MAADCO

Black, trans, queer, and nonbinary people were harmed by the lack of access to abortion and reproductive healthcare long before Roe v. Wade was overturned — along with anyone who deals with racial, gender, cultural, income-based, and geographic disparities. The reproductive justice workers of the Asheville-based Mountain Area Abortion Doula Collective shared their experiences, priorities, and perspectives with Janet Hurley, a former abortion-rights organizer and mom of one of the co-founders.

Words by Janet Hurley | Photos by Micah Mackenzie

Evan (She/ Her)

Evan, 32, grew up in Savannah, Georgia, but has lived in the mountains since graduating from Warren Wilson College in 2012. While a student, she volunteered with Our Voice in Asheville, which provides crisis intervention and support for survivors of sexual violence. It was there she learned about advocacy and what support work means. Evan also trained with the Umbrella Collective, an abortion doula collective based in Asheville that worked with Femcare, a private clinic. After Femcare closed in 2014 and the Umbrella Collective disbanded the following year, Evan began trying to organize a new collective in 2018 — MAADCO — to provide support to people going through the abortion process. The group lost traction as doulas moved away and was reconfigured in its current iteration in 2020 and 2021 with Maren and Alice.

Being nonjudgmental is “the glue that holds the concepts of doula together,” according to Evan, who is white and cisgender, the owner of her own birth doula business and co-founder of MAADCO in 2018, which lost traction as the other doulas moved away.

Reconfigured into its current iteration throughout 2020 and 2021 with abortion doulas Alice, Ash, and my daughter, Maren, MAADCO provides emotional, informational, logistical, and family support to people considering and seeking abortion in Western North Carolina. Each co-founder brings their own extensive experience. Outside of those who lead the doula trainings, no one in the collective — which includes seven doulas and 20 volunteers who provide practical support — is compensated financially. This could be but isn’t limited to: transportation to clinics, childcare, and dropping off abortion care packages containing items such as pads, tea, snacks, herbal tinctures, and pregnancy tests. Physical support or advocacy on behalf of the client might come in, too, but only with consent. Additionally, MAADCO maintains an abortion fund for procedures and related expenses such as travel or missed days of work. 

For MAADCO, community care, unlike state care, is not transactional. It is directly responsive to the needs of people, based on relationships and values, whether resources are acknowledged by the state or not. The MAADCO organizers are always aware of capacity: of their own energy, time, and available money. “We’re really slow and steady, really solid, but there is only a handful of us,” Evan says. “We’re using each other as a network to support people; that’s a lot of what we’re doing on the day-to-day.”  

Once AW decided to have a medical abortion, she had to make an appointment at a clinic to receive a prescription for mifepristone and misoprostol, which she would take at home. The first pill, mifepristone, stops the production of progesterone, thus ending the growth of the pregnancy. The second, misoprostol, causes uterine cramping and cervical softening to empty the uterus. Safer than many over-the-counter medications, “pill” abortions are very effective — between 91 and 98 percent — for pregnancies under 10 weeks.

On April 21, the U.S. Supreme Court protected access to mifepristone after legislative and lower-court attempts to restrict it, despite a rigorous approval of the drug by the FDA and more than two decades of safe use by millions, according to the Guttmacher Institute. Legal challenges continue, but unless they make their way back to the Supreme Court and there is a new ruling, mifepristone remains legal and available.   

After Roe was officially overturned, it meant abortion bans and restrictions were triggered and went into immediate effect. Abortion-seekers throughout the country were left without local and accessible resources, especially in the South and Middle Atlantic States. At that time, abortion was still legal in North Carolina up to 20 weeks. Asheville’s Planned Parenthood, the only clinic in all of Western North Carolina that provides abortions, saw a doubling in out-of-state numbers, from 37 percent of patients in August of 2021 to 74 percent in August of 2022, according to Kat Lewis, the clinic manager. The clinic saw patients from across the country.

On May 16, the North Carolina General Assembly overrode the governor’s veto of a new ban on abortion after 12 weeks, while chants of “Shame, shame” from reproductive justice supporters echoed throughout the chamber and left at least one pro-choice legislator weeping at her desk. A six-week ban of most abortions in South Carolina soon followed, though it was blocked a day after it was signed into law until it could be reviewed by the state’s Supreme Court.

“Patients are traveling upwards of four hours, and that shouldn’t be the case for anybody,” Lewis says. “It’s a real representation of where we’re at.”

