Placer, alegría y experiencias emocionales positivas en acompañamientos de abortos después de la semana 17 de gestación

Katrina Kimport, Julia McReynolds-Perez, Chiara Bercu, Carolina Cisternas, Emily Wilkinson Salamea, Ruth Zurbriggen and Heidi Moseson.

Summary

Research shows that the abortion experience can be emotionally difficult and stigmatizing, but it has not generally been considered whether and how participating in abortion-related experiences can be a source of positive emotions, including pleasure, belonging, and even joy. The absence of explorations that start from the possibility that abortion provides pleasure and joy represents an epistemic cancellation. Moreover, it points to the way in which the social sciences have tended to emphasize the negative aspects of abortion care in ways that produce or amplify negative associations. In this article, we investigate positive emotions, pleasure, and joy related to participation in abortions, based on interviews conducted in 2019 with 28 abortion escorts from Argentina, Chile, and Ecuador regarding their experiences accompanying abortions of more than 17 weeks' gestation. Abortion accompaniment is a response to unsafe or inaccessible abortions, through which volunteer activists guide those in need of medical abortion through the process. Interviewees describe how the practice of accompaniment generated positive emotions by building a feminist community, sharing intimacy among women, and witnessing the empowerment of those having abortions. It is important to highlight that these positive experiences of abortion accompaniment are not detached from the broader marginalization of the practice of abortion, but on the contrary, are rooted in that marginalization.

Introduction

Engaging in abortion care actions, whether as a provider, activist, or other, may involve uncomfortable interactions and tasks (Ludlow 2008; Foster et al. 2020) as well as some exposure to social stigmatization (Joffe 2010; Simonds 1996; Roe 1989; Martin et al. 2014; O'Donnell, Weitz, and Freedman 2011; Kimport and Freedman 2018; Cardenas et al. 2018; Gantt-Shafer 2020; Giovannelli et al. 2023) and a risk of criminalization (Joffe 1995; Payne et al. 2013). However, it can also provide a sense of purpose, pride, and gratification (O'Donnell, Weitz, and Freedman 2011; Wolkomir and Powers 2007; Chiappetta-Swanson 2005; Fernández Vázquez and Brown 2019) and highlight the empowerment and autonomy of people who require abortions in ways that can be meaningful to those involved in abortion care actions (McReynolds-Pérez 2017; Bercu et al. 2022). Often, however, these positive aspects are presented as existing in spite of-or counterbalancing-the emotional, professional, and social challenges and difficulties associated with abortion-related work, rather than as phenomena worthy of independent consideration.

In this regard, the academy has not meaningfully considered whether and how abortion interventions can be an independent source of positive emotions such as pleasure, satisfaction, and even joy. As research increasingly explores the possibility (and normative cancellation) of people experiencing a "happy abortion" (Millar 2017; Wollum et al. 2022), this omission has become more conspicuous. The paucity of research on the possibilities provided by participation in performing abortions as a source of pleasure, joy, and other positive emotions is consistent with what the academy has identified as a "joy deficit" in research on the life experiences of marginalized people (Shuster and Westbrook 2022). Drawing on case studies of transgender people, Shuster and Westbrook (2022) argue that joy is an understudied but crucial element in the life experience of people who have experienced social marginalization. Importantly, this use of the word "deficit" is distinct from the use in the academic literature that argues against the prevalence of a cultural deficit framing-preferring a cultural asset-based framing-to characterize groups and individuals who are not white, cisgender, heterosexual, and financially stable (e.g., urban African Americans [Hunter and Robinson 2016]). However, it takes up the critique in this type of literature of the predominance of academic interest in cataloging the failures, difficulties, and problems of marginalized populations rather than their novel responses, resistances, and creative adaptations to structural constraints. Indeed, Shuster and Westbrook's analysis suggests that the lived experiences of joy for transgender populations are inextricably linked to the marginalized status of such populations. Similarly, Higgins and Hirsch (2007) have highlighted the existence of a "pleasure deficit" in sexual health studies, with most of the academic literature emphasizing the risk and negative health effects of sexual activity, with a general absence of mentions of pleasure and positive health effects. In this article, we assert that a similar deficit exists in the academic literature dealing with people who participate in abortions, arguing that this subject field has not started from the premise that participation in abortions can generate positive emotions.

