We interviewed a total of 23 women who had abortions between 14 and 23 gestational weeks. Fifteen participants lived in urban areas, while eight lived in smaller towns. All women interviewed during the study were included in this analysis. The interviewees were between 18 and 41 years old. Thirteen had been pregnant previous to the pregnancy discussed: interviewees reported on 19 prior pregnancies total, 11 of which ended in live births, 3 in miscarriage, and 5 in abortion.
Consistent with previous literature, reasons for having an abortion beyond 13 weeks included not recognizing signs or symptoms of pregnancy until later on in their first or beginning of their second trimester, difficulties accessing abortion services with health professionals, and, for a smaller group, changes to their life circumstances motivated them to seek an abortion later in their pregnancy [17,18,19,20, 49]. Several women had multiple reasons for the delay in seeking care.
The interviews guided women to discuss the trajectory of their abortion experience, including all interactions with healthcare professionals, which included doctors, nurses, social workers in the hospital, and ultrasonographers. We identified three main time points in their experience when women had interactions with healthcare providers (before, during, and after) and how women made decisions about how to interact and share their abortion desires and experiences, as well as their experiences of treatment by those health professionals.
Experiences seeking abortion-related services in the healthcare system
Before their abortion, most women went to a health professional to confirm the pregnancy, ask for help accessing an abortion, and/or for a dating ultrasound. Those who had made the decision to terminate the pregnancy described weighing what to say to the health professionals that they encountered, including if they wanted to ask them about abortion options.
Sharing the decision with a health professional
Before their abortion, almost all women went to a health professional to confirm the pregnancy, ask for help accessing an abortion, and/or to have an ultrasound to determine how many weeks along they were. Upon finding out that they were pregnant and deciding that they would terminate the pregnancy, women described how they had to decide how to act with the health professionals that they encountered during the ultrasound or clinic visit and if they wanted to ask them about abortion options. Over half of the participants spoke with a health professional about their desire to have an abortion; advice from health professionals ranged from fear tactics to straightforward referrals.
Several women described how they received negative treatment and a lack of support when they mentioned they were seeking an abortion. These women described how some providers completely rejected the idea, telling the women they couldn’t help them, that they would have to continue with the pregnancy, and scolding them for thinking about an abortion. Women also described how a few providers tried to scare them, telling them that they could encounter legal trouble, such as the quote below, or put their health at risk:
On top of not helping me, [the doctor] made me more scared… saying ‘no, if you are going to do it you could go to prison’ and things like that. I mean, the way that [the doctor] treated me made me more scared about what I was going to do. (23 years old, 18 weeks)
In a few cases, women reported how the health professionals who tried to dissuade them from their decision to have an abortion still provided some kind of additional information or support. In one instance, the woman described how the provider, after scolding her, gave her a prescription for medications for abortion (which ultimately didn’t work):
[The doctor] spoke to me and kind of scolded me, “How could you not be aware, how could you not have protected yourself”. But I explained to him that he[partner] did use protection. So then he said to me, “I’m going to give you these pills,” you have to take them. (18 years old, 14–15 weeks)
In approximately half of the cases where women shared their desires with a health professional, they were told by the providers that they couldn’t help them, but subsequently referred the woman to the Socorristas.
[The gynecologist] told me that she couldn’t help me because I was too far along, that I should be careful, because I could put my life at risk. But, that’s when she mentioned your [Socorristas] name too… (26 years old, 16 weeks)
In several other cases, when the women told a provider that they wanted an abortion, the provider supported the woman’s decision, although some women had to go to multiple providers and appointments before finding a provider who would help. When women did find a supportive provider, they described feeling extremely relieved:
Luckily at some point they helped me, even though I thought they wouldn’t, but they helped me because they passed me your information [The Socorristas], I had never heard of the group. If the doctors hadn’t given me that information, I really don’t know what I would have done, I would have taken something through the internet and it would have been really dangerous. (21 years old, 14 weeks)
In almost all of these cases, the providers’ support was in the form of referring them to the Socorristas. These cases were in regions where the Socorristas had local groups and a strong presence.