The clinic began to add more doctors and staff to meet increased demand when the Dobbs decision was leaked in May of 2022. Still, the location didn’t have an appointment available in the time frame that AW needed, so the doula found one two hours away at the Greenville Women’s Clinic in South Carolina. “I wasn’t thinking to look outside of my area,” AW says. “If it weren’t for her, I wouldn’t have found that resource.”   

Lewis refers to MAADCO as a “gift.”

“In this post-Dobbs world, we’ve needed a lot of transport support,” Lewis says. “[MAADCO has] helped with all the practical support needs really I can think of,” including working with Lewis to connect patients to support when they need to travel to the Triangle area because of clinical or health concerns. “It’s like a team effort,” Lewis says. 

MAADCO doulas can accompany patients to the Asheville clinic and sit with them to provide support and care while they wait. They aren’t present in the procedure room, but Lewis says that this is a goal of hers. ”It’s so important for all patients to have access to a doula in a reproductive health experience,” Lewis says. “But we do want patients to be able to advocate for the type of doula they want to bring in, how and where and when.”

Most of Asheville Planned Parenthood clinic’s patients, around 62 percent, receive a prescription for a medication abortion, higher than the national average of just over 50 percent, so patients are able to choose their doula for their home-based process.

AW chose a medication abortion because she thought being at home and the process would be “easier” physically. However, she discovered that it was very painful and took longer than she had thought. AW had family members who were “basically supportive of her decision,” and a friend who had offered to come over if needed, but she called her doula for in-person support. The doula arrived with cold packs and asked AW’s consent to place them on sensitive areas, and to rub her lower back. “It just felt good to have or hear a comforting voice around me,” AW says. “I felt safe.”

Maren Hurley (She/Her)

Following four years of living in Brooklyn, New York, Maren, now 26, moved back to her hometown of Asheville in the first months of the pandemic. She’d started her abortion doula work with The Doula Project, a 16-year-old nonprofit organization that, prior to the pandemic, worked with Planned Parenthood and hospitals throughout the boroughs. Instead of focusing on the mechanics of abortion procedures, Maren learned how to address the systemic, cultural, and individual context of each abortion seeker. Conversations lifted up race, medical racism, and the history of abortion.

After formal training and an apprenticeship, Maren worked full-day shifts in clinics attending to clients who were having surgical procedures. She loved facilitating supportive abortion experiences and worried when she prepared to return to Asheville that she wouldn’t be able to continue her abortion doula work. “Honestly, it was the first thing I thought about,” she says. “‘If I am moving back, how do I find the other abortion doulas, how do I tap into this?’” 

Unlike so many who were shocked by the fall of Roe v. Wade on June 24, 2022, members of MAADCO were unsurprised. 

“I’ve hated being asked the question, ‘What has changed?’”Ash says, speaking of reporters who called after the Dobbs decision. He points out that many of the people they have been caring for never had any money to pay for their abortions, and that they have always been inconvenienced by floods, climate disasters, poverty, police, and by pro-forced-birth people at the clinics. “If anyone was prepared or knew what this moment was going to bring, I think it’s repro people under the Mason-Dixon Line.” 

“Post-Roe” was a term used for years by folks working in the fields of reproductive health, reproductive rights, and, like MAADCO, reproductive justice, the latter being a movement framework developed by people of color that expands the realm of reproductive health and human rights by including conditions for people who face a lack of clean water, poverty, climate emergencies, structural racism, and racial disparities in maternal and mental health care. 

Ash ticks off the three basic principles of reproductive justice on his fingers, paraphrasing: “One, every person has the right to have a baby. Two, everyone has a right to not have a baby and to decide the conditions under which they would terminate a pregnancy or gestating. Three, all of the people in the world get to exist free from harm from another person, from the government or the state, and from the environment.”

The third principle is the most expansive for Ash, a Black trans man. “Because of who I am, I need a way to talk about how Black people need a way to access the best fucking water and end anti-Black racism at the same damn time.”

Attacks on body sovereignty and bodily autonomy related to reproduction and healthcare have been especially prevalent in the South, with its history of large plantations and populations of enslaved people. In addition to being property, enslaved Black girls and women were considered breeders, endured rape by their owners, and underwent forced medical research without anesthesia to benefit white women’s reproductive healthcare. Some slave owners even supported the cessation of the trans-Atlantic slave trade as a way to corner the market with their “breeding stock,” law professor and activist Pamela Bridgewater wrote in Breeding a Nation: Reproductive Slavery, the Thirteenth Amendment, and the Pursuit of Freedom.