The paucity of research that starts from such a possibility represents a problem for the broader literature. As Shuster and Westbrook (2022) assert about joy in transgender people, the scholarly deficiency in exploring the pleasure and joy associated with abortion represents an epistemic cancellation. Vast numbers of research questions go unasked when the possibility of abortion-associated pleasure and joy cannot be imagined. Moreover, when the literature focuses only on some aspects of abortion and, specifically, on aspects that illustrate the negative and difficult characteristics of abortion, it runs the risk of essentializing abortion as negative and difficult. In this sense, one also runs the risk of participating in the production of what Baird and Millar (2019, 2020) call the performative nature of academic abortion studies. Baird and Millar have identified a tendency in the abortion literature from the social sciences to emphasize the negative aspects of abortion care in a way that may contribute to reproducing or amplifying a negative normative association with abortion. Even when such literature seeks to disprove narratives and constructions about abortion as negative and/or to identify causes for such negative consequences other than abortion itself (e.g., legislation), its effect in practice may be to crystallize them through repetition. Conceptualizing and studying abortion participation largely in terms of its burdens and negative effects, especially to the extent that these are presented as inherent to abortion, may operate as a normative constraint on knowledge, understanding, and discourse about abortion.

In this article, we work with evidence suggesting that participation in performing abortions can engender feelings of pride and gratification (Wolkomir and Powers 2007; O'Donnell, Weitz, and Freedman 2011; Fernández Vázquez and Brown 2019; Chiappetta-Swanson 2005) to study specifically the positive emotions, pleasure, and joy associated with abortion accompaniment. Abortion accompaniment is a response to unsafe and/or inaccessible abortions, in which volunteer activists guide those seeking abortion by phone, text message, or in person, relying on WHO-approved protocols according to stage of pregnancy (Bercu et al. 2022; Moseson et al. 2022; Braine 2020; Moseson et al. 2020). At the time our data were collected in 2019, abortion was illegal or difficult to access through the formal health care system in much of Latin America (Guttmacher Institute 2018) and fear of discrimination, criminalization, and abortion stigma resulted in additional barriers for those seeking abortion (Culwell and Hurwitz 013). It is important to note, however, that legal restrictions do not eliminate demand for abortions (Bearak et al. 2020; Ganatra et al. 2017). With the emergence of medication abortion, abortion accompaniment has emerged as a feminist and activist strategy to facilitate access to performing abortions even in highly restrictive contexts (Moseson et al. 2022; Jelinska and Yanow 2018; Veldhuis, Sanchez-Ramirez, and Darney 2022). Although there is no single abortion accompaniment practice (Atienzo et al. 2023), due to the feminist roots of this model, the practice focuses on the abortionist (Veldhuis, Sánchez-Ramírez, and Darney 2022; Assis and Larrea 2020; Duffy, Freeman, and Rodríguez 2023; Bercu et al. 2022) and seeks to achieve positive effects on these individuals, which have been empirically documented (Vacarezza and Burton 2023; McReynolds-Pérez et al. 2023)-this includes positive emotional effects (Wollum et al. 2022).

We seek to contribute to this academic literature with an analysis based on interviews with abortion escorts from Argentina, Chile and Ecuador, in which we inquire about whether and how escorting abortions can be a source of pleasure, joy and other explicitly positive emotions. Our research is set up as a secondary analysis of data originally collected to study experiences of on-site abortion accompaniment (Bercu et al. 2022), a less common accompaniment practice (Gerdts et al. 2018; Zurbriggen, Keefe-Oates, and Gerdts 2018) that accompaniment groups typically reserve for individuals seeking abortions later in pregnancy (i.e., after 17 weeks) or who are particularly socially vulnerable (e.g., youth). Accompanied abortions after 17 weeks gestation often involve multi-day commitments that can be physically and emotionally intense for all involved and involve increased risk in restrictive contexts (Zurbriggen, Keefe-Oates, and Gerdts 2018). From the case of a marginalized activity (in-situ accompaniment over 17 weeks gestation) within a marginalized practice (abortion accompaniment), we inquire: in what ways is in-situ accompaniment of people over 17 weeks gestation a source of positive emotions, including pleasure and joy?

