When people talk about psychological safety, they usually mean things like open communication or freedom from retaliation. In abortion care, it means something much more literal: safety from harassment, from criminalization, from being outed in your own community.
Right after the U.S. Supreme Court’s Dobbs decision, I looked around and realized I only had two staff members left. Everyone else had “jumped ship,” as I put it at the time.
I don’t blame them. The stress was unbearable, and the uncertainty was constant. We were already stretched thin from the fallout of COVID-19. Dobbs just pushed us over the edge.
I had to reduce our hours to match what I could realistically cover with the few staff members who stayed. That kind of calculation doesn’t show up in policy debates or news coverage, but it’s the ground truth of what post-Dobbs abortion care looks like.
Our staff hold the line in a political fight that puts targets on our backs. When people leave, they’ve reached their limit. They worry about their safety, their partners, and their futures. Staying would mean ignoring the signs that tell them to get out, and I can’t ask that of anyone.
What I can do is build the kind of clinic I’d want to work in myself. I make sure we take breaks. I insist on health insurance and competitive wages. I create space for people to speak honestly, rest, and ask questions.
When the Fight Comes Through the Clinic Door
Every day, I brace for the moment the political fight finds its way inside the clinic. I’ve watched new hires back out after one security briefing. One woman told us she needed a few days to think after orientation, then never came back. I suspected that her fiancé convinced her it wasn’t safe.
As one abortion doula and clinic staffer in Maine told Vogue, what used to be a simple 15-minute appointment has become a multi-day ordeal for abortion patients involving travel, missed work, and childcare logistics. Behind every patient trying to get in the door is a staffer who has to help manage their crisis.
That interview highlighted how clinic workers feel abandoned not just by politicians and systems, but sometimes by their friends and families. That struck home for me. People who claim to support abortion access don’t always understand what it means to do this work in public. They think voting “pro-choice” is enough. Meanwhile, we’re facing the brunt of anti-abortion backlash with no backup.
The Emotional Triage of Abortion Care
People think of this work as just medical, but it’s not. It’s emotional triage, where you have to weigh your mission against your limits to manage your anxiety and respond to patients going through an incredibly stressful experience.
In talking with other independent providers, I’ve learned I’m not the only one feeling this way. In fact, in a 2023 report from the National Women’s Law Center, abortion workers described feeling unsupported even inside the very organizations meant to protect them.
Some spoke about unsafe working environments, others about feeling disposable when they raised concerns. That reinforced what I already knew: If we want people to stay in this work, the support can’t just be for patients. It has to be for providers, too.
What Real Support for Staff Looks Like (and Where It Fails)
I detail my intentional steps to care for my team: mandatory lunch breaks, paid health insurance, and competitive wages. But I also acknowledge it’s sometimes not enough. The broader culture of fear, surveillance, and stigma seeps into everything and works against our best efforts.
What I’ve tried to do—and what I keep trying to do—is create a kind of counterculture inside the clinic, a place where people are encouraged to ask questions or say, “I’m not okay.” I often ask my staff directly: “Have you eaten? Have you taken your break?”
It’s a way of signaling that they matter. And when a clinic is under siege, that sense of belonging can be the difference between someone staying or walking away.
I firmly believe that trauma-informed care must extend to the staff as well as the patients. This healthcare model identifies six key principles that shape a healing-centered workplace:
- Safety: Staff and patients need to feel physically and psychologically safe at every level of the organization.
- Trustworthiness + Transparency: Decisions are communicated clearly to build and maintain trust within the team.
- Peer Support: People with shared experiences are integrated and valued in care delivery.
- Collaboration: Power differences between leadership and staff are flattened to support shared decision-making.
- Empowerment: Staff strengths are acknowledged, developed, and reinforced, including their ability to recover from trauma.
- Cultural Humility + Responsiveness: Historical and identity-based trauma, including racism, ableism, and gender-based discrimination, are recognized and addressed directly.
Still, I’ve learned that even the most intentional workplace can’t fully shield people from burnout. I’ve had staff cry in my office, and others quietly disappear. Support doesn’t guarantee someone will stay, but it gives them a reason to try.
We’re Not Cops. We’re Providers.
Vague laws and aggressive enforcement mean front desk staff, nurses, and clinic escorts are vulnerable to investigation. A prosecutor might subpoena anyone who touched a file, answered a call, or offered support.
I don’t put staff in positions where they’re forced to interpret the law in real time while trying to care for someone. I create protocols that limit legal exposure and make sure people understand their rights. We build psychological safety by removing fear from the job wherever we can.
Staff need to know they’re not at risk just for showing up. According to Human Rights Watch, post-Dobbs laws in several states not only turn doctors into criminals for merely doing their job. They also target anyone accused of “aiding or abetting” abortion, including administrative staff, therapists, clergy, and rideshare drivers.
Some states even allow private citizens to sue anyone who helps someone access abortion care, creating an environment where strangers or neighbors could target clinic staff. Staff need protocols that shield them, policies that back them up, and leadership that draws a line between care and compliance.
Why Psychological Safety Is a Justice Issue, Not a Perk
We can’t treat psychological safety like a human resources initiative or a bonus feature. It’s the groundwork that lets people survive in this work without breaking down. Without it, the risk accumulates quietly through resentment, fatigue, and disengagement. We lose people one by one until the mission starts to collapse.
This is where reproductive justice intersects with employee morale at abortion clinics. If we want a future for abortion care, we need to build the kind of workplaces that can sustain the people doing it. That means creating space for people’s fears and refusing to normalize trauma. And it means supporting people who say, “I can’t do this alone anymore.”
I view this work as a calling, but no one should have to answer that call alone.