Colonization and oppression have always been based on the control of bodies, whether they were murdered, kidnapped, removed, forced into labor, contained, restricted, or used for experimentation. In the United States, this continues in the name of capitalism and white supremacy. The fall of Roe, according to MAADCO members, must be connected to the mass incarceration of Black bodies; immigration policies impacting so many bodies of color; laws seeking to control lesbian, gay, trans, queer, and nonbinary bodies; over-policing and excessive force used on Black and Brown bodies; the lack of medical research for the benefit of women’s, trans, and Black and Brown bodies; climate emergencies suffered predominantly by Black, Brown, and Indigenous bodies; pipelines running through ancestral lands of Indigenous bodies or communities of low-income bodies, mostly of color; and the removal of Black children’s bodies from their homes by departments of Children and Family Services.

“We were never afforded the same rights. This country has never really given Black bodies the chance to say yay or nay,” says Mel G, a Black, queer, nonbinary abortion, loss, and postpartum doula who lives in Charlotte. They collaborate with MAADCO to provide support to those seeking an abortion.“We see it from the whole medical industrial complex and it rolls out to education to housing to jobs to medical insurance – it rolls all the way out.”

Mel G was a teen parent of two when they got pregnant for the third time. With a 2-year-old and a 4-month-old, they could not mentally, emotionally, or financially have another child and had an abortion. At 20, they felt prepared for their next pregnancy and wanted to have the baby, but didn’t want to get pregnant again. When they asked their doctor for a tubal ligation, he refused, saying that they were too young to make that decision. It took Mel G six months to prevail.

“Black women and femmes and nonbinary persons have to fight, still to this day, for abortion, or they’re snatching our children from us,” Mel G says. “This world is not safe for our children,” they continue. “To actually have the right to choose [abortion], God bless us.” 

While MAADCO provides care to anyone who seeks an abortion, their work centers Black and trans people and has made it a priority to find more Black trans abortion doulas. In addition to Ash, there are two other Black doulas — one of whom identifies as trans, the other as nonbinary — providing care as part of the collective.

MAADCO has a moratorium on taking on more white doulas, and Ash was glad Maren encouraged this. Maren, a white, cisgender woman, says she “is constantly interrogating her own internalized white supremacy and transphobia to implement this learning into my work, generally.” Still, a moratorium isn’t going to solve the challenge. “We’re working on what we need to do to be a place where nonwhite doulas want to be,” Ash says. This includes intentional, honest, self-reflective, risk-taking processes and relationship-building as they meet and work together. “We’re communicators. We’re doulas. We’re not conflict-avoidant,” Ash says.  

“With birth work, you can shout it from the rooftops because people are like, ‘Oh my gosh, you are a saint,’” says Evan. “If you say you are helping people have abortions, you never know how someone is going to respond.”

Evan’s passion for education and training stems from helping folks learn what abortion and doula work entails. “This might create a wider understanding and normalize talking about abortion. I think anything that is stigmatized is also mysterious,” she says. 

Stigma can also be used as a political tool. According to reporting by media outlets, including Politico, Teen Vogue, and MSNBC, an alliance of the conservative Right, Evangelical Christians, and conservative Catholics focused on criminalizing abortion only after segregation became unpopular to gain political power and win seats in Congress during the Carter administration.   “The quote unquote women’s rights movement and the gay rights movement and desegregation movement were all in this confluence,” Maren says. This led to the dramatic rise in the controversiality of abortion in the last 50 years. 

Even people who are pro-abortion often don’t talk about choosing to have one because abortion is perceived as deeply shameful and private, Alice says, and this means it’s kept out of the public sphere, unlike other struggles. This is something I know firsthand. 

When I interviewed Maren for this article, she told me that during high school, she spent a lot of time thinking about what would happen if she or her friends got pregnant, wondering who were the “cool parents” they could go to. I felt uncomfortable. I wanted to raise my hand: I was cool then. (Wasn’t I?) And then I thought about how I’d never confided about such things to my mom, who had a master’s degree in Public Health and volunteered for Planned Parenthood. It’s the rare teenager who does share with parents, even when they are ostensibly on the same page. But then, what do parents, or adults, confide in teens that might help them make their choices?

Maren told me she didn’t get pregnant in high school or in college and has never had an abortion. I had an abortion a couple of years after I graduated college, by then living outside of Chapel Hill, where I’d gone to school. I had never regretted that decision, but that insidious abortion stigma kept me from talking with her or her brother about it when they were teens. What if I had? 

Ash emphasized the importance of sharing abortion experiences, what he called “reproductive justice stories,” when I spoke with him, which made me look back with regret and forward with resolve.

In 1990, at the age of 28, I  left my corporate job to work for the National Abortion Rights Action League-North Carolina (NARAL-NC ) as a community organizer in Raleigh. This was six months after the Webster v. Reproductive Health Services decision, in which the U.S. Supreme Court upheld several provisions of a Missouri law that regulated the performance of abortions. I’d climbed on buses for the National Mall protest marches with a renewed awareness of participatory democracy, sure that this was just a bump in the long but hard-fought journey for reproductive freedoms. 

In my first year of working for NARAL-NC, our main focus was on Harvey Gantt, the first Black mayor of Charlotte, in his bid to unseat Jesse Helms from the U.S. Senate seat. We also endorsed and funded other pro-choice candidates for the state Legislature. I organized mostly white volunteers to support these electoral races, to choose which candidates would receive our funding, and, post-election, to lobby in Raleigh. During this time, I began seeing the disconnect between a predominantly white organization working on health issues deeply impacting people of color. I wasn’t the only one, of course.  

In 1991, our state chapter joined an effort organized by national NARAL to start addressing the impacts of racism, classism, and white privilege on our work. We committed to Barriers and Bridges, a three-year process led by Grassroots Leadership out of Charlotte, which organized predominantly white, progressive Southeastern grassroots groups into a cohort to analyze oppressive organizational structures and systems, and their roots in white supremacy. We hired Black staff, and began working to center people of color and reproductive health. We had many volunteers and some staff who identified as lesbian, gay or queer. I don’t remember conversations about expanding our vision to include trans and nonbinary people, though some may have been happening. When I left NARAL-NC in 1993, the language was still about women’s rights and choices and the organization was still white-led. This speaks, in part, to the  hard, slow, and necessary ever-present process of dismantling white supremacy and homophobia, from the personal to the systemic. 

Since then, I have moved away from electoral politics as a main strategy for change, because, despite wins in Congress and the White House, Roe v. Wade was never codified into law. Instead, I have been putting my energy into local, even hyperlocal, Black and Latinx-led work — which broadly falls under the third principle of reproductive justice: All of the people in the world get to exist free from harm.

What MAADCO works for every day.

(From left) Alice, Maren and Evan, like all the MAADCO doulas, are committed to community care no matter the bans.

In the first year of the Collective, MAADCO supported about 20 clients, who found them via Instagram, the Carolina Abortion Fund, clinics, and word of mouth. After developing its infrastructure, the co-founders began training new doulas through online abortion doula workshops. 

“Start from zero” is an almost constant among evolving guidelines used in the MAADCO training, meant to encourage participants to stay open to learning about reproductive justice and related frameworks, and the history and importance of normalizing abortion. Because language is so important, MAADCO doesn’t use terms like anti-choice or anti-abortion; they use the term pro-forced-birth, to make the language less abstract and more true for those who can’t access abortion.

In 2022, demand for their work exploded. They supported more than 70 clients, trained over 100 new abortion doulas nationwide, and distributed thousands of dollars in abortion funds. They hope to raise enough money eventually to give stipends to Black doulas for their work; for now, however, donations are used to meet the constant financial need of people having abortions in North Carolina. Though the 12-week ban went into effect on July 1, Maren says, “MAADCO will continue to provide care and support to anyone seeking an abortion, no matter what bans are enacted.”

Alice, who is white and nonbinary, has big dreams for MAADCO, including a clinic, which they acknowledge is far in the future. In the meantime, they hope it becomes a group consisting primarily of doulas of color who are or support trans, queer, and nonbinary people. But they want that growth to be at the “speed of trust.” Even if people aren’t in the collective, Alice says, they can benefit from the MAADCO education and then support their own webbed networks.

“I think ultimately that feels like the safest outcome, that people are able to be these little nodes of abortion support throughout the region,” Alice says. “We are decentralized and we’re everywhere. Like a bunch of kudzu.”

MAADCO’s seven doulas and 20 volunteers have helped find appointments for those seeking abortions, provided transportation to clinics, helped with childcare, and dropped off abortion care packages, among many other supportive services.

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