Methodology and materials

Context

This project focuses on the work of three support groups: Colectiva Feminista La Revuelta from Argentina, Con las Amigas y en la Casa from Chile and Las Comadres from Ecuador. At the time the information was collected, abortion in the three countries was permitted only in very restricted circumstances: if the life or health of the pregnant woman was at risk or if the pregnancy was the result of rape (no gestational limit in Argentina; only up to 12 weeks of gestation or up to 14 weeks if the woman was under 14 years of age in Chile; and only if the pregnant woman had a mental disability in Ecuador). Chile allowed an additional exception if the fetus had no chance of surviving the pregnancy. ¹.

All of the groups began by providing accompaniment via telephone or text messages, and after a while began to accompany some abortions in person, especially those performed after the 17th week of gestation. The Colectiva Feminista La Revuelta is a feminist group that has operated a network for people who need access to abortion since 2010. The group began accompanying on-site abortions in 2016. Con las Amigas y en la Casa was formed in 2016 and began offering on-site accompaniments in 2018. Las Comadres has been operating since 2015 and began accompanying in-situ abortions in 2018. The present study was conducted through a collaborative research alliance between members of the nonprofit research group Ibis Reproductive Health (Ibis), referents from the three accompaniment collectives, and two researchers with university institutional membership.

Call for applications

The details of the collaborative research partnership between Ibis researchers from the United States and members of the groups from Argentina, Chile, and Ecuador have been described in another paper (Bercu et al. 2022). Briefly, during a global meeting of abortion escort groups in 2018, the three feminist collectives contacted Ibis researchers for help in the process of documenting the model of escorting on-site abortions at advanced gestational ages. We formed a 12-person research team that included four Ibis researchers and two to three members of each accompaniment group. The collaboration was intentionally structured as an alliance, seeking to reduce the hierarchical relationships that often structure research groups, creating instead a space for collaborative decision-making in which power could circulate among all participants.

In early 2019, the research team invited a number of eligible female candidates to participate in a key informant interview about on-site accompaniments of medication abortion for pregnancies over 13 weeks gestation (i.e., from the second trimester onward). Participants were over 18 years of age and had participated in at least two in-situ accompaniments within the framework of one of the three accompaniment groups in the previous three years. As far as possible, we invited participants with varying degrees of seniority in order to capture a wider range of experiences. All eligible candidates invited agreed to participate in the interview.

Data collection

To conduct the interviews we used a semi-structured interview guide that included questions related to their experiences in accompaniments, how the participants had joined the group, and their personal histories with the collective. The study was not designed to specifically capture information related to pleasure or joy, but was designed in a way that allowed participants to share their opinions about the accompaniment experiences in a broad way. It is relevant to the analysis to indicate that the interviews encouraged reflections about the most satisfying aspects of accompaniment, the impact of accompaniment on their lives, what had surprised them most about accompanying abortions, the lessons learned from accompaniment, and their desires for what abortion care should be in an ideal world. Following Shuster and Westbrook's (2022) methodological point about the absence of joy-related questions to marginalized subjects, we describe in Table 1 the specific questions whose answers were relevant to this analysis.

Four members of the research team -two accompaniers from the accompaniment groups and two Ibis researchers- conducted the interviews, following training in qualitative interviewing methods. In some cases, this implied that the interviewers had a pre-existing personal relationship with the interviewees. Although this may have influenced the content of the interviews, we chose to include chaperones in the interview teams because of the sensitive nature of the topics to be covered, the need to build trust between interviewer and interviewee given the difficulty that outsiders may have in establishing this trust, and the access that these specific interviewers had to potential participants. Given that talking about positive emotions does not usually cause discomfort, we were not concerned that in general these personal relationships might negatively affect the information analyzed here. All interviews were conducted between February and April 2019 and were conducted in Spanish language, in person or by telephone, lasting between 60 and 90 minutes.

