Abortion Doulas Prepare for Increased Criminalization

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Abortion Doulas Prepare for Increased Criminalization

Abortion doulas provide critical support for those receiving abortion care. Now that Roe is gone and many states’ legislation is more restrictive, these doulas are strengthening their networks and taking digital security precautions.

Story by Tina Vásquez

Published on Jun 26, 2022

EDITOR’S NOTE: The following story was originally published in Prism, in the days before Roe v. Wade was officially overturned on June 24. But the insights and recommendations assume the need to navigate a post-Roe America. It is reprinted here with permission

Note to readers: States are increasingly proposing legislation and passing laws that criminalize people who provide abortion support. Some of the abortion doulas who spoke to Prism for this reporting are using their real first names, while others are using pseudonyms. To better protect abortion doulas’ anonymity, this reporting does not indicate the doulas using pseudonyms or link to the websites of full-spectrum doulas who are solo practitioners.

About a month ago, Lue noticed an alarming uptick in the kind of Google searches that led to her website.

“How does an abortion doula help with abortion?”

“Someone aiding and abetting abortion.”

Lue is a full-spectrum doula, meaning alongside the abortion support she offers, she also provides support for birth and postpartum. She is based in Texas, a state that has historically implemented some of the most restrictive anti-abortion laws in the nation—and one that has a “trigger law” that will virtually eliminate abortion access and make performing an abortion a felony if Roe v. Wade is overturned.

Lue noticed some similar Google searches leading to her website last year after Texas Gov. Greg Abbott signed SB 8 into law. The legislation bans abortion after detecting electrical activity in the embryo, which is roughly six weeks of gestation, and before many people even know they are pregnant. While the law does not criminalize the pregnant person, it allows anyone—regardless of whether they live in Texas or have any association with a patient—to sue an abortion provider who violates the six-week ban or anyone who helps a patient obtain an abortion after six weeks gestation.

On May 2, Politico published a leaked draft of an opinion by the Supreme Court signaling the court’s intention to overturn Roe in its upcoming decision on Dobbs v. Jackson Women’s Health Organization, a case in which the state of Mississippi directly asked the court to overturn the 49-year-old decision guaranteeing the constitutional right to abortion. Lue says after the leak, the troubling searches leading to her website “went apeshit.”

“It’s hot out in these streets,” Lue said. “These searches are different from the ones that usually help people find their way to me. It’s clear they are trying to find us.”

Who “they” are is unclear, but none of the likely culprits—law enforcement, vigilantes, rabid anti-choice activists—are good news for Lue.

“I can support people in Texas to get the care they need, and I can provide the means, the travel, and the connections to get people to other states to access abortion. But at the end of the day, there is no safety for me,” Lue said. “There is a complete lack of humanity and dignity in these anti-abortion laws, and I live in a state and a country where Black people like me are already overly criminalized and where other people who live in oppressed, marginalized, colonized, and racialized bodies are already treated without humanity and dignity. Overturning Roe is going to put all of this into overdrive.”

Two-thirds of Americans want to keep Roe v. Wade in place, but if the Supreme Court follows through on its leaked draft ruling in the coming days, 22 states are certain to ban abortion because of their existing laws or constitutional amendments. The draft opinion, coupled with repeated failures to overturn Texas’ SB 8, has emboldened anti-abortion lawmakers, who are vowing to enact even more draconian restrictions in their states.

In the nine months since Texas’ SB 8 went into effect, 15 states and counting have introduced or signaled intent to introduce copycat legislation. In March, Idaho became the first state to enact a law modeled after SB 8. The Idaho law bans abortion after about six weeks of pregnancy and deputizes private citizens to enforce the ban through lawsuits. In Oklahoma, the post-Roe world is now. Last month, Oklahoma Gov. Kevin Stitt signed the nation’s strictest abortion ban, effectively ending abortion access in the state except in cases of life endangerment or instances of rape or incest that have been reported to law enforcement. Like SB 8, the Oklahoma law relies on private citizens to sue abortion providers or anyone who “aids and abets” an abortion.

These dystopian laws not only severely restrict abortion and disproportionately impact the low-income Black and Latina women who make up an overwhelming majority of abortion patients, but they also incite fear, sow confusion, and legitimize the surveillance and policing of pregnant people, abortion providers, and doulas like Lue who offer abortion support.

Prism spoke to seven doulas who offer abortion support in states with radically different political realities. Some have navigated severe restrictions for years, others live in “destination states,” regions with far fewer restrictions that already are—or will soon become—havens for pregnant people who have the means and ability to travel for abortion care.

No matter their location, each abortion doula has reached a turning point. For years they were able to do their work largely under the radar. Now they must grapple with the legalities of providing abortion support in a frightening and quickly changing landscape. Some are seeking legal counsel for the first time. Others are scrubbing their websites and taking their networks offline. A few are working with the Digital Defense Fund, which provides digital security, privacy, and technology trainings to people doing abortion access work. All of them are assessing the amount of risk they are willing to take on in a post-Roe world.

“Constellations of Care”

Most people are familiar with doulas in relation to birth, but doulas generally support people going through major life transitions. This is why there are gender doulas, for example, and death doulas. An abortion doula is someone who is trained to provide support to a person before, during, and after their abortion. What this support entails depends on the person, the type of abortion they are having, their informational needs, and the level of emotional, physical, and practical support they desire. Abortion doulas are trained to provide this support through programs offered by collectives and organizations. Currently there are no certifications specifically for abortion doulas that are administered nationally or through individual states.

Abortion doulas who spoke to Prism described the “constellations of care” they offer people in their communities: they accompany abortion patients to clinic appointments, connect them to local abortion funds, strategize with them about how to access abortion, give them abortion care packages, spend the night with them when they take abortion medication, provide child care, cook them meals, help them process their emotions over the phone or on long walks, pick up their medications, hold their hand through grief, and even give them massages. Sometimes abortion doulas are connectors, helping people in their communities find someone they would feel more comfortable with or someone who is better suited for their needs. Hannah Matthews explained that as a cis white abortion doula who knows this would make her many folks’ last choice as an abortion companion, she has helped people find trans abortion doulas and abortion doulas who are people of color.

“Across history, Black women have said, ‘That’s illegal, but I’m going to do it anyway,’ because we know the reward is worth the risk, and we know the needs of our communities are urgent.”

(Photo by Johnny Silvercloud/Shutterstock)

Matthews is working on a book about community abortion care called “You or Someone You Love” set to be published by Atria Books in 2023. She has been an abortion clinic worker in Maine, an abortion funder, a community organizer for abortion access, and a clinic escort since 2017. She is also a writer, a mother, and someone who has shared her abortion story publicly.

“I like to say that it takes a village to raise a child, but it also takes a village to have the abortion experiences we need and deserve,” Matthews said.

Tired of the limitations of her job as a clinic worker, Matthews became an abortion doula because she no longer wanted to send patients home to “incredibly isolating, lonely, alienating, and sometimes unsafe circumstances” where they often did not have adequate emotional or practical support.

“There is only so much you can do while wearing scrubs in a clinical setting, maintaining the necessary personal and legal boundaries of clinic staff, and working to support 20+ patients in one day,” Matthews told Prism over email. Even in a state with fewer restrictions than others, Matthews sees firsthand how marginalized people—those without housing, people who use drugs, youths, immigrants, LGBTQ+ people—are left to navigate the “cruel labyrinths” of local systems.

People can access abortion doulas in different ways. Sometimes they work in clinic settings. Sometimes they work together as part of community collectives, like Asheville, North Carolina’s Mountain Area Abortion Doula Collective, Portland, Oregon’s Cascades Abortion Support Collective (CASC), and Maryland’s Baltimore Doula Project. Some are solo practitioners like Gabrielle, who offers abortion support as part of a wider range of doula services.

Like Lue, Gabrielle is a full-spectrum doula. She offers abortion support, and she is certified to provide support for fertility and adoption, pregnancy and labor, and postpartum. Gabrielle began working as an abortion doula about a year ago when she saw that people in her Georgia community were opting for abortion care because of pandemic-related financial instability or because they were otherwise afraid to give birth in a hospital or start a family as variants of the coronavirus spread.

Georgia severely limits abortions beyond 22 weeks after the last menstrual period, and the state has a number of medically unnecessary restrictions that make accessing abortion care difficult. In 2020, a federal court struck down Georgia’s six-week abortion ban, though it will likely go into effect once the Supreme Court overturns Roe. Georgia also has one of the highest maternal mortality rates in the country. According to the Center for Reproductive Rights, Black women in Georgia are 3.3 times more likely to die from pregnancy-related complications than white women are, and more than half of these deaths are considered preventable.

Gabrielle said this is an “exhausting” environment to operate in, both as a Black woman and a full-spectrum doula whose clients are overwhelmingly Black women in “undervalued and underserved communities.” Trauma-informed care is a central tenet of the support that Gabrielle offers, and it comes from a very personal place.

