A global infrastructure is emerging to guide people through self-managed abortions, reshaping how pregnancies are ended.
As barriers to clinic-based abortion care increase, a growing number of women are self-managing their abortions: finding and using abortion pills independently of the formal medical system—usually through online abortion pill services, community networks sharing pills for free or websites selling pills.
To support self-managed abortion, feminists are creating a global network of online abortion doulas—trained companions who offer one-on-one support by phone, email and text to people using abortion pills. A leader in this effort is the organization Rouge Doulas, which runs the Rouge Abortion Doula School.
Founded in 2024 by long-time reproductive health advocate Lynsey Bourke, Rouge Doulas is a collective of feminists who support abortion seekers through the process of finding and using abortion pills. Bourke has more than 15 years of experience leading cross-regional initiatives in sexual and reproductive health, and has directed programs across Africa, Latin America and the U.S.
Drawing on her years of work in reproductive health, Bourke said Rouge Doulas aims to transform how people are supported during self-managed abortion: “We’re looking to revolutionize abortion support and also to fill the gaps in the field worldwide around emotional accompaniment.”
The word “rouge”—pronounced rooj—means red in French.
“Rouge is meant to signify the full power of the womb experience, a large portion of which involves blood,” says Bourke.
It’s really an authentic and organic sharing of the self-managed abortion underground from all over the world.
Lynsey Bourke
Rouge Abortion Doula School
In just a year, Rouge has built a small but growing global network of abortion doulas. The Rouge Abortion Doula School held its first training class in November 2024, graduating 40 doulas in May 2025. Rouge Doulas began offering abortion support services in July 2025 and has since served at least 150 people—around five to 10 abortion seekers each week.
Rouge’s training is a six-month intensive program that brings together trainers and students from all over the world.
“Right now, we have almost all of the continents represented in some sort of way,” said Bourke. “It’s really an authentic and organic sharing of the self-managed abortion underground from all over the world. It’s connecting North and South experiences in really interesting ways.”
Bourke explained that the training draws on practical expertise from different regions: “Midwives from Burkina Faso are teaching about how clients manage bleeding in under-resourced locations, where they don’t necessarily have access to pads. And then the Mexican and South American participants inform us on different advanced methodologies in how to manage second trimester care. They have a wealth of knowledge there that’s really specific.”
She describes the school as a “feminist abortion incubator,” where participants learn to build cross-border feminist community and collaboration.
This cross-border structure also enhances safety. “Because of restrictions in the U.S, we can have doulas from Kenya, from Nigeria, from South Africa or from Europe actually counsel the American clients. That provides a layer of support that is really beautiful,” says Bourke, noting it may be more risky to advise from inside one’s country than across borders.
Abortion is not just healthcare. Abortion is so much more, and it hits on the emotional, the physical and the spiritual aspects of an individual.
Bourke
Bourke’s path to Rouge grew out of long-standing work in feminist healthcare. Born in the U.S., Bourke worked for several years at the independent feminist health center Blue Mountain Clinic in Missoula. She has also worked in safe abortion distribution and one-on-one abortion support around the world. In 2021, she created a website called Self-Guided Abortion to offer one-on-one emotional and spiritual support to clients using abortion pills. In 2024, Bourke joined with another dedicated abortion doula, Kate Taylor based in New York, to create Rouge Doulas.
With their shared background in feminist healthcare, Bourke and Taylor turned their attention to developing Rouge’s training approach. Drawing on Alissa Perrucci’s groundbreaking book, Decision Assessment and Counseling in Abortion Practice, Peg Johnston’s Options Pregnancy Workbook and Charlotte Taft’s work, they developed a counseling-centered curriculum that addresses the medical, emotional and spiritual aspects of abortion. It follows the World Health Organization (WHO) medication abortion protocols and incorporates role play practices, somatic therapy techniques and counseling for women who feel ambivalent about abortion.
Bourke sees Rouge Doulas as carrying forward the counseling traditions of independent feminist health centers. “The whole conceptualization of Rouge is based on the independent feminist health center type of counseling, which provided a lot of emotional closure and emotional holding through the process of abortion counseling,” says Bourke. “That isn’t happening with the revolution of self-managed abortion. Everyone says that they do counseling. However, most of the counseling shies away from the emotional core of what’s going on. Abortion is not just healthcare. Abortion is so much more, and it hits on the emotional, the physical and the spiritual aspects of an individual.”