At the beginning of each interview, the interviewer reviewed the consent-related materials and the interviewee provided verbal consent. The interviews were audio-recorded and professionally transcribed verbatim. Participants received approximately US$20 per diem, which was distributed individually or donated to the support group. We ended the call when we reached saturation on the primary research questions formulated by the alliance (see Bercu et al. 2022).

In 2020, after the end of the survey period, Argentina legalized abortion up to 14 weeks of pregnancy. As of September 2023, the regulatory environment in Chile and Ecuador was the same as at the time of the survey. ↩︎

Table 1. Questions included in the interviews relevant to this analysis.

Original question in Spanish

What is the most rewarding thing about your role as an escort for second trimester situations?

Can you tell me about your first second trimester on-site accompaniment? What was it like, what did you feel, what happened?

What does accompaniment mean to you?

What are the lessons learned or what has had the greatest impact on you from the women you have accompanied in the second trimester?

What has surprised you the most during the second quarter on-site visits you have accompanied?

In what ways do you receive support for your role as a companion?

The Allendale Investigational Review Board, USA, served as the review board for this international research and reviewed and approved the study protocols (approval number: IBISSECT09021018). We followed all local guidelines and regulatory procedures for human subjects research in each country.

Analysis

The first and second authors, both sociologists residing in the United States and with university institutional affiliation, joined the project for the analysis stage, once the data collection was completed, contributing their skills for qualitative analysis and their experience in the issue of abortion throughout pregnancy and/or abortion provision in Latin America. We analyzed the original Spanish transcripts through an iterative team coding process using MAXQDA software. Prior to analyzing the transcripts, the research team developed a deductive codebook based on the interview guide questions. After analyzing several of the transcripts, we updated and adapted this codebook to more adequately capture the main ideas and sub-ideas that emerged from the interviews. Some team members then applied this updated codebook to all transcripts and met regularly with the entire team to discuss the data and identify patterns. Throughout this process, feelings of joy and positive emotions related to abortion accompaniment emerged from the transcripts and in various conversations of the research team.

Using joy and pleasure as sensitizing concepts (Charmaz 2006), the second author surveyed the coded data in search of fragments relevant to the themes of interest for the research. Then, the first author conducted a grounded theory-based sub-coding of all fragments related to positive emotions, with the aim of identifying general themes. In keeping with the collaborative principles of the partnership, throughout this process and during the production of the text, the entire team met to discuss the findings as they emerged, translating the summaries and materials into Spanish as required, including a professional translation of the draft text from English to Spanish.

For the publication, one of the authors - bilingual in Spanish and English - translated the quotes from the original Spanish into English. Two other bilingual authors reviewed these translations for accuracy. It is important to mention that most, but not all, of the people who had accompanied the interviewees identified as women and several interviewees mentioned that the gender assigned at birth and the gender binary do not adequately fit the ways in which all abortionists experience their gender. However, interviewees often used the word "woman" to describe the social category of people who have abortions. In this article, we use pseudonyms to refer to the participants.

The satisfaction of creating a feminist community

Accompaniment, for all interviewees, is fundamentally rooted in feminist practice. However, several of them mentioned that feminism and the goal of living according to feminist values can be somewhat abstract and complex. In accompaniment, the interviewees identified a concrete practice that allowed them to embody and put into practice their feminist convictions. Juliana, an Argentinean accompanier, explains: "What else can bring down to earth everything we think, everything we believe, everything we are building from feminism in our ideas and our feelings? Like, bring it down to earth in this concrete practice of accompanying each other." Accompaniment is, as Carmen, another Argentinean accompanier, explains, "the way I found to live," making it not just an activity, but a way of life that gave her purpose and meaning. Others replicate this sentiment: Monica, from Argentina, explains that, far from being something secondary to the way she inhabits the world, accompaniment "harmonizes me with the world."

Significantly, the interviewees do not live their feminist values in isolation: accompaniment is collective. By definition, accompaniment means not being alone - neither the abortionist nor those accompanying her - and usually two or three accompaniers are involved. This collective aspect of the practice differs from many other aspects of the interviewees' lives and is therefore something that some of them had to learn, which they found revitalizing. As Amelia, an interviewee from Ecuador, points out, comparing accompaniment with her daily work in which she works alone in a role of supporting others:

[My profession] is a very solitary job because I give support on an individual basis. When you work as part of a network, it is nice to know that the accompaniment is collective. I had to learn that in practice, that I was not making decisions alone.

In accompaniment, Amelia is part of a group of feminists. Maribel, another accompanier from Ecuador, describes it similarly, "I feel that we formed a good team. There was a great synergy, it was very nice."

Significantly, this teamwork includes activities based on feminist praxis, which the accompaniers understand as ways of contesting social norms. Valentina, a Chilean accompanier, explains that abortion accompaniment has a political objective "to facilitate access to safe abortion," but that is not all. Implicitly noting that the majority of escorts and those accessing abortions identify as women, she continues:

also aims to implement a different kind of relationship between women and to show us how to love each other, trust each other, be more loving to each other, be supportive and help each other, help each other do something that no one else wants to help us do.

For Valentina, part of the pleasure of participating in on-site accompaniment comes from the more generalized absence in her life of the feminist and collective caring values that accompaniers put into practice during accompaniment. As Amelia, the accompanier from Ecuador who worked alone, explains:

I think it is very gratifying to do it accompanied - in other words, to share the space between companions. I feel it is beautiful to be able to have these spaces of shared complicity, knowing that we are doing something that is on the margins [of society], that we are transgressing and that we are not doing it alone.

Moreover, this shared space is inclusive of people's lives and identities - escorts are not present strictly as providers of an abortion service but as whole human beings. Amelia continues:

We ended up sleeping next to them [the people who were performing the abortion], because you end up staying for more than 12 hours. So, you end up not only talking about abortion but about whether or not you like chocolate, or other things in life. That's beautiful and I think we need more of that, to be able to enjoy the company, moments of pleasure.

This completeness does not end when the abortion is performed. Vanessa, an accompanier from Ecuador, describes accompaniment as an activity and as a practice of continuous conversation: "When we finish an accompaniment, we talk about it and share knowledge with each other. Knowing that we are together." Through accompaniment, the interviewees are able to live according to their feminist values, which generates positive emotions.

Pleasure in physical intimacy

Interviewees also highlighted the positive emotional impacts of the bodily practice of accompaniment, describing how accompaniment allows and necessitates physical intimacy and trust and creates emotional bonds between the accompanied and the escorts, as well as between the escorts themselves. Accompanied abortions during the second trimester involve considerable physical processes: bodily changes, cramping, intense pain and expulsion of the contents of the uterus, including blood and tissue, through the vagina. Andrea, an Argentinean escort, describes these experiences as "intimate," explaining that escorting "involves sharing not only bodies and taking care of bodies, but also a moment that is very intimate." She is amazed by this intimacy, and shares her appreciation and surprise "that they [abortionists] allow you to participate in a moment as intimate as an abortion."

On-site accompaniment also involves intimacy in the sense of physical contact. In this sense, Sandra, an accompanier from Chile, describes a key moment during the accompaniment of a woman who had an abortion:

[She] was in a lot of pain, she couldn't even open her eyes. She was very tense, her body was very tight, and I started to stroke her head and she started to relax. Then she started thanking me. It was as if I had never had this kind of contact with women, so based on affection, on doing things with affection.

As Sandra's story points out, the intimacy of accompaniment occurs between strangers and between women.

Companions affirm that physical intimacy between women during accompaniment - in which the woman is the recipient of care and does not have the responsibility of providing care to others - is absent in most of the social spaces to which abortion providers have access. Sofia, a Chilean escort, explains:

Humanity does not offer women a space of complicity like accompaniment does. It's a different life experience [...] being with a stranger, looking into each other's eyes, committing a crime - all in the same day. It's very intense and very profound and it can also be a very extreme experience, so I think that's why those of us who escort abortions escort abortions.