Gabrielle is a mother of three, and she’s also a licensed practical nurse and a student midwife. Personally and as a trained medical professional, she is well versed in how Black women and other BIPOC communities experience injustice in the health care system.

“I entered this work not only to be an advocate for BIPOC, but because I wanted to help others advocate for themselves in spaces that continue to keep them marginalized,” Gabrielle said.

It didn’t take a Supreme Court leak to push Gabrielle to assess risk. In Georgia, her work is inherently perilous. Not only will she continue to offer abortion support in the post-Roe world, but the route she is taking to be a midwife is already illegal.

There are different types of midwives in the U.S. and regulations of the practice vary by state. According to professionals in the field, many of these regulations can be burdensome to public health interventions. Midwifery care has the potential to substantially reduce the maternal mortality rate, but different entry points into the practice can be illegal or otherwise criminalized.

Only Certified Nurse-Midwives are licensed to practice in Georgia, which means that as a direct-entry midwife—credentialed as a midwife, but not as a nurse—Gabrielle will be unlicensed when she attends home births.

“Before long, all of the ways I choose to support women will probably be outlawed,” Gabrielle said. As a Black mother and business owner, she knows she’s putting a lot on the line. Sometimes she feels fearful, she said. But these moments are fleeting—especially when she considers the larger landscape in Georgia, a state where it can be dangerous for Black women to give birth, abortion may soon be banned, and badly needed home birth midwives are illegal.

“Across history, Black women have said, ‘That’s illegal, but I’m going to do it anyway,’ because we know the reward is worth the risk, and we know the needs of our communities are urgent,” Gabrielle said. “This is part of my lineage, and I’m not going to shrug off my calling because I’m afraid of being criminalized.”

Abortion Destinations

For people who do abortion access work, what was surprising about the Dobbs draft opinion leak was the delivery—not that Roe is likely to be overturned. A literal playbook for a post-Roe world was published in 2019 by journalist and activist Robin Marty, who is now the operations director at the West Alabama Women’s Center. But it’s still a lot to process, and there are ramifications beyond abortion access. What does the end of Roe mean for other pregnancy outcomes, like ectopic pregnancies? How does it open the door for restrictions on contraceptives or further attacks on LGBTQ+ rights? It’s enough to make your head spin, and Matthews said she’s still trying to make sense of it—especially as it relates to criminalization.

As the push to further criminalize abortion has escalated, Matthews said she is seeing the “causational escalation” of suffering and harm—more people from the South are traveling up to Maine, people are having to wait until they are further along in their pregnancies, people’s abortion experiences are being infused with “more and more fear and isolation.” People are also being trapped—with their abusive partners or families, with debt they have to take on to get abortion care, with a child they cannot support or did not want.

“All of this is by design,” Matthews said. “I think right now, I am working through it, just trying to help get one person their abortion, then the next person, then the next. One foot in front of the other.”

Shené told Prism that as a full-spectrum doula in California, she understands that her risk of criminalization for abortion support is different compared to doulas in states with severe restrictions. But unlike the other abortion doulas Prism spoke to in high-access states, Shené is a Black woman. The Black and non-Black people of color who do abortion support work are inherently taking on a different kind of risk because of how the toxic stew of white supremacy, surveillance, policing, immigration enforcement, and criminalization play out in their communities.

California certainly has its fair share of problems, but Shené said she is moved by recent efforts in the state to defend abortion access for Californians and people traveling for abortion care. The right to abortion is already enshrined in California’s Constitution, but lawmakers are also ramping up efforts to become a “sanctuary state for abortion rights” by considering a package of bills that would increase abortion access, reduce abortion costs, and protect people from abortion criminalization.

In Maryland, where the right to abortion is enshrined in state law, there are promising efforts also underway. Beginning July 1, health practitioners other than physicians—including nurse practitioners, nurse midwives, and physician assistants—will be able to perform abortions in the state. The effort required Maryland lawmakers to override Republican Gov. Larry Hogan’s veto of the bill, which also establishes an Abortion Care Clinical Training Program. As part of the program, the state will contract with an organization to develop abortion care training programs at a minimum of two community sites to expand the number of healthcare professionals with abortion care training and increase diversity among healthcare professionals who provide abortion care.

Elyssa, an abortion doula with the Baltimore Doula Project, said building out abortion access infrastructure is crucial. But for now, she has concerns about the capacity of abortion destination states like Maryland.

