Fighting for More Than Access: Why the Quality of Your Abortion Matters

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Culture & Conversation Abortion

Fighting for More Than Access: Why the Quality of Your Abortion Matters

Derek P. Siegel

Being an abortion counselor has taught me the importance of having more candid conversations about abortion that center bodies and lived experiences.

Abortion access has multiple dimensions.

There’s the legal right to an abortion, but that doesn’t make it accessible—since January, 16 states have enacted a record-breaking 83 abortion restrictions, including the extreme abortion ban that went into effect in Texas at the beginning of this month.

Then there’s financial accessibility, which is hampered by the Hyde Amendment preventing federal funds like Medicaid from paying for abortion.

But what does the language of access have to do with people’s actual abortion experiences, or what it feels like to have your cervix dilated or to pass the pregnancy?

I have spent six years working as an abortion counselor, offering financial, logistical, and emotional support to clients. From 2017-2018, I interviewed 27 people from around the country about their abortion experiences. They described their abortions step by step, and I asked them what they were thinking, feeling, and physically experiencing at every stage of the process. They told me what surprised them and what made them feel comfortable. Some told me about the disappointment or frustration they felt when their experiences with abortion differed from their expectations.

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From my work and my interviews, I’ve concluded that providing better support starts with having more candid conversations about abortion that center bodies and lived experiences. The way we talk about abortion has consequences.

What kinds of abortions do people want? And where do these ideas come from?

Two-thirds of my respondents describe abortion as “normal.” For many, that means they desired a clinical and emotionally detached experience. They echo the words I’ve heard so often in the pro-choice movement: that abortion is health care and that only its stigma separates abortion from other medical procedures. Normalizing abortion is a strategy to increase legal access by decreasing stigma; for many patients, that rhetoric seems to have influenced the way they understand their own abortions.

Sam, a 25-year-old artist and doula, said normalizing the telling of their story is what resonates with their abortion experience. “My abortion was a normal part of my life, and I experienced this thing that a lot of people experience,” they said. (Respondents’ names are pseudonyms to protect their privacy.)

The other word that kept coming up was “natural.” That’s how over a third of folks described their experiences, particularly with medication abortion, contrasting it to procedural abortions that involve dilation and aspiration. “It seemed less invasive,” Hermione, 27, said, “and the pills didn’t seem like such a big deal.” Some people compare their medication abortions to a miscarriage or a heavy period.

While medication abortion is safe and increasingly common, it is not inherently more natural than any other abortion method. The allure of a “natural” abortion, though, seems to follow the logic of the “natural childbirth” movement, which encourages pregnant people to follow their natural instincts and to take responsibility for their birth (or in this case, their abortion).

Actual abortion experiences vary

Whereas the concept of a “normal” or “natural” abortion might seem one-size-fits-all, actual experiences are far more varied. For example, like many of my survey participants, RJ, 33, worried about whether her medication abortion was complete after bleeding lasted for a month afterward. “I would call my doctor,” she said, “and be like, ‘Is this normal?’”

While technically no longer pregnant, some people feel their abortion “isn’t over” until their next period. I’d never considered that an abortion could be understood as lasting an entire month, and neither had these respondents. When we fail to discuss this variation, we leave people unequipped to navigate the nuances of their own experience.

Even if someone wants a “normal” or “natural” abortion, their experience might not meet those expectations. Holly, for instance, had planned to set up a mini-altar to commemorate her medication abortion. “But I was just writhing on the floor all day, not paying attention to my crystals or my tea,” she said. “It’s humbling. I had all these rituals, but the day of … none of that shit mattered.”

Racial and class hierarchies can make it even more difficult for a patient to achieve their desired abortion. In terms of medication abortions, not all people have the ability to control their environment. For example, I have worked with clients who cannot have a medication abortion because they lack stable housing or a private place to pass the pregnancy.

Meanwhile, Valerie, 27, struggled to have the “normal” abortion she desired, given the racism she encountered at the clinic. She recalls being shuffled from room to room without explanation, along with the other Black women being seen that day. “Whenever I tell this story,” she said, “I say that we were herded like cows.”

Valerie’s experience sharply differs from many white participants who describe positive encounters with clinical staff. One white participant, Julie, said there was a person whose job at the clinic was to “hold [her] hand and look into [her] eyes, which was comforting.”

How to better support abortion patients

Practical support: Practical supports, including rides to and from the clinic, doula services, and child care, give a patient more control over their environment, thus enabling them to create the kind of abortion experience they desire. Many abortion funds already strive to provide practical support, in addition to financial support, for their clients.

Remember that someone might need different kinds of support at different stages of the abortion process. For example, Sandy, 30, wanted company while acquiring the medication but preferred solitude when passing the pregnancy.

Comprehensive options counseling: When discussing the differences between various abortion options, counselors can unintentionally shape their clients’ expectations. In my work as an abortion counselor, I tell clients that some people feel comfortable having a doctor by their side, while others feel that a medication abortion is more natural. But I also try to point out concrete differences: for example, that vacuum aspiration takes less time and has a faster recovery period, or that medication abortion can occur at home or at another preferred location.

This doesn’t mean counselors need to remove words like “natural” from their vocabulary. But they should put it into context. I might say that “some people prefer the medication abortion because it feels more natural, but it’s different for everybody.”

Body talk: Candid conversations about abortion should also occur outside the clinic. Although these discussions might be perceived as graphic and thus harmful to abortion’s public image, body talk can help people navigate their own abortions. So we should avoid euphemism and explain what the process of vacuum aspiration and medication abortion look and feel like. If someone asks, we can talk about pain, cramps, and discomfort. And we should create space for people—across the political spectrum—who do feel attached to their pregnancy. After all, not everybody describes or experiences their abortion in clinical terms.

Abortion storytelling groups such as We Testify and Abortion Out Loud (formerly the 1 in 3 Campaign) have already begun to disrupt dominant abortion discourses by elevating lived experiences. But we need more shared language to discuss abortion, so that people can articulate their varied needs and receive the support they deserve.

So yes, we’re fighting for folks to be able to get an abortion. But the quality of your abortion experience also matters. We can care about both.