As Sandra's story points out, the intimacy of accompaniment occurs between strangers and between women.

Humanity does not offer women a space of complicity like accompaniment does. It's a different life experience [...] being with a stranger, looking into each other's eyes, committing a crime - all in the same day. It's very intense and very profound and it can also be a very extreme experience, so I think that's why those of us who escort abortions escort abortions.

In a cultural context in which the norm is lack of intimacy or care for many people who are also primary caregivers for others, going through these experiences together physically and emotionally - and being explicitly linked to each other's lives - generates deep feelings associated with having a purpose in the companions.

Companions described the close relationships forged from companionship as unique in the context of their social settings. Indeed, rather than providing space for this type of bonding and physical intimacy, the escorts noted, dominant social norms associate these experiences and activities with revulsion and shame. During accompaniment, by being present with the abortionist as she undergoes these physical changes, the escorts felt that they were rejecting these social norms. Celeste, the Chilean escort quoted above, describes accompaniment as "wanting to get rid of the repulsion [associated with bodies], to stop feeling ashamed at the sight of another person's vagina, you know?" Companionship, in other words, is about challenging not only the forced continuation of a pregnancy, but also the expectations underlying a social system in which women's bodies are not valued. In the same vein, Paula, an escort from Argentina, explains:

We always miscarry much more than a pregnancy. It is also like being able to break with this anguish and not be defeated, isn't it? It is like, at least the feeling I have, of a much greater freedom because we also eliminate - we abort - many prejudices at that moment.

For companions like Paula, the pleasure of accompanying an abortion goes beyond terminating a pregnancy and extends to how the emotional and physical accompaniment of the abortionist is practiced. Together, accompaniers and escorts oppose not only the legal prohibitions against terminating an unwanted pregnancy, but also a social system that does not value autonomy over their bodies and rejects physical intimacy between women.

To the extent that the accompaniers conceptualize the accompaniment they offer as a correction to the absence of mutual care spaces for women, they also marvel at the beauty of what they have created. Their motivation is not only to fill a gap in abortion access. They also found the process of filling that void through accompaniment and witnessing this intimacy and this kind of care to be emotionally rewarding. Paula, quoted in the previous paragraph, continues her story:

It amazes me how a person can trust someone who is a complete stranger. I mean, being able to cry, scream, curse, say anything to each other, kill each other with laughter or hug each other, you know what I mean? Or even walk around the house completely naked, and we're strangers, and yet this other person is sharing themselves and they trust each other. And that shocks me, yes, it shocks me, it shocks me, and it never ceases to amaze me.

As Paula's account points out, to the extent that accompaniment depends on, and at the same time produces, trust and intimacy - within the framework of an unequal society - it becomes a source of pleasure and admiration.

The joy of empowerment

Finally, the interviewees emphasized the satisfaction they experience when they see people who require an abortion being able to have one, especially in those cases in which they had doubts about their ability to do so. In describing this experience, Beatriz, an escort from Chile, comments, "because it's like they realize at that moment, like it's not-it's something they discover there, the power they have within themselves, what they are capable of doing." Witnessing this, the chaperones feel positive emotions. Ailén, another escort from Chile, explains:

The most gratifying thing [is] the gratitude of the women when they manage to abort, when they manage to finish the process, when they realize that they have had enough internal and physical strength to be able to abort [for example] a 20-week fetus.

The accompaniers experience positive emotions from being able to help people who often come to them overwhelmed and desperate. As Marta, an escort from Ecuador, explains, she feels pleasure in being able to share her knowledge and help those in need. Marta explains that "abortion has, in general, something very gratifying and that is that it is something that you solve - they are life situations or problems that are solved. I find it very nice to solve it together, to solve it accompanied." However, Marta continues, there is a fundamental part of the accompaniment that is not collective but depends on the person having the abortion. "It is about a concrete situation in a woman's life, it is a situation where she can decide." Marta also stresses that many of the women she has accompanied have little experience of exercising power and making decisions:

Many times, it is the first decision that many women make in their lives for themselves. So I think it's a decision that can be empowering even if it doesn't change the woman's context, but it's the possibility to decide, concretely. I think that is gratifying. It is also gratifying to feel that it is resolved.

By referring both to the pleasure of being able to solve the problem of a pregnancy that the person did not want to continue and to witnessing the moment when someone with structurally restricted social power recognizes her own strength and takes ownership of this possibility, Marta describes the appeal of accompaniment rooted in a collective effort to reveal and shed light on the power and agency possessed by people who have abortions.

For many accompaniers, accompaniment is about sharing joy with the person having an abortion, which includes responding to and reflecting the expressions of emotion of those being accompanied. Victoria, an accompanier from Chile, describes the transformation of these people throughout accompaniment: from a place of anguish and fear to having "like another face, of absolute joy." The theme of joy at the end of the abortion resonates throughout the interviews. Paola, an accompanier from Ecuador, describes seeing people who had an abortion "cry but with relief, but also with joy, like that ambivalence that the abortion experience has." Sofia, from Chile, explains:

The happiness of a woman who has had an abortion is an indescribable feeling, how it rubs off on you. I mean, the feeling of relief that she feels, and when she passes it on to you, I think it's something that makes you happy and that's why we all do what we do. Sometimes I think we are - we don't even do it for the other person, but for ourselves, because it's a pleasure, it's really a feeling of freedom, autonomy, trust, complicity. It has a whole mixture of feelings that I think it is very difficult to find in other spaces that humanity -or in humanity- offers you.

This does not mean that accompaniment is easy or simple. In fact, the interviewees emphasize the physical and emotional repercussions of on-site accompaniment. However, it is these same repercussions-which the accompaniers accept voluntarily-that may make accompaniment so rewarding. When asked if the experience of accompaniment is tiring, Valentina, from Chile, says:

Yes. But every time an abortion ends, the joy the women feel, the relief-the women tell us that we gave them their life back, that they have their life back, that they are so happy. That's when [the fatigue] passes. It's reward enough.

Recognizing the arduous challenges faced by many of the people they accompany allows the companions to put their own physical and emotional efforts into perspective. Ailén, from Chile, explains: "There are girls who arrive with advanced pregnancies in the second trimester, who do not want to give birth. And since they don't want to give birth, some of them have suicidal attitudes, they want to kill themselves. So helping them solve the problem of an unwanted pregnancy is saving their lives." Recognizing their circumstances, Ailén continues, made her appreciate their expressions of gratitude for the accompaniment. "[When they say] 'thank you for existing.' That's the most gratifying thing." Indeed, Sofia, from Chile, describes this feeling of satisfaction and exhaustion that comes with accompaniment as almost addictive:

It's addictive... you say 'no, I don't want to do it anymore', and then it's the first thing you go and do. It is very addictive. Or you are super tired, you have a lot of things to do, but there is an accompaniment and it's your only day off and you prefer to do that [accompany].

The joy that accompaniment of abortions produces is not, therefore, totally separate from the marginalization of abortion in these same contexts.

In this sense, the companions also describe the joy of their own transformations, of their own empowerment that comes from participating in the accompaniments. Celeste, from Chile, tells about an experience of accompaniment: "I felt that we were like wolves, there were some wolves hidden in our bodies, and I had not realized that power, because of course every woman has the power to have an abortion. I hadn't noticed the most surprising thing, feeling capable myself." The joy of accompaniment, in other words, happens in a context of societal expectations that dictate that escorts and abortionists are incapable of empowerment and should not be empowered.

Discussion

In this analysis, we explore how the practice of escorting abortions on-site after 17 weeks gestation can be a source of positive emotions for escorts. Interviewees described key aspects of the practice of abortion accompaniment, including building feminist community, sharing intimacy with other women, and witnessing the empowerment of abortion escorts, as eliciting feelings of pleasure, joy, and other positive emotions. These findings reflect accounts from the academic literature about the positive emotional experiences of abortionists who are accompanied in their abortions (Wollum et al. 2022; Vacarezza and Burton 2023), showing the existence of a variety of positive emotions related to accompaniment as a model of care.

