From left to right: Exhale co-founders Susan Criscione, Aspen Baker and Culebra De Robertis

SAN FRANCISCO (WOMENSENEWS)–When Aspen Baker was 23 she had an abortion. Baker had just completed her college degree in Peace and Conflict Studies from University of California, Berkeley, and, after weighing her options, she chose to have the procedure at a local hospital.

"That first couple of days afterwards, I felt relief," says the upbeat Baker, now 26, chatting in her small office, her Rottweiler sleeping in a corner. "But I also had the assumption that someone would hand me a card and say, ‘If anything comes up–just anything at all–here’s a safe place to call.’ I was really shocked when I didn’t get that."

And so the idea for Exhale was born. Exhale is the first post-abortion counseling hotline in the country that is not linked to a pro-choice or anti-abortion group. Based in Oakland, Calif., the volunteer-run toll-free line started taking calls in January and serves the San Francisco Bay area.

Baker acts as founder, executive director and peer counselor. She has recruited a handful of other counselors who take calls on weekday evenings. Funding comes from friends, family and a recent $3,000 grant from the Third Wave Foundation. The group’s monthly budget of $500 pays for phones, brochures and office space.

"We’re not a political organization and we’re not a pro-choice organization," Baker says adamantly. However, counselors must be committed to reproductive freedom and are screened on their ability to provide non-judgmental support to all callers, especially in regards to callers whose decisions fall outside social norms, such as callers who are young or have had several abortions.

Exhale runs off two truths, Baker says: Abortion is legal and abortion is normal.

However, Baker says that abortion is such a polarized issue that women’s post-abortion emotional health is often overlooked.

Despite the fact that abortion has been legal in the United States for nearly 30 years, post-abortion counseling remains rare–often lost in the roar of the debate over whether abortions are moral and whether they should remain legal. With most of the attention of pro-choice activists absorbed in preserving the option and anti-abortion groups focused in preventing abortions from occurring, little attention has been paid to the emotional aftercare that may be required, Baker says.

"When I got my abortion, I was really mad at the feminists," Baker says. "’You gave me this choice–great! But then I’m on my own afterwards? What’s up with that?’"

The National Abortion Federation does have a toll-free hotline and Web-based aftercare resources, but the hotline acts primarily as a referral service for women seeking family-planning counseling or a post-abortion checkup.

In an political climate in which pro-choice activists are often placed on the defensive, "there have been moments where the movement has been scared to say that abortion may have emotional effects," says Anna Mautz, who coordinates a project by the California Abortion and Reproductive Rights Action League to ensure access to reproductive health services in the state.

Primary Emotion after Abortion Is Relief

One argument anti-abortion activists use in their efforts to change laws and minds is the existence of a so-called "post-abortion psychological stress syndrome"–or the idea that abortion causes long-lasting psychological trauma such as that found in post-traumatic stress disorder.

The idea has been discredited by most therapists and by the American Psychiatric Association. Research on post-abortion emotions suggests that the predominant feeling among women is relief. Dr. Brenda Major, a psychology professor at the University of California, Santa Barbara, has conducted numerous studies the psychology of abortion and found that extreme post-abortion stress affects less than 1 percent of women.

But feelings of guilt, shame and isolation are not uncommon.

Peg Johnston, president of the National Coalition of Abortion Providers and director of Southern Tier Women’s Services in upstate New York, surveyed 212 of her patients over four weeks in 2000 and found widespread feelings of emotional distress. Some 36 percent of women were concerned about how they would feel after the abortion; 23 percent said they felt ashamed and 32 percent said they felt sad about their decision; 6 percent said they had no one to talk to about the abortion.

"This issue is so contentious," Johnston says. "Feelings of isolation are almost universal. There’s no Hallmark card for abortion. No one is bringing over a casserole."

Anti-Abortion Groups Offer Ideology-Based Counseling

Anti-abortion groups do provide some post-abortion emotional support, though the services remain closely tied to the ideology that abortion is a wrong and can cause deep psychological damage.

Project Rachel, a nationwide ministry of the Roman Catholic Church founded in 1984, provides post-abortion counseling by licensed therapists and lay "mentor supporters," as well as priests trained in post-abortion ministry. Project Rachel offers phone counseling and a six-week to 15-week process for women that includes airing emotions, self-forgiveness, recognizing loss, and, finally, naming the aborted fetus.