Several women either did not go to a healthcare provider before going to the Socorristas, or came into contact with a healthcare provider and chose not to share their abortion decision. For a few of these women, they had already been in contact with the Socorristas and didn’t feel it necessary to share their decision with a provider. For the rest of the women, however, they chose not to share because they were afraid of legal consequences, or because they did not think that the health professional would help, such as one woman who described her dilemma:
You don’t know where to go, who to talk to, who can you ask [about an abortion]. You can’t ask just any doctor because they could throw you out, they could report you to the authorities. (35 years old, 22 weeks)
Experiences during ultrasound
A large majority of women also visited a clinic or hospital to have an ultrasound before beginning their abortion process, as recommended by the Socorristas. While some women characterized the treatment they received from the person performing the ultrasound as positive or neutral, most participants described experiencing some kind of negative treatment or feeling uncomfortable during their visit. In the majority of these cases, instead of asking women if they wanted to see or hear the ultrasound, the health professional showed them images, turned the volume up to hear the cardiac activity, and in several cases even told them the sex of the fetus. Most of these women described how these experiences caused them negative feelings such as guilt or sadness:
Yes, they showed me images…and it was awful. They showed me images. They told me the sex. And well, this was, uff! [takes a deep breath]. But I had already decided. You feel really bad, more like cruel, but I had already decided. (27 years old, 18 weeks)
In two cases, women shared that they felt they had to go along with what the ultrasonographer did because they didn’t want anyone to suspect that they were going to have an abortion. Seeing these images, however, did not dissuade women from their decision.
Some women reported that the health professionals asked their preferences during the ultrasound, while some women pre-empted this discussion by telling the provider at the beginning they did not want to see the image. However, this did not necessarily mean that women’s preferences were respected by those health professionals. In several cases, a woman said she did not want to see the image and yet the ultrasonographer still showed it:
I went and I asked the ultrasonographer, I said I didn’t want to see or hear it. And the man seemed like at all costs he wanted me to hear and see it. Or he wanted to tell me what the sex was, everything, everything. And I kept telling him, “no, I don’t want to”, and he would say to me, “ok, and why don’t you want to” “Because I don’t want to” I would say. And the man was saying, “if you start like that, listen, it’s going to feel like a lot of months.” And I said to myself, what part of no doesn’t he understand? He doesn’t understand “no.” (23 years old, 21 weeks)
There were a few women who reported that they had friendly health professionals who performed the ultrasound and asked about their preferences and accepted those preferences without pressure.
Experiences with the health system during post-abortion care
The majority of women decided to go to a hospital after taking the medication to see a medical provider. In all cases, they explained one of two reasons for this: because the Socorristas had suggested they go to ensure the abortion was complete, and in other cases, some women reported feeling safer and/or comfortable going to a hospital to see a doctor.
Weighing safety and fear when deciding whether to go to the hospital
Many women described feeling afraid to go to a hospital for fear of being treated poorly, being accused of having an abortion, and/or reported to the authorities. While some participants reported wanting to go to a hospital because they felt it would be better for their physical health, many of these same women were concerned about their abortions being discovered. This preference for going to the hospital was more prevalent in cases where the Socorristas could help arrange the visit so that the woman could go to the hospital when there was a friendly, supportive provider on call:
They had already told me who would be at the hospital, at what time I should go to the hospital according to the time that this doctor would be starting, we calculated the timing of when I should take the pills so that I would arrive when he was there…for me it was better that he was there, I felt more calm that way. (35 years old, 22 weeks)
In cases where it was safe to do so, the women described how the Socorristas advised women that, if they wanted to, they could share with a health professional that they had taken medication, because those providers would not put the woman in legal danger.
In other cases, the fear that someone in the health system could find out about the abortion and report it to the authorities or treat them poorly did not subside even with the Socorristas’ assurances. One woman chose not to share anything in the hospital because she had to hide the abortion from her partner, who emotionally and physically abused her:
I was afraid that…for example, if I went there and a doctor found out about this…for example, that they examined me and said, “No, she tried to have an abortion.” This was my fear, I was so afraid that this would really happen. Because I said to myself, “I will die if they say that I tried to have an abortion, because he [partner] would kill me. This was my fear.” (32 years old, 23 weeks)
A smaller group of women did not go to the hospital after taking abortion medications. For two women, the fear and uncertainty about what could happen in the hospital was enough to encourage them not to go:
No why, so that they treat me poorly or something like that? No, forget about it. No, no because with the fuss that would be made, it would be a mess…I never felt that bad, the pain that I felt, I mean, it was like very, very strong cramps, but no more than this. (23 years old, 21 weeks)
Finally, several women didn’t seek support from a health professional either because the abortion happened quickly and they didn’t have time to go to a health facility, and/or they believed it wasn’t necessary in that moment. Among this group, all women had abortions between 14 and 16 weeks; the majority had been pregnant before and two had had an abortion before and said they had felt prepared for what would happen this time around.
Experiences with health professionals in the hospital
The majority of women who went to a hospital after taking the medication, often when they were still showing signs of an abortion, reported some mistreatment from a health professional—including receiving judgmental/stigmatizing care, or inappropriate treatment for the situation. While some women were clear that the mistreatment stemmed from a health professional suspecting that they had self-induced an abortion, in other cases the reasons for mistreatment were less clear.
