Over a year and a half ago, the Supreme Court overturned Roe v. Wade, opening the door for states across the U.S. to heavily restrict or ban abortion access. Ever since, innovators have been working to support access in the abortion care ecosystem, including by drawing from experiences in other countries with restrictive legal settings. Vitala Global Foundation is one such pioneer, whose digital accompaniment model, Aya Contigo, has provided over 7000 people with virtual, evidence-based support through safe medication abortion and family planning journeys. Last year, Dalberg supported Vitala to consider how they might bring their platform to the U.S. context. Vitala recently launched Aya Contigo in the U.S. on International Safe Abortion Day to support Latinx abortion seekers, who are disproportionately impacted by state abortion bans. Their launch highlights the rising importance of self-care, alongside continued advocacy to restore and protect the rights of abortion seekers, in the increasingly complex reproductive health landscape in the U.S.
Originally developed and piloted in Venezuela in 2022, Aya Contigo builds from the feminist accompaniment model to empower people with information and live support during their abortion journeys. The platform includes a step-by-step guide for a medication abortion, connections to providers as needed, social and emotional support throughout the process, information about different contraceptive methods to avoid future unintended pregnancies, as well as information about other local and national organizations providing other kinds of assistance (e.g., financial, legal, logistics). Aya Contigo also offers a live chat to support users facing additional hardships or barriers to access.
The Role of Self-Care in Reproductive Health
The changing legal landscape has increased the financial and logistical strain of accessing abortion for many, especially those in marginalized communities who faced similar barriers even when Roe vs. Wade protected abortion rights. In the new legal environment, abortion seekers may face increased stigma and fear, and demand for at-home medication abortions has increased, making models like Vitala’s that facilitate self-care more crucial than ever.
The concept of self-care recognizes individuals as active participants in managing their own health, and the World Health Organization (WHO) defines self-care as “the ability of individuals, families, and communities to promote health, prevent disease, maintain health, and cope with illness and disability with or without the support of a health worker.”
On one hand, embracing self-care practices demonstrates women and marginalized populations taking agency of their sexual and reproductive health. On the other hand, it stems from a place of precarity in health systems that have historically committed acts of medical injustice against women of color. Self-care in the context of sexual and reproductive health has helped underserved communities access care where the formal healthcare system has historically fallen short. A noteworthy example of self-care support is the instruction guide for transgender and gender-conforming individuals on self-injection delivery methods for hormone replacement therapy (HRT).
In the context of abortion, self-care could look like taking abortion pills at home, but could also entail a range of actions to access reliable, culturally competent information and support throughout the abortion process, outside of the traditional clinic setting. Self-care and clinical care can and should be integrated and mutually supportive. For those undergoing medication abortion, self-care at home, with clinical support from digital providers, could help offset capacity issues in brick-and-mortar clinics, which are seeing surges in demand. In rare cases when at-home medication abortion leads to medical complications, healthcare facilities play an important role. And for those who seek care in a facility, support for self-care before and after their appointment can help patients gain a sense of power and self-determination in the process, which is especially critical at a moment when reproductive rights are under attack.
As Dr. Genevieve Tam, Vitala’s co-founder and Director of Projects, emphasized, “There are different components of care that can be self-managed, regardless of whether individuals seek assistance through the formal healthcare system. We are aware of the experience when leaving the doctor’s office and feeling uncertain about what to do next. That part of the process falls under self-care and self-management. It’s about reframing the concept to acknowledge that there are limitations to what the formal system can provide. A significant portion of responsibility lies with the patient, but how can we bridge the gaps in care? We aim to offer support for different aspects of care. This is how we are framing our approach in the U.S. as well. Some people may prefer virtual consultations, while others may opt for surgical procedures, but they also require ongoing self-care support throughout their journeys.”
Cross-Pollinating Transnational Learnings
Meeting the needs of abortion seekers in a moment of extreme and growing barriers to access will require both innovation and deep collaboration with and across the existing ecosystem of providers, advocates, and support organizations working to get them care. Vitala’s launch of Aya Contigo — and their community-driven, user-centered, collaborative approach — can be a model for how other innovations from around the world can be adapted to the U.S. context to support abortion seekers. Vitala has collaborated with communities, reproductive healthcare leaders, and local organizations across the U.S. — for example, through user testing with Latinx patients in partnership with Planned Parenthood Federation of America — to ensure their efforts were inclusive, additive to the field, and tailored to the needs of Latinx abortion-seekers in the U.S. Feminist movements that have long supported self-care and the fight for reproductive rights transcend national borders, and so too can new models for support that build on their legacy.
Aya Contigo is available for free in both Spanish and English on Google Play and the App Store.
