"I can be pro-abortion and pro-birth": Opportunities and Challenges for Full Spectrum Care Among Doulas in Georgia Open Access
Lindsey, Alyssa (Spring 2022)
Abstract
Background: A full spectrum doula is “a non-medically trained community care worker who offers support to people during the full spectrum of pregnancy”. There are evidence gaps about the scope of work for abortion doulas and how other doulas view them. The Georgia Doula Study, a community-engaged project created in collaboration with Healthy Mothers Healthy Babies Coalition of Georgia, seeks to better understand abortion, family planning, and full spectrum doula services in Georgia. Methods: This cross-sectional, observational study utilized concurrent mixed methods (qualitative and quantitative) exampled abortion doula care in Georgia. Data were collected in the Fall 2021 from adult participants who had been practicing as a doula in Georgia at least six months. Analysis was conducted from November 2021 to February 2022. Descriptive and bivariate analyses were calculated from quantitative data. Qualitative interview data were fidelity checked, de-identified, and coded using a semi-deductive coding structure with a constant comparative method resulting in deductive and inductive codes. The survey included demographics and doula practice information, abortion attitudes, and stigma felt by abortion doulas. In-depth interviews asked participants to elaborate on their survey answers about abortion attitudes and experiences of abortion stigma as well as abortion client stories and ways to improve doula care in Georgia. Results: Our data revealed three key themes: doulas of all kinds center reproductive autonomy; abortion doula services have many benefits; and abortion doula service challenges and potential solutions. Regardless of their scope of doula offerings, most participants saw the value of abortion doulas in supporting pregnant clients. Abortion doulas highlighted key benefits such as holding space for their client and offering educational resources on accessing abortion services in Georgia. However, several challenges to access were identified including affordability of abortion doula services and restrictive legislation. When asked how these challenges could be solved, abortion and non-abortion doulas cited a need for destigmatizing abortion work and advocating for pro-abortion legislation in Georgia. While it was originally hypothesized that non-abortion doulas would be disapproving of those that offer abortion services, our findings revealed the opposite. All but two participants supported the role of abortion doulas who support pregnant people through a major reproductive health decision, and many were interested in how to provide abortion support outside clinical settings. Conclusion: It is imperative for all doula training organizations to include abortion and to follow the lead of existing abortion doula collectives. This study’s public health implications include organizational support for full spectrum doula collectives in Georgia as well as educating doulas and abortion providers on the benefits of and challenges to accessing abortion doula services. By supporting all clients through their reproductive health experiences, doulas ensure they feel adequately supported through reproductive experiences that can be isolating and stigmatizing.
Table of Contents
Chapter 1: Introduction 1
Chapter 2: Literature Review 3
Perspectives on Support in Abortion Care 4
Abortion Doula Scope of Work 5
Benefits of Abortion Doula Care 7
Conclusion 9
Chapter 3.1: Methods 10
Study Design and Recruitment 10
Procedures 11
Instruments 11
Data Analysis 13
Ethical Considerations 14
Limitations and Delimitations 14
Chapter 3.2: Results 15
Demographic Information 15
Doulas of All Kinds Center Reproductive Autonomy 17
Abortion Doula Services and Benefits: Holding Space and Much More 21
Abortion Doula Challenges and Solutions: Overcoming Stigma 24
Chapter 4: Discussion and Recommendations 31
Recommendations 34
References 1
Appendix A. Follow-up Survey Instrument 1
Appendix B. New Participant Survey Instrument 9
Appendix C. Follow-up In-Depth Interview (IDI) Guide 27
Appendix D. New Participant IDI Guide (Abortion Doula) 30
Appendix E. New Participant IDI Guide (Non-Abortion Doula) 34
About this Master's Thesis
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