“The potential impact is that people who live here may have to wait longer to access abortion care because of an influx of people coming to the state to access this care,” Elyssa explained. “We have a lot of great clinics here. Our clinics are amazing, and our abortion workers are amazing, but there’s still limited capacity when you only have one procedure room or you only have three spots in your waiting room—especially during Covid when you’re trying to distance people. As much as we all want to help people access care, the reality that we have to account for is that it’s also going to put a strain on clinics in states where abortion is more accessible. The people who will pay the price in our state are the people in our state who already experience barriers accessing abortion because of logistical, financial, and other reasons.”

Helen Scott, a member of CASC in Portland, said that funneling people to different states for abortion care isn’t ideal for anyone, and it certainly shouldn’t be seen as a long-term solution.

“I also just think it’s a matter of time before there is legislation that restricts or criminalizes a person’s ability to leave their home state and access care elsewhere,” they said. “We need time and space to think through all of these potential scenarios, but because the attacks are so constant, we are forced to be in this constant state of reactivity that’s actually very unhealthy and unsustainable for our movements.”

Shené certainly understands why states with far fewer restrictions aren’t centered in conversations about abortion access, but living and working in California has helped her better understand the crisis facing the country and the “unimaginable damage” set to unfold when Roe is overturned.

“When you think of California, you think of a place where people can access abortion no problem, but I’ve heard hundreds of stories where individuals experienced harm or weren’t treated well, and that makes me think about what people are up against in other states and how it’s about to get worse,” explained Shené. The full-spectrum doula is considering creating an abortion support group comprised of people who have had abortions and pregnant people who will soon access abortion care or who are considering it.

“…‘abortion support’ looks different depending on the person and their experience, and people can be traumatized even in states where abortion is accessible.”

“I have noticed that people who have upcoming appointments or people who just had abortions have this need to connect with other people who have already had the procedure. They want to ask questions about the process, or check in about what is ‘normal,’” Shené said. As an example, Shené relayed the story of a woman who went to a facility for a surgical abortion and was shocked to encounter “a crowd” around her during her procedure.

“It was a teaching facility, which she wasn’t aware of prior to making an appointment,” Shené said. “She told me she felt dehumanized, like she was a study. So ‘abortion support’ looks different depending on the person and their experience, and people can be traumatized even in states where abortion is accessible.”

Safety in community, offline

Some of the abortion doulas who spoke to Prism said that the people they support are overwhelmed and confused by the Supreme Court leak, which has left them unsure of their rights and concerned for their safety.

One pregnant person who plans to access abortion care outside of their state asked their abortion doula if they should refrain from telling their partner they are pregnant. Gabrielle said that when abortion becomes inaccessible to nearly half the country, she anticipates that the needs of pregnant people who want to access care will only grow—they will need more information, more emotional support, more practical support, and more resources, perhaps in the form of legal counsel.

Matthews said she’s already seeing people in her region in desperate need of additional help, which is why she says more clinics, practical support organizations, and abortion doulas are urgently needed because “everyone is already traumatized and exhausted.”

“Some clinic staff already kind of bristle at the idea of abortion doulas because our existence implies a certain lack of holistic care or emotional support within clinics,” Matthews said. “But the truth is—as someone who does both jobs—we are less and less able to meet the needs of patients as these laws create ripple effects of trauma for them. We simply don’t have time or capacity as our patient schedules overflow and waitlists grow. Patients are coming to us with increasing stress levels, and often they are being met with increasingly stressed providers and clinic workers, and systems of support. The gaps are widening, and the needs are growing.”

It is a tumultuous time for people who do abortion support work, and increasingly abortion doulas are looking for ways to better protect patients and themselves. There’s a real tension between the need to reduce their digital footprints and ensuring that the people who need them can find them. Maren, a member of the Mountain Area Abortion Doula Collective, said that even though abortion access in the U.S. feels like a never-ending “five alarm fire,” it’s more critical than ever for abortion doulas to take a pause and strategize safety precautions, contingency plans, and legal protections. They should also reconsider the information they share about their work online.

Among the abortion doulas Prism spoke to, there are wildly differing approaches to online anonymity. For example, the Mountain Area Abortion Doula Collective has a website, but it’s devoid of abortion doulas’ photos and bios, and it doesn’t include specific information about the collective, including how many members it has. Maren said the reasons for this are twofold: to reduce the chance of harassment, and because abortion doulas in the collective have previously been doxxed for their activism. Matthews has a website where many prospective clients find her, but it does not include photos, and it offers limited information about her. The full-spectrum doulas Prism spoke to are in a difficult bind. The majority of their daily work has little to do with abortion. While their sites minimize information about their abortion doula services, their background information, credentials, and photos are on full display because these are important components for prospective clients to look over when they are in search of a trusted doula who will guide them through pregnancy.