It is important to emphasize that these positive emotional experiences related to abortion do not occur despite, or even outside of, the broader structural and cultural marginalization existing in these contexts. On the contrary, the companions describe these positive emotional experiences as at least partially rooted in the marginality in which this work takes place. The pleasure of experiencing the experience together with other women, for example, occurs in contexts of heteronorma and misogyny, in which intimacy, support and the physical aspect of accompaniment come to reject the rules and expectations of a sexist culture. Thus, the positive emotions described are better understood when emotions are considered as social and cultural practices (Ahmed 2004). Throughout Latin America, accompaniment takes place in a context that marginalizes abortion, the people who abort and the bodies that abort. When escorts experience physical proximity, observe and interact with each other and with the abortionists, emotions arise from these relationships. Emotions, even those that are positive, cannot therefore be separated from the very marginality of accompaniment.

Consistent with the origins of accompaniment as a feminist activist response to the cultural and health system failure to ensure access to reproductive autonomy (McReynolds-Perez et al. 2023; Braine 2020), our findings demonstrate the centrality of the feminist underpinnings of accompaniment in terms of producing these emotional effects. While other studies have identified the pleasure of abortion-related work when done with people with whom one has things in common and being present for abortionists at a physically and emotionally intense time (O'Donnell, Weitz, and Freedman 2011; Chiappetta-Swanson 2005), feminism and the feminist community have not surfaced as important issues in relation to positive emotional experiences in this research (conducted in the United States). However, for the chaperones who participated in this study, the pleasure of chaperoning is linked to feminist politics that critique misogynist culture. Their positive emotional experiences arise from understanding accompaniment as a practice that rejects normative gender restrictions and offers a feminist alternative.

Limitations

While these findings offer evidence about how escorting abortions can generate positive emotions, including pleasure and joy, our research has limitations. Accompanying abortions in restrictive contexts is a different experience than outpatient clinical treatment in contexts where abortion is legal. Also, within the experiences of accompaniment, our analysis focused on accompaniment of on-site abortions in pregnancies of more than 17 weeks gestation may limit the generalizability of our findings. As many of the interviewees mentioned, some of the positive emotions they experienced were generated by the emotional and physical labor involved in multi-day on-site accompaniment. First-trimester abortion escorts and/or by text message or telephone may not be associated with the same emotional effects.

Conclusions

Overall, our findings echo Shuster and Westbrook's (2022) conclusions regarding the importance, both theoretically and methodologically, of considering and investigating feelings of joy, especially in socially marginalized populations. By starting from the premise that participation in abortions can generate positive emotions, and by examining how research can show a more complete picture of the experience of being part of a socially marginalized activity, new insights and new research questions can emerge. Moreover, doing so serves as a corrective regarding the largely performative nature of academic studies of abortion, which (often unintentionally) produce and amplify a negative normative association regarding abortion (Baird and Millar 2019, 2020). Although focusing on pleasure and joy was not the initial goal of the research, the interview guide with open-ended questions about the positive aspects of participating in abortion accompaniments allowed evidence of these emotions to emerge. Future abortion research-about other types of abortion participation in addition to the experiences of individuals seeking abortions-should be designed with the possibility of capturing positive experiences and studying the mechanisms that generate them.

Acknowledgments

We thank Sofía Filippa for her contributions to the research design and data collection, Yasmin Reyes for her contributions to the research design, and Sofía Carbone for her contributions to the analysis. We thank members of the Colectiva Feminista La Revuelta, Con las Amigas y en la Casa, and Las Comadres, who contributed to the conceptualization, design and implementation of this research. We thank Laurel Westbrook for her enlightening comments on a draft of the article.

Declaration of conflict of interest

The authors report no potential conflicts of interest.

Additional information

Financing

This work was supported by grants from the National Center of Excellence in Women's Health at the University of California, San Francisco (UCSF) and the David and Lucile Packard Foundation (#135329). The sponsors had no role in the design, analysis, or decisions regarding publication.

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