White Coat, Black Art·Q&A

'We aren't going to hide the fact that this is what we do': How abortion doulas are breaking down stigma

Lack of funding, distance, a patchwork of provincial laws and stigma are some of the barriers facing women seeking abortions in Canada, says Shannon Hardy, who volunteers as an abortion doula.

Shannon Hardy says doulas can provide support for women undergoing the procedure

Shannon Hardy, founder of Abortion Support Services Atlantic, says stigma remains one of the challenges facing women seeking an abortion. (Darren Calabrese/The Canadian Press)
Listen to the full episode26:31

Shannon Hardy believes the simple act of saying the word abortion out loud is one of the first steps to reducing the stigma that's still associated with the procedure. 

Hardy, who volunteers as an abortion doula, says that's why she openly advertises her services on Facebook and never shies away from talking about her work. 

"Being very public about what I do … people immediately felt a safety in that," said Hardy, who founded the Nova Scotia-based Abortion Support Services Atlantic (ASSA).

In 2012, Hardy had been working as a birth doula when she discovered women seeking abortions in Prince Edward Island had to trek to Nova Scotia or New Brunswick — and pay for their travel expenses out of pocket.

"That kind of blew my mind," she said. "I can't imagine forcing someone to give birth."

As a doula, Hardy volunteers to help women through the logistics and emotions of an abortion. She's pictured here in 2019 holding a training session for other volunteers in St. John's, N.L. (CBC)

Prince Edward Island was the country's last holdout. The last elective abortion on the island was in 1982. But P.E.I. agreed to offer abortion services within the province in 2016, following a legal challenge from a women's advocacy group.

Still, knowing that women could face limited access to abortion moved Hardy, a Halifax social worker, to become a "full-spectrum" doula, helping women in all stages of reproduction, including abortions.

As a volunteer abortion doula, Hardy says much of her work — and of those she trains — involves providing transportation for appointments, helping people find lodging, raising funds for travel and offering emotional support. Unlike midwives, doulas aren't licensed to perform medical procedures.

There is at least one volunteer abortion doula working in each province, according to Hardy. The network of volunteers is growing, she says, as women south of the border are seeing restrictive legislation against abortion services.

In the U.S., Alabama, Mississippi, Ohio, and Missouri are among states that have passed laws that limit and even ban abortion rights.

Even though abortion is legal in Canada, barriers remain, Hardy says, citing stigma, a patchwork of provincial laws and doctors who oppose providing abortion services on religious grounds.

White Coat, Black Art's Dr. Brian Goldman spoke to Hardy, who outlined the challenges facing women seeking access to the procedure in this country. Here is part of their conversation.

People may assume that because abortion is legal in Canada that women don't need help accessing care. What are the barriers that women face in this country?

Information is a big one. Of course abortion isn't talked about in sexual health classes so there's that stigma. If people don't talk about it then that immediately creates this sort of cloud around it. Maybe it's not OK. 

The protesters — whether they're outside your clinic or whether they're just in the news again — if people are protesting, maybe there's something wrong — so stigma.

Our geography. We're a giant country. So when we think of people, say in Labrador trying to access services, they need to take a flight down into St. John's and that can be said for Ontario, Saskatchewan, anywhere you can think of [where women have to fly to larger cities].

There are huge geographical barriers. There are barriers because doctors can choose to not perform abortion.

Money. So if you're flying, you have to take two days off. How do you do that if you're working at a minimum wage job? How do you find babysitting? How do you have enough gas money to drive into town?

Mifegymiso — better known as RU-486 — is a compound incorporating two drugs that together terminate early pregnancies. It was approved for use in Canada in 2015. (CBC)

We have had the approval of RU-486 or mifepristone, the so-called abortion pill. Has that increased access to medical abortion across the country?

Yes, but with a caveat.

So when mifegymiso first came out — so that's mifepristone and misoprostol combination. When that first came out, Health Canada had put a regimen around it that was really intensely frustrating ...  it could only be used up to 49 days.

You had to live within 100 kilometres of a doctor, you had to have a two-week follow up, you had to have an ultrasound before … Doctors had to take a six-hour training.

There were just all of these hurdles that people had to get through. Slowly, those have been chipped away, but they're still not to the point where we thought that mifegymiso was going to come out and solve all these problems … There's still a lot of barriers, including finding a doctor who will prescribe it for you.

I know you do training in the U.S. The landscape is quite different there. Abortion laws are being challenged in various states. What kinds of stories and concerns are you hearing from doulas and women there?

The stigma is much greater …  [An] abortion doula that I know just went to a meeting down there a couple of months ago, and there was armed guards and they [doulas] weren't allowed to wear their conference badges outside. They weren't allowed to talk about what they were doing.

It was pretty scary … you go to an abortion conference and there's somebody standing there with a machine gun.

Anti-abortion protesters rally near a Planned Parenthood clinic in Philadelphia, Friday, May 10, 2019. (Matt Rourke/Associated Press)

You mentioned stigma, and despite abortion being legal in this country, there is still stigma in some parts of the country. How much do you think stigma is a barrier to accessing care — accessing abortion services in this country?

I think it's huge. When I start the training … it's called trauma-informed abortion doula training, I let people know that we don't believe abortion is in and of itself traumatic. 

What we believe is that these systems — we have to go through the hoops — those things are traumatic because they exist on every level. 

We don't talk about it. We don't know who is safe to talk about it with, you know. Family members may have said … off-the-cuff things that make you think, "Oh, are they anti-abortion? Can I talk to them?" 

We don't talk about it in health-ed classes.

So then you get the idea, maybe it's not an option.

What's your role in reducing that stigma for the women that you help?

This comes from somebody we actually helped who we were supposed to pick up because everybody needs a ride home …  She texted me and said, "You don't need to come. My sister is coming. Because you were so open and wonderful, I felt safe to talk to her."

That's what we do … And again just putting the name in our title — we aren't going to hide the fact that this is what we do.

Where do you see abortion doulas heading next?

I would like to see more people being trained in how to offer trauma-informed abortion support. I would like everyone who will potentially come into contact with somebody who's seeking an abortion to also be trained in how to navigate that. 

I would really, really like us to look at our conscientious objector allowances for doctors.

It would be great to have an abortion doula, you know, available to come into the [termination] unit ... just to have that option for people.

Q&A edited for length and clarity.


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