Matthews says people who offer abortion support should have some security measures already in place, but now is especially the time to prioritize safety and privacy. For her, this means encrypted communication. She uses Signal for messages and phone calls and Protonmail for emails. When possible, any meetings about abortion are held in person.

In Portland, Scott said abortion support collectives like CASC are experiencing an “increased and heightened visibility,” which doesn’t necessarily serve its abortion doulas. For the first time, the collective is having concerted conversations about the legalities of providing support to people who’ve come from outside of Oregon to access care. The collective has already been threatened with litigation once. CASC was recently helping a minor from out-of-state access abortion care, and their guardian found out about it and threatened to sue the collective.

According to the Guttmacher Institute, most states require parental involvement for minors accessing abortion care. Usually, the consent or notification of just one parent is required, but a handful of states require the involvement of both parents. The judicial bypass process enables a young person to get an abortion without notifying their parents, but it requires getting an order from a judge. In Oregon, there is no law that requires parental consent or notification for abortion, but minors under the age of 15 who receive medical care or treatment, including abortion, are required to have parental consent.

“The threat of legal action was a jarring experience for us, and I can’t imagine how traumatic it was for this young person who tried to get the support they needed and was punished for it,” Scott said.

Given the rapidly shifting conditions, CASC recently began working with the Digital Defense Fund to strengthen their online security practices. For others, the strategy is to build more substantial community ties, rely less on online connections, and—most importantly—take on riskier work “without shouting it from the rooftops,” as Gabrielle said. In Georgia, she wants to see more people in her community passing on their knowledge of herbal abortion and other traditional forms of care.

“Social media is a powerful tool that allows us to connect, but when we’re talking about things that can put us in jail, we have to start speaking to each other and meeting with each other in our homes, in community gardens, in parks, wherever,” Gabrielle said. “We have to really be in community with each other. If we want to help people and not get caught, that requires moving more thoughtfully—and making sure people know who the pillars are in their community. They need to know who will help them and defend them and fight for their rights when it seems like no one else will.”

Lue, like so many other reproductive justice advocates, knew the end of Roe was coming. If nothing else, the leaked Supreme Court opinion affirmed her decision to “keep shit offline.” Community networks have always been the most reliable and safest forms of support, she said. Now is the time to reinvest and strengthen these hyper-local networks and to rethink the reliance on smartphones.

When the people who haven’t been tuned into the fight for abortion rights jump into movement work, their efforts can perpetuate harmful dynamics, like erasing the leadership and experiences of women of color. Time is also wasted on “invent recreating long-established work.

(Photo by Jordan Uhl / CC BY 2.0)

Not only can period and fertility apps aid in abortion criminalization, but phones are chock-full of surveillance data that can provide law enforcement with information about users’ whereabouts and Google searches. When combined, this data is capable of revealing if a person had an abortion. Lue considers all of the doula work she does “sacred,” so she doesn’t take photos of any of it. The fact that this reduces her risk of criminalization is merely an added bonus.

“Your phone isn’t always your friend,” Lue explained. “It’s really important for people to learn how to move in the ignored spaces. It’s not just about us; it’s also about protecting the privacy and integrity of the people we help. We have to protect their peace and their space. Right now, attention-seeking behavior will get you hurt, especially if you work in communities like mine that are the most policed. Everyone wants to be out here loud and proud on social media doing the most. You don’t need 10,000 followers; you need people to be able to find you when they need safety and they need help.”

Life and death and hope

Everything isn’t doom and gloom in the world of abortion access—as much as it might feel like it. There are glimmers of hope.

Abortion doulas are strengthening their relationships with local abortion funds and building new inroads with clinics in their state. To better combat abortion criminalization, some doulas are engaging in cross-movement organizing for the first time, working with movement attorneys and activists fighting mass incarceration and immigrant detention. Full-spectrum doulas are seeking out abortion doulas to learn from and build relationships with. Shené said this could be a moment of opportunity to re-envision abortion access and community care—a sentiment echoed by Gabrielle, who wants to see reproductive justice advocates lead the nationwide fight for abortion rights.

Matthews said it’s also time for white doulas like her in high-access areas of the country to unlearn harmful traits.

“We are late to this fight—and historically, that hasn’t stopped us from barging in and crying and talking over other people and trying to lead—but really this is a crucial moment to learn how to not do that,” Matthews said. “To learn how to listen and follow and keep all of us and our communities as safe as possible. Ego has to fall by the wayside now—and individualism and white-lady attