In-person later abortion accompaniment: a feminist collective-facilitated self-care practice in Latin America

Abstract

In Argentina, Chile and Ecuador, abortion at later durations of pregnancy is legally restricted. Feminist collectives in these contexts support people through self-managed medical abortion outside the healthcare system. The model of in-person abortion accompaniment represents an opportunity to examine a self-care practice that challenges and reimagines abortion provision. We formed a collaborative partnership built on a commitment to shared power and decision-making between researchers and partners. We conducted 28 key informant interviews with accompaniers in Argentina, Chile and Ecuador in 2019 about their model of in-person abortion accompaniment at later durations of pregnancy. We iteratively coded transcripts using a thematic analysis approach. Accompaniers premised their work in a feminist activist framework that understands accompaniment as addressing inequalities and expanding rights, especially for the historically marginalised. Through a detailed description of the process of in-person accompaniment, we show that the model, including the logistical considerations and security mechanisms put in place to ensure favourable abortion outcomes, emphasises peer-to-peer provision of supportive physical and emotional care of the accompanied person. In this way, it represents supported self-care through which individuals are centred as the protagonists of their own abortion, while being accompanied by feminist peers. This model of supported self-care challenges the idea that “self-care” necessarily means “solo care”, or care that happens alone. The model’s focus on peer-to-peer transfer of knowledge, providing emotional support, and centring the accompanied person not only expands access to abortion, but represents person-centred practices that could be scaled and replicated across contexts.

Centring rights-based access to self-care interventions

“…Embracing the strength of the women’s movements in the study countries and the importance of social support central to their cultures, the authors highlight the importance of leveraging these dynamics within the context of self-care interventions. 16 The four papers on abortion in non-humanitarian settings in Latin America all draw on the strength of the feminist movement and situate their work as a means to address inequalities and expand human rights, working around restrictions imposed by the law. 15–18 In the paper about safe abortion within the humanitarian context in Venezuela, medical abortion is described as “an act of resistance to reproductive injustice”.…”

Reach, experience, and acceptability of an abortion self-care intervention in Bolivia: a mixed-methods evaluation

“…To ensure that people self-managing their abortions had access to information and support, feminist collectives created and championed a model of care known as abortion accompaniment. 15 Abortion accompaniment models exist around the world – in Argentina, Mexico, Ecuador, Chile, Peru, Nigeria, and Venezuela, to name a few. 15–19 Accompaniment is generally provided by trained volunteer activists, without a clinical background, who provide a combination of information, emotional, and physical support, and sometimes also provide the medication and/or referrals to clinical care if desired or needed.…”

Abortion beyond 13 weeks in Argentina: healthcare seeking experiences during self-managed abortion accompanied by the Socorristas en Red

“…In these cases, the activists have an initial contact with an individual to provide them information about the medication and emotional support when an individual might need it. They are then in touch with the individual throughout their abortion process, most commonly via phone but occasionally in person, to provide them the support they need to ensure they have a safe, high-quality abortion [ 25 , 27 – 29 ].…”

“…Data on these experiences are sparse, however two retrospective chart reviews showed high rates of abortion completion among those accompanied after 13 weeks, similar to rates of completion in clinic-based studies, and high rates of satisfaction with the experience of being accompanied later in pregnancy have also been reported [ 12 , 31 , 32 ]. Two qualitative studies documenting activists’ experiences providing accompaniment for medication abortion beyond 13 weeks in Latin America found that activists had to be more attentive to people’s needs compared to a first-trimester abortion because the process took longer, and because there were more legal and medical risks involved [ 25 , 29 ].…”