The Abortion Counseling Conundrum

"I had a previous abortion at age 21, and it wasn't this hard. It didn't seem like a 'baby' to me at that age. But after raising two children I know now that I really did lose a living being inside me." -- An anonymous participant in Emerge, a pro-choice support group for women who've had abortions

Those sentiments would raise the eyebrows of many a pro-choice activist. After all, the feminist movement is built upon the cornerstone of women controlling their reproductive destinies -- on the imperative of valuing women's lives over the potential for life represented by a pregnancy. In the past, that often meant not talking at all about post-abortive women's feelings about the fetus.

But that is changing. The anti-abortion rights movement has become more sophisticated in recent years, co-opting themes of female empowerment to argue that women are abortion's central victims -- a line of reasoning that reached the Supreme Court in last year's Gonzales v. Carhart decision. In response, some reproductive health advocates have decided to deal head-on with the psychological aftermath of abortion. And though they're winning over skeptical elements of the pro-choice movement, these younger activists are having trouble convincing donors to fund their cause.

While most doctors agree so-called "Post Abortion Syndrome" is a myth, there is no doubt that dealing with an unplanned pregnancy can lead to anxiety and depression for some women. "It's about the relationship they were in when they got pregnant, or the fact they're currently financially dependent, or the relationship they had with their mother or father," says Nikki Madsen, associate director of Pro-Choice Resources, a Minneapolis-based non-profit that works to increase access to abortion and other reproductive health services. "An unplanned pregnancy elevates those things in our lives."

So in 2006, Pro-Choice Resources began hosting Emerge, a six-week secular support group for women who'd had abortions -- the first pro-choice after-abortion support group in the nation. And in San Francisco eight years ago, five women in their twenties and thirties who'd had abortions launched Exhale, a national telephone hotline offering non-ideological counseling to post-abortive women. Both groups are treading uncharted ground; nationwide, almost every support group and talk line for post-abortive women is sponsored by religious groups that oppose abortion rights.

Pro-choice leaders initially worried that discussing abortion's after effects would play into Christian right talking points. But both organizations have track records of success. Since 2002, Exhale has served 15,000 women on its hotline, and while Emerge is a local group that has reached only a few dozen people, pro-choice groups across the country are using it as a model for new post-abortion counseling services, Madsen says.

Nevertheless, both Exhale and Emerge are in danger of going under. The problem? Lack of funding from health foundations scared to tackle abortion and from pro-choice donors worried about discussing abortion's psychological complications.

"Big health funders won't touch these issues," says Shira Saperstein, deputy director at the Moriah Fund, which has given Exhale, the national hotline, a $30,000 grant. Exhale had a budget of $272,000 last year. The group hopes to create a social networking website where women who've had abortions can share their stories and connect with one another, says Aspen Baker, Exhale's co-founder and executive director. For that, Exhale hopes to raise $450,000 before the end of 2008. But for an organization that has lost some of its major funders and continues to attract a typical grant of only about $30,000, it will be an uphill climb.

"The thing that makes us unique and special is also sometimes our biggest challenge," Baker told the Prospect. A direct service organization at the edges of a contentious political debate, "We don't fit into sort of traditional categories."

Indeed, Exhale refuses to identify as "pro-choice," calling itself "pro-voice" instead. At an off-the-record meeting with pro-choice professionals in Washington, D.C. on June 19, Baker fielded many questions about how her organization could accomplish its goal of reducing abortion's stigma without taking a stance on whether the procedure should be legal.

Exhale's reasoning, Baker explains, is that women from across the political spectrum choose abortion, and that carrying a highly politicized label such as "pro-choice" would turn off potential clients. Forty percent of women who have abortions identify as Christian or Catholic, for example, and may also consider themselves pro-life. Few women want to talk about politics when they call Exhale, Baker says; many just want to tell someone they've had an abortion, and talk through feelings ranging from relief to grief.

Although Exhale publicly identifies as apolitical, the group is closely allied with the Beltway pro-choice movement. Baker participates in the Women's Health Leadership Network at the Washington-based Center for American Progress, a center-left think tank founded by former Bill Clinton chief-of-staff John Podesta. The purpose of the network is to connect grassroots reproductive health groups to the national policy debate, says its founder, Jessica Arons, director of CAP's Women's Health and Rights program.

Emerge, the Minneapolis in-person support group, does explicitly identify as pro-choice, but that hasn't made fundraising any easier than it is for Exhale. "This is the most challenging program [at Pro-Choice Resources] to fundraise for, by far and away," Madsen says. Emerge's annual budget is $30,000, one-third of which is provided by the Minnesota-focused Otto Bremer Foundation. The rest comes from Pro-Choice Resource's program budget.

"We don't feel confident at this point," Madsen admits. "We have submitted proposals to several foundations for this funding and continuously get rejected for it. We've found that traditional reproductive health funders aren't really connected to it. And foundations that might be more health care-related feel like the topic is too controversial. It's hard to have people understand that women can have negative feelings toward their abortion and still feel abortion should be legal."

An election year as exciting as this one means a tough fundraising climate for many small non-profits, particularly new projects outside of New York and Washington, D.C. power structures. But Exhale's Baker, at least, is hopeful. She's planning on reaching out to social entrepreneurship and mental health funders. And Exhale's proposed shift from "pro-choice" to "pro-voice" does seem to fit within a broader agenda of neutralizing abortion's hold over our national political debate. That's what Hillary Clinton tried to do in 2005 when she famously pronounced abortion "a sad, even tragic choice to many, many women." Like Exhale itself, that statement was greeted with both acclaim and disappointment in the pro-choice community, with the dividing lines often running between the generations.

"It has a lot to do with how younger women think and feel about abortion these days," says Arons of the Center for American Progress. "That it's important to have legal access, but it's not the same fight that it was for the Second Wave generation of feminists. Abortion doesn't symbolize women's liberation to the same extent as it did."

The Moriah Fund's Saperstein is even blunter. "If you've been in the women's rights arena for decades fighting the same battle over and over and over again, it's easy to feel defensive," she says. "But everyone knows abortion is a complicated experience."

Reprinted with permission from Dana Goldstein, "The Abortion Counseling Conundrum," The American Prospect Online: June 30, 2008. www.prospect.org. The American Prospect, 2000 L Street NW, Suite 717, Washington DC 20036. All rights reserved.