A trauma-informed examination of the hardships experienced by abortion fund patients in the United States by Gretchen E. Elya

“Abortion restrictions in the United States can contribute to trauma by delaying the procedure, which often results in later abortions, or abortions being denied outright thereby multiplying the potential for stress-induced trauma responses”(Elya 2).

“two-thirds report difficulty paying for an abortion or meeting-
related expenses (in USA)” (Elya 2).

“Trauma-informed care emphasizes awareness of how patients’ prior or existing trauma exposures are brought into their current service-use experiences (Knight, 2015), suggesting that providers should offer service experiences focused on choice, safety, and empowerment, to help avoid re-traumatization”(Elya 2).

50,000 women die annually from unsafe abortions

“hardships occur globally at the individual level (financial, personal hardships), community (lack of service providers, long distance to travel to services) and policy level (wait periods, restrictions on public funding)” (Elya 3).

“Coverage through Medicaid can be difficult to obtain even when it is allowed because of rape, incest, or danger to the patient’s life; and this process can require significant self-advocacy that can cause trauma”(Elya 3).

Lack of access to and use of contraceptive use is commonly reported by patients

Pages 3-4 give good examples of broader hardships in access to abortion:


“seeking abortion services. Approximately, 40% of abortion patients report preabortion contraceptive use, and reasons for nonuse include concern about contraceptive costs, concerns about side effects and difficulties getting prescriptions refilled”(Elya 4).

“Abortion funds provide direct financial assistance for abortion and they engage in advocacy to promote reproductive justice, reduce stigma, and reform abortion policy, which encourages the minimization of trauma surrounding abortion access” (Elya 5).

Sum: Abortion funds provide critical service to those seeking to access abortion where there is lack of public funding and policies that create hardships and perpetuate trauma.

Tiller Memorial Fund, which provides direct funding pledges to patients in any region of the United States. This fund was established in 2005, and then renamed in 2009 in memory of Dr. George Tiller, who provided abortion care in the US state of Kansas for 35 years. His clinic was bombed in 1985, he was shot in 1993, and was shot again and killed in 2009, while attending church. This fund is maintained in his memory, entirely through private donations”(Ely 6).

Findings of Study :

  • 40% are already parents seeking to provide an economically stable and safe environment for their pre-existing children. “This is important in light of findings that parental trauma has been shown to negatively impact childhood development” (Ely 12).
  • 1/3 were on some form of public assistance such as: a range of programs such as SNAP, which stands for Supplemental Nutrition Assistance Program, formerly known as Food Stamps, Women Infants Children vouchers (food assistance for pregnant or nursing women and young children), or unemployment benefits.
  • Travel as a hardship
  • “not having birth control/nonuse of birth control or birth control failure was identified as a hardship experienced by abortion fund patients in the current study. This is important in light of knowledge suggesting that vulnerable women, including those living in poverty and women of color, often experience class and race-based hard- ships in accessing the reproductive health care needed to prevent unintended pregnancy in the first place”(Ely 12).


INSURANCE: “The current study also found that
patients from states that do not use state Medicaid funds to exceed coverage of
abortions (outside of instances of rape or incest) had a higher average reporting of
hardships related to abortion and abortion care. This finding was also true for
patients from states that restrict the private insurance coverage of abortion, with
patients from these restrictive states experiencing a higher average number of
hardship experiences. This is also not surprising, given that states must elect to use
their own Medicaid funds to cover the procedure, and the states not covering it are most often located in the South or Midwest, where the greatest numbers of hard-
ships were found. Even when these states should be covering abortion in cases of rape or incest, problems getting the procedure paid for by Medicaid are common”(Ely 13).

The trauma informed approach:

(a) acknowledging the potential hardships and existing potential traumas that
patients bring with them into the abortion-seeking experience;

(b) acknowledging that navigating the abortion seeking experience, which is fraught with stress that strains coping skills and depletes resources, can be a source of stress and can exac-
erbate existing trauma

(c) acknowledging the support services needed to facilitate access to abortion, which would including providing guaranteed funding for the procedure as the abortion fund was trying to do for patients in the current study

(d) providing a physically and emotionally safe environment for services that mini-
mizes stress and existing trauma and reduces the potential of causing new trauma, which would include advocating for legislation that facilitates abortion access and distances protesters from clinic entrances;

(e) providing services from a strengths-based and empowerment perspective at all stages of the abortion-seeking process, including at the time when patients may ask for abortion referrals from providers who do not expect this request or agree with abortion as a choice

(f) screening abortion patients for co-occurring problems such as partner violence and providing referrals when necessary (Ely 14).

Citation: Ely, Gretchen E., et al. “A Trauma-Informed Examination of the Hardships Experienced by Abortion Fund Patients in the United States.” Health Care for Women International, vol. 38, no. 11, Nov. 2017, pp. 1133–1151. EBSCOhost, doi:10.1080/07399332.2017.1367795.

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