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What it's like being an abortion doula in a state with restrictive laws

Ash Williams poses for a portrait outside of his home in Asheville, N.C., in August. Williams is a transgender abortion doula and activist.
Jessica Tezak for NPR
Ash Williams poses for a portrait outside of his home in Asheville, N.C., in August. Williams is a transgender abortion doula and activist.

In the hectic days after Roe v. Wade was overturned, Ash Williams, an abortion doula, welcomed panicked pregnant people into North Carolina's abortion clinics. His job has become even more challenging after the state tightened its abortion laws.

In general, an abortion doula is a person who provides support to a patient, and the term is often used to describe someone who gives guidance during labor. As an abortion doula, Williams provides physical, emotional or financial help to people seeking to end a pregnancy. If he can, Williams does all three.

"My goal is to get people the best abortion they can have because I know that it is possible," Williams said.

Williams remembers turning on the television June 24 to learn Roe v. Wade had been overturned. Williams thought he was prepared for this decision, but even still, a stoic face and somber demeanor settled over him for the rest of the day.

In a text to his fellow abortion doulas, he only said two words: "It's done."

"From there we just started to remind each other that we made certain agreements to answer the call to provide care at this time," Williams said.

"I had a moment where I was like, oh, well I'm an abortion doula, I fund people's abortions, I make sure they can get to their appointments, period. I can do that. I just need to keep doing that."

Demanding gender-affirming care

For years, North Carolina was an abortion safe haven, especially for people of color in bordering states with more restrictive abortion policies. Prior to the Supreme Court's decision, North Carolina was poised to become the nearest provider of abortions to an additional 11.2 million women from surrounding states, under the most restrictive scenario. That's according to the Guttmacher Institute, which supports abortion rights.

But in August, U.S. District Judge William Osteen lifted a three-year injunction, forcing North Carolinians to travel elsewhere for an abortion after 20 weeks, or carry out a pregnancy against their will. Before Osteen's ruling, people in North Carolina were able to get an abortion before fetal viability — typically sometime between 24 to 28 weeks of pregnancy.

"The 20 week ban came very unprovoked; there was no reason for it," Williams said. "I really see it as an attack."

With the ban in place, some abortion clinics in North Carolina refuse to treat people who are even 17 weeks pregnant. Now, Williams refers patients later in gestation to clinics outside the state, including as far as Washington D.C.

As a transgender man, he intentionally provides gender-affirming care — for example, he insists hospital staff address his clients by their correct names and pronouns.

"Trans folks often have to travel [farther] to get a doctor to use their pronouns," Williams says. "I might be the only one asking, that's a part of the care as well."

Time is an undue burden

In North Carolina, various restrictions make it difficult to access abortion, including amandatory 72-hour waiting period and state counseling every pregnant person must undergo. This waiting period was implemented to lead to fewer abortions. Williams said this is one of the longest waiting periods in the country.

"Time is an undue burden. It costs more," Williams said. "The procedure costs more, the pill costs more the further you are in gestation. We're also talking about serving areas that don't have abortion clinics. People are already traveling six or three hours from their homes to get to a clinic."

Williams said his patients are often young, low-income, parents, undocumented, Black, transgender, or many of these demographics. Most of them cannot afford the time or money required for an abortion. But this is not new in North Carolina.

He said that in the South, communities have been navigating tight restrictions for years — realities that are new in other parts of the country. "What is different now is there is a lot more fear. There's a lot of misunderstanding about what can be done," Williams said.

Many of Williams' clients come to him with limited knowledge about abortion procedures, especially surgical abortions. His clients have usually seen dramatized abortions portrayed on TV, or heard horror stories from their friends, which can have a negative and limiting influence on the abortion options. Williams said his clients are often uninformed about their options even after speaking to clinics that provide abortions. So, he uses his initial meeting to talk through their fears, and then offers information and a list of options suitable for their situation.

"[For example] someone is telling me they're really afraid of the pain they might experience," Williams said. "So, I'm going out of my way to find sedation options for them because they exist."

This summer was a blur

When he helps patients navigate an abortion, Williams is speaking from experience.

Williams had two surgical abortions, one in 2016 and another in 2018. Williams has a tattoo on his left forearm of a tool used for manual vacuum aspiration – a type of abortion procedure. Williams said he loves the procedure because, "it's one and done. It's quick."

When Williams was seeking his abortions, he struggled to fund himself. He had help from abortion doulas and his local queer community, which inspired him to focus on funding people's abortions today. Williams jokes that he tells his abortion stories as often as a broken record. He says it's a part of his job, but he is careful not to center his own experience when providing options to clients.

"Yes, we're pro-choice, we're pro-abortion, but being pro-choice means we have to be pro-even [for] the choices we wouldn't choose for ourselves," Williams said. "I'm trying to meet people where they are and just make sure that they can have the best abortion. That looks like making sure they have child care and a ride. It looks like making sure they're not choosing between their utility bill and their abortion."

In September, Williams raised $1,000 to support two Black women from South Carolina seeking abortions in Charlotte, N.C. When the Supreme Court overturned Roe v. Wade, South Carolina began to enforce a six-week abortion ban. While South Carolina has many abortion restrictions, including criminalizing people who self-manage their abortions, minority women and people continue to seek abortion access at the expense of making ends meet.

As of Aug. 17, the South Carolina Supreme Court temporarily blocked the six-week abortion ban, allowing people to get an abortion up to 22 weeks. This temporary rule is looser than North Carolina's ban.

"This summer was a blur," Williams said. "But we are not going to stop showing up for people in the face of criminalization; we're going to keep providing care."

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Destinee Adams
Destinee Adams (she/her) is a temporary news assistant for Morning Edition and Up First. In May 2022, a month before joining Morning Edition, she earned a bachelor's degree in Multimedia Journalism at Oklahoma State University. During her undergraduate career, she interned at the Stillwater News Press (Okla.) and participated in NPR's Next Generation Radio. In 2020, she wrote about George Floyd's impact on Black Americans, and in the following years she covered transgender identity and unpopular Black history in the South. Adams was born and raised in Oklahoma City, Oklahoma.