Master's Project Title:

Assessment of the Design and Delivery of an Abortion Doula Program

MCH Student:

Nancy Pitsenbarger

Date of Defense:

December 17, 2015


Introduction: Abortion doulas support individuals during an abortion procedure.  Limited information exists regarding the use and effects of abortion doula support.

Objective: The aim of this formative evaluation was to identify any problems or issues inherent in the design and/or delivery of an abortion doula program at one abortion clinic in Minnesota.

Methods: Mixed methods were used to analyze data from primary and secondary sources. Abortion clinic staff and non-doula patient support volunteers completed pre-/post-surveys.  Abortion doulas completed a demographic survey and semi-structured interviews.  Abortion patients completed comment cards.  Summary calculations were conducted on categorical items and interview transcripts were analyzed using thematic analysis.  Program reach was calculated by comparing the number of patients eligible for doula support to the number of patients who received it.  Data were collected between January 12, 2015 and July 31, 2015.  The program began on February 11, 2015.

Results: The sample of clinic staff/volunteers (n=14) consisted of 43% physicians, 36% patient support volunteers, and 21% other staff.  Seventy-one percent agreed there was a need for abortion doulas at the clinic.  Eighty-five percent thought the program would have either a positive effect or no effect on clinic workflow.  Three abortion doulas participated in an interview and each had experience as a birth doula.  Three themes emerged: Birth Doula to Abortion Doula, Welcome to the Clinic, and Tailored Support.  Issues in program design and/or delivery identified within these themes included: meeting multiple volunteer requirements, no distinction between doulas and clinic staff/volunteers, and tailoring support to patients in limited time.  Among abortion patients who completed a comment card (n=53), 85-98% agreed their abortion doula helped them cope physically and emotionally; 100% were satisfied with, and would recommend, their abortion doula to other patients.  Eleven abortion doulas supported 161 patients, out of 997 eligible patients, for a program reach of 16%.  Low response rates prohibited the analysis of the clinic staff/volunteer post-survey and the abortion doula demographic survey.

Conclusions and Recommendations:  Results suggest the program was implemented with limited difficulty, but continued evaluation is recommended.  Assessment of patient need for doula support would enable the calculation of optimal program reach.  Tracking the number of doula-supported patients using the clinic’s electronic medical record system would facilitate the calculation of program reach over time.  An outcome evaluation to assess whether doula support results in a different abortion experience for patients, compared to an unsupported procedure, may inform program delivery and would add to the knowledge base of abortion doula support.