Mary Ann Schwab, coordinator for Project Rachel in San Francisco and a licensed social worker, says the ultimate goal for a woman is reconciliation with the church and with herself. Schwab receives between 10 and 25 calls per month from women seeking post-abortion counseling and most referrals are from pamphlets distributed at local churches.

"The church has been a strong voice saying that abortion is taking a human life," Schwab says. "This program presents the church in a message of salvation that Christ does forgive and does embrace."

Abortion providers and pro-choice activists disagree on whether anti-abortion services such as Project Rachel hurt or help women. Both Baker and Johnston say that they have a place for some women, especially those who are struggling with their religious beliefs and their abortion.

Exhale Provides Non-Judgmental Counseling

In contrast, Baker says Exhale offers non-judgmental counseling. Volunteers listen, validate the caller’s feelings, ask questions and brainstorm options. "We’re not your therapist and we’re not your best friend," she says. Counselors, she adds, don’t put their political views or personal experiences into the call.

Baker is not a professional therapist, and doesn’t claim to offer psychiatric services to callers. She works full time as development and community director for Men Overcoming Violence, a group fighting domestic violence. Previously, she interned at the California Abortion and Reproductive Rights Action League and volunteered on a rape-crisis hotline. She and the other peer counselors, who Baker found by placing ads in local newspapers and on Web sites, went through a six-week, 40-hour training designed by counselors at the non-profit Bay Area Women Against Rape. The training included sessions on ethnicity, depression, suicide, rape and domestic violence.

"Abortion can be one piece of many in a person’s life," Baker says. "A woman may call and say, ‘I can’t tell my husband I had an abortion because he wants a child and there is no way that I’m bringing a child into this family.’ We say, ‘OK, wait a minute, why don’t you want to bring a child into this relationship?’ And we can link women to other resources, like those that provide domestic violence support."

Some abortion providers have begun to refer women to Exhale for post-abortion counseling if they want it. The Planned Parenthood Golden Gate clinic offers face-to-face post-abortion visits, but only about 30 to 35 percent of women who have had surgical abortions return after the procedure. Exhale is filling an important need for some women, says Carla Eckhardt, the agency’s vice president for medical services.

"At Exhale, because it’s a phone visit, women don’t have to take time off work or worry about parking; they can do it at their convenience," Eckhardt says.

Exhale receives about three calls per week, which are forwarded to volunteers’ cell phones. Each call lasts about 30 minutes. Baker says about half the callers are men whose partners have had abortions. The calls often involve issues of how to act around their partners, and Baker says that counselors focus on checking in with how the men are handling their emotions.

Inspiring New Counseling Services

The initial success of Exhale is getting attention among reproductive health activists. A New York City service called Epilogue is being developed by Jane Bogart, the director of Center for Health Promotion at New York University, and Keeley McNamara, a peer educator also at NYU and an intern at the National Abortion and Reproductive Rights Action League New York. Modeled after Exhale, Epilogue is scheduled to open this fall and will provide comprehensive post-abortion counseling services in person, online and over the telephone.

Epilogue will be more closely aligned with the pro-choice movement than Exhale and has members from Planned Parenthood and other pro-choice groups on its board.

"We were inspired by Exhale," Bogart says. "There’s so much energy spent just keeping abortion legal, the post-abortion services don’t get the support they need."

Baker has no plans to go national with Exhale, arguing that post-abortion counseling should be local. "Abortion as a political issue is treated differently in the Bay area than in, say, Illinois, where more people may have anti-choice stickers on their cars. That brings up different issues."

She hopes to make Exhale available to Spanish speakers soon, provided she can come up with more funding and Spanish-speaking volunteers. And she is working out the details of creating training manuals for those who want to start similar services in other communities. Bogart and McNamara say they would like to use Exhale’s guide to train Epilogue counselors.

For Baker, Exhale’s mission goes beyond abortion. It’s about validating women’s ability to take care of themselves and to seek help when they need it. "A lot of women will never need Exhale," she says. "And it’s not up to us to make those decisions for people."

Rebecca Vesely writes from San Francisco.


For more information:


National Abortion Federation Aftercare:

Project Rachel Information: