle Herrera, a 26-year-old Texan was arrested, charged with murder, and held on a $500,000 bond in April for an allegedly self-managed abortion. It's likely that a health care provider reported Herrera, and had the support to do so under Texas' new law. Swift action from local grassroots reproductive justice movements like Frontera Fund pressured the district attorney to ultimately drop the charges.
Kentucky's two clinics were temporarily shuttered on April 13, following a new state law passed to "eliminate access to all abortion services." However, a federal judge issued a temporary restraining order on April 22 allowing the clinics to reopen.
So, what do we do? Fellow abortion doulas weigh in.
In conversations with three Southern abortion doulas before the SCOTUS leak, we talked about a world without Roe—one that we've been prepared to face.
"The abortion bans don't scare us," Ash Williams, an abortion doula and organizer in Western North Carolina told me. He is a member of the Mountain Area Abortion Doula Collective. The collective supports folks in Western North Carolina with fundraising, technical support, and childcare. Ash has been prepared to care for communities for several years sans Roe.
"We, in the South, we are not putting all our eggs in the basket of Roe. I'm also not putting all of my eggs in the basket of the law. I think if you care about the abortion bans that are sweeping, you also care about the anti-trans legislation that is also sweeping. Reproductive Justice teaches us that controlling people's bodies is the key to controlling entire communities."
Want to know more about how abortion workers in the the South will continue their work?
Listen to our no-holds-barred Twitter Space conversation.
Khye Tyson, founder of Kuluntu Reproductive Justice Center in Atlanta, envisions ways to support folks having abortion outside of our current legal state.
"I think there should be folks who are thinking outside of the current system. As we are knocking things down, we simultaneously must be building things back up," they told me. "What are the alternatives and what are the ways we as Black folks and as Southerners are we going to resist and bounce back? Folks have been managing abortion since people have had the ability to get pregnant."
Yemi Miller-Tonnet is a reproductive justice organizer and full-spectrum doula. She assists with births and birthing plans, fertility, and abortion care. Yemi enjoys supporting people through their life transitions. She highlights that Atlanta, the capital, is a hub for people five to eight counties away for abortion care and other services. Half of Georgia counties are without an OBGYN, and 96 percent are without an abortion clinic. That means people are driving multiple hours for everything from their pap smear, to prenatals, to post-partum appointments—or for an abortion. This is a reality for millions of Southerners.
"What most matters to me in a Southern context is the sheer access piece—of people living their entire lives in communities that are deprived of any type of health care," Yemi said. "I think that doulas—and even people who don't call themselves but still take on that role in the community—are really important for people who are in care in ways that may seem impossible."
The overturn of Roe will not prohibit me from assisting folks from seeking abortion support. I will continue to fund for abortions. I will continue to provide resources and use my social networks to link folks to accommodations and childcare. I also will use this time to assist as a doula virtually. Our own fate is in our hands, I have the complete confidence that we possess all of the knowledge we need to give our communities the care that they deserve.
How you can support Southern reproductive justice funds today:
Restrictions to abortion care have left providers, organizers, and volunteers working overtime to help people get the health care they need. The best way to support reproductive justice is by giving our time and resources to providers and mutual-aid organizations across the South. We've rounded up a list of abortion funds that serve Southern folks, but this is just the beginning.