She Didn't Choose This: Accompanying Women Who Have Been Coerced into Abortion

Rosalie Markezich did not know she had taken abortion drugs until after the fact. Her then-boyfriend had obtained mifepristone and misoprostol through a telehealth prescription, then gave them to her without her knowledge. By the time she understood what had happened, her pregnancy was over.

Heartbeat International, which operates a national tracker of reported forced abortion and abortion pill poisoning incidents, has identified 17 cases reaching back to 2007, with two already confirmed in 2025. Spokesperson Andrea Trudden notes these numbers reflect only what surfaces publicly. 'Many women never report what happened to them,' she has said, 'particularly when the person responsible is someone they know and trust.'

That proximity — the harm coming from a partner, a husband, a boyfriend — is what makes it so difficult to name, and what makes accompaniment so demanding.

What She Is Carrying

Women coerced into abortion — through force, deception, or sustained pressure — often arrive at a care encounter without a clear vocabulary for what happened. They may describe a miscarriage, a relationship gone wrong, or simply an abortion, leaving the coercive circumstances unnamed because they are still sorting out what was done to them versus what they agreed to.

Christa Brown, senior director of Medical Impact for Heartbeat International, puts it plainly: 'Many of these women are frightened, confused, and unsure where to turn. They often are afraid that no one will believe them.'

That fear of disbelief is one of the central features of the experience. When harm is inflicted by someone trusted, and in a domain where the woman's agency is already publicly contested, she often suspects her account will be questioned or quietly dismissed. This shapes whether she speaks at all.

The grief is layered in ways standard bereavement models don't fully capture. Reproductive coercion attacks the whole person simultaneously — the body is acted upon without consent, the will is bypassed, and the woman's self-understanding as a moral agent and potential mother is undermined at the moment it mattered most. Because the loss is also the loss of a child, the grief has a specific object. The Catholic tradition does not soften this: when a woman is deceived or coerced, her body is used as an instrument, and her child is taken without her consent.

The Specific Texture of Moral Injury

Trauma researchers use the term moral injury to describe distress following not merely from danger but from a violation of one's core beliefs about how people are supposed to behave. For women coerced into abortion, this injury centers on trust. She trusted him. She trusted that her body would not be used against her. She trusted that her desire to continue the pregnancy would be honored. Each trust was broken — intimately.

Therapeutic accompaniment that misses this dimension will miss what is actually wrong. It is not enough to address pregnancy loss grief, though that grief is real. It is not enough to address intimate partner violence dynamics, though those are present too. The woman is grieving a child, a relationship, and a version of herself — the self who believed she was safe — all at once.

What Accompaniment Actually Looks Like

The word accompaniment in Catholic pastoral theology describes a presence that does not rush toward resolution. For women who have been coerced, this means several practical things.

Hold the ambivalence. She may still love the man who harmed her. She may be angry, grief-stricken, and confused in the same session. Accompaniment does not ask her to resolve this prematurely. Pressure toward closure — 'you need to forgive yourself,' 'you need to move on' — forecloses the process it claims to support.

Take the coercion seriously as the primary event. There is a temptation to collapse this into a general post-abortion healing framework. That framework is insufficient here. She did not choose this. Beginning with that fact — and returning to it — keeps the accompaniment honest.

Don't defer the spiritual dimension. Questions about the status of the child, about whether God is present in this suffering, about what forgiveness means when the wrongdoer is the other person — these are often the center of the experience, not peripheral concerns to address after the clinical work is done.

Be willing to name what happened. Not diagnose it for her — but when she names it, confirm it. 'Yes, what he did was a violation. Yes, your grief is real. Yes, you are not alone.' That confirmation is not technique. It is the basic act of witness that makes trust possible.

Finding Her

Because many women never report what happened, they often arrive in care settings without having named the coercion at all. Clinicians and pastoral counselors working with women who have experienced ambiguous pregnancy loss — particularly in relationships marked by control — may be accompanying a coercion survivor without either party having identified it.

Pregnancy help centers affiliated with Heartbeat International are increasingly training staff to recognize signs of coercion and to ask directly: 'Is this pregnancy ending because you want it to, or because someone is pressuring you?' For a woman who hasn't yet found language for what is happening, that question can be the first time anyone has treated her experience as a possibility worth taking seriously.

The women Christa Brown describes — frightened, confused, afraid no one will believe them — are not asking for a theological position on abortion. They are asking for someone who will stay in the room long enough to hear what actually happened. That is where the work begins.