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The Radical Doula Merging Pregnancy and Abortion Care

Miriam Zoila Pérez on her activism, her work as a doula who helps women with both giving birth and abortion, and the way in which systemic racism affects the pregnancy experiences of women of color.
Photo courtesy of Miriam Zoila Perez

In honor of Planned Parenthood's 100-year anniversary, we're taking an in-depth look at the history and future of reproductive rights. Read more of our coverage here.

The health care system in the United States often fails women. Extremists in the conservative right want to strip away women's right to abortion access; at the same time, however, women who choose to keep their pregnancies are denied federally mandated maternity leave. Given the seemingly constant attacks on reproductive health care, it really isn't surprising that our infant mortality rate is so high.


Miriam Zoila Pérez, a radical doula who has merged "birth activism" with social justice, wants to change that by supporting women throughout the spectrum of their reproductive healthcare needs. Traditionally, a doula is someone who professionally aids women throughout the process of birth, providing all kinds of psychological and physical support during pregnancy and after a child is born. In an interview with Broadly, Pérez explains that she sees doula work in the US today as a stopgap for an ineffective health care system that is failing women.

Read more: 'We Are to Be Respected': The Woman at the Helm of the Fight for Abortion Rights

Pérez's journey began in college, when she formed the Radical Doula blog, a resource for women and doulas. Unlike most doulas, and somewhat controversially, she advocates for "full-spectrum" doula work, which means providing care for women beyond their needs related to pregnancy and birth—meaning miscarriage and abortion. As Pérez explains, there is this persistent societal idea that abortion and birth exist separately, siloed off from each other as if they're not related, or as if women who have abortions do not also give birth. "The reality is that people have abortions and they also have kids," she says.

According to Pérez, when she began her Radical Doula blog ten years ago, the concept of a full-spectrum doula was far more controversial than it is today. Since then, the field has expanded significantly—and she's been an important part of that. The Radical Doula Guide, her self-published manual for the aspiring radical doula, has sold hundreds of copies in the last few years. "I joke that everyone is a doula," Perez says, by which she means that everyone has the capacity to provide this sort of direct support to women. But she sees the potential most clearly among people in social justice and activist circles.


There's something rewardingly tangible about the change a doula can make in someone's life. "We don't get that support in our lives generally," Pérez says. "I'm just here for you." This may be especially important and helpful for women of color, who are disproportionately affected by restrictive abortion legislation like the Hyde Amendment, and whose experiences with reproductive health exist in the context of a society that Pérez describes as racist; according to a study by the Center for Reproductive Rights, "For the last four decades, Black women have been dying in childbirth at a rate three to four times their White counterparts."

Read more: Every Pregnant Woman Should Get a Doula, Study Says

"Radical Doula is trying to raise alarm and attention to how racism impacts maternal health," Pérez said. The last few years, she explains, her work has shifted to focus on race. From daily experiences with racism, to institutional racism in legislation, Pérez says that women of color's health is ultimately and tangibly damaged by racism in America: Research suggests that the stresses of dealing with systemic racism and discrimination place black Americans at an increased risk of developing hypertension and other cardiovascular diseases.

This plays out clearly in reproductive health care—according to a study from 2000, black women who scored high on a measure of perceived racial discrimination were twice as likely to deliver infants with low birth weights. "There's these cascade effects, and then in pregnancy it gets all manifested in higher blood pressure, in giving birth too early, because that stress can have that impact in thinking your womb is no longer a safe space for a child," Pérez says.

While hiring a doula might help, Pérez adds, "What we need is a systemic shift."