Rouge Doulas focus not only on one-on-one counseling, but also on building local support systems for women in different spaces. “We work with our networks on the ground in all these different countries to make sure that we’re able to give that kind of support, and also create different abortion ecosystems of support where there aren’t any,” said Bourke.
Rouge’s approach has generated rapid interest and immediate demands for this kind of support. Bourke recruited the first cohort in November 2024, drawing over 100 applicants. About 40 became certified doulas in May 2025 and are now working on the Rouge Doula team, providing services to clients around the world.
Rouge has grown from a pilot training to a global doula team, attracting experienced and passionate abortion movement workers, who are now stepping into facilitator roles and helping run different parts of Rouge’s work.
“In a very short time, it has essentially created this tsunami caused by the force of our facilitators—primarily Magdalena Goldin of Argentina, an innovator in digital abortion counseling, and Aimee Maple of the USA with decades of U.S. feminist independent clinic experience of training abortion counselors,” said Bourke.
The second doula school began in September, with a cohort of 70 students from all over the world, many with high-level skills and experience in the abortion movement, says Bourke.
A third class will begin in January 2026, led by Sonia Wendlassida Reine from Burkina Faso and aimed at a primarily Francophone audience (applications due December 21, 2025).
Rouge anticipates launching the next English cohort sometime in Fall of 2026, and will announce the next application launch in the spring. (Sign up for the waitlist here.) Doula school participants meet three times a week online synchronously. To keep the training accessible, the doula school has a sliding scale fee structure.
How Rouge Doula Services Work
Rouge’s global network of doulas offer direct support to people navigating self-managed abortion. Their website provides information on how to find and use abortion pills, and includes a link to request doula support. Women seeking support fill out an intake form and are then matched with a doula.
“Some of our doulas have niche specializations such as LGBTQI issues or later trimesters,” said Bourke. Counselors invite the client to begin with a one-hour telephone conversation to create rapport, then they communicate mostly by text.
Bourke noted that much of the work starts with naming and addressing the client’s fears. “Abortion is so multi-layered,” says Bourke. “When you get a client, is their first fear that it’s going to hurt? Or that their family is going to abandon them? Or that it’s geographically impossible? So, we address the first fear first, and then go through the rest of the fears as they arrive.”
Rouge Doulas also aspires to provide “compassionate spiritual support” for clients who are struggling with the meaning of abortion in the context of their religion or spirituality. Alongside emotional and spiritual support, Rouge helps clients move through the practical barriers to obtaining pills. When clients need pills, Rouge refers primarily to the global telehealth providers Women on Web and Abortion Pills in Private.
Rouge Doulas serves people at all stages of pregnancy, though the vast majority of clients are in their first trimester of pregnancy. They offer doula services in over 20 languages and never charge for their services. To ensure privacy and security, Rouge doulas use Signal and all messages are deleted after 48 hours. Bourke said they are developing their own secure app to manage client-doula matching and facilitate communication.
The whole process usually lasts for about two weeks, said Bourke. “We like to close cases after confirmation that the abortion was complete, that the person is no longer pregnant. And ideally, a check-in, too, to confirm that menstruation has returned.”
Of the 150 abortion seekers they have served so far, most come from Canada and Africa and found Rouge Doulas through social media and their website. They also maintain a YouTube page that shares videos with information about self-managed abortion, but they have faced censorship.
“Getting the word out has been very difficult, as our Google, YouTube, Facebook and Instagram accounts regularly get shut down,” says Bourke, who notes their Instagram account was shut down after they posted a video tutorial on how to use abortion pills based on the WHO Abortion Care Guideline. “We got the account back, but it significantly set back marketing efforts for the French Abortion Doula School.”
To Bourke, the stakes of abortion are high. “Abortion involves the question of creating life and only those who can become pregnant are the arbiters,” said Bourke. “They make that sacred choice whether to have an abortion or to parent, which is key to human sovereignty. Creating avenues for people to process this and destigmatize the process is what’s absolutely necessary in these times.”
You can support Rouge Doulas and the Rouge Abortion Doula School here.