When asked directly, or even pressured by health professionals, over half of participants who went to a hospital chose not to discuss their use of abortion medication. Most commonly, women said they did not feel comfortable discussing their use of medications to induce abortion and were afraid of the consequences of doing so:
And there she [health professional] came in to bother me, “did you take anything?” And to my mother, “Did she take anything”. But awful, always awful, never saying it like, “ok, if you took something, tell me so I can help you, tell me what you took.” Instead, always treating me poorly, scolding me, “No, no,” I kept saying, “no.” (35 years old, 22 weeks)
Three of these women, all of whom reported interacting with health providers who suspected them of having induced an abortion, also reported receiving painful and/or unnecessary treatment and reported that they thought it was attributed to the suspicions of the provider.
Participants also reported cases of poor medical care that they attributed to providers not being properly prepared to manage their case. In several cases, when women first went to a hospital showing symptoms of an abortion, such as bleeding or cramping, the providers determined these women did not need care, or didn’t believe they were pregnant. Most of these women were sent home and ended up finishing their abortion at home without the medical attention they had been seeking. One woman was in the process of her abortion when she went to a clinic but the clinicians told her she had to go to a lab for a blood test for the pregnancy before they could provide any additional care. Afterwards, they wanted to send her home:
Those stupid people [referring to the doctors], I was telling them I was pregnant, that it hurt, that they look at me, at something (because I thought I was close to expelling, I wanted them to see if they could do something), and they gave me buscapina [pain reliever] and told me to go home to bed. Imagine if I had wanted this baby?! Those stupid people would have made me lose the baby! (37 years old, 20 weeks)
In three cases where women did not feel comfortable revealing their use of abortion medications to healthcare providers, they were transferred to other hospitals because the providers, thinking that the women wanted to continue the pregnancy, believed they needed a higher level of care (such as a neonatology unit). In several additional cases where women were afraid to disclose their abortion, providers assumed that women wanted to continue the pregnancies and placed them in rooms with other women who were in the process of giving birth. As a result of non-disclosure, the justifiable actions of health professionals caused stress and anguish among the women having abortions. For example, one participant was in a hospital for three days while providers tried to maintain the pregnancy:
They would come and do tests on me, I heard the heart beat for three days in a row. It was really hard. (24 years old, 18 weeks)
Women also spoke of positive experiences with some health professionals, where the care they received was supportive and judgement-free. One woman describes her response when a provider asked her if she had taken anything:
I started to cry, I thought, I don’t know, that they would treat me badly, verbally, lots of things go through your head… what about the police…when it’s so difficult you imagine lots of things, your brain is working in overtime. And I don’t know, I started crying and told them the truth. They didn’t ask me anything in that moment about it, not what it was, or with whom, they just said, “Ok, we don’t judge. Only the three of us and you will know.” (27 years old, 18 weeks)
While over half of participants who went to hospitals during their abortion did not disclose their use of medications, the other half of participants did disclose to at least one provider. Several participants who were asked directly by health professionals about use of medications for abortion chose to disclose their abortion. Even then, however, some women expressed some concern with sharing the information:
Well, so I told them [paramedics who came with an ambulance] that yes, I had used the medication… “I’m not sure, I’m a little afraid that the police will show up to interrogate me,” I said, “What if they put me in prison or something?” And [the paramedics] said to me: “No, we are not going to bring you to the police or anything, we want to know because we have to tell the doctor. We will leave you in the hospital and we have to tell the doctor what happened. It’s a secret amongst us.” (21 years old, 19 weeks)
In a few cases, women reported that providers were ready to receive them at the hospital due to prior contact between the Socorristas, who had let them know that the woman would be going to the hospital after taking the medication. In these cases the doctors simply attended to them directly, without asking questions:
Well, when I arrived at the hospital I was having a lot of contractions, and they attended to me immediately. When I was admitted there was [the doctor the Socorristas had notified], with another doctor, a woman, the two of them… it was clear they already knew something because they admitted me immediately, and didn’t ask many questions, it was clear they were already aware of what was going on. (21 years old, 14 weeks)
Though the participants often did not know whether the health professionals were considered ‘friendly’ by the Socorristas, all participants who reported feeling supported by a hospital-based health professionals lived in areas where the Socorristas have strong collectives and have developed relationships with health professionals. While not every provider that these participants interacted with was supportive, based on the experiences they described, most of the supportive providers they came into contact with were identified by the research team during the interviews as part of the Socorristas’ extended network of “friendly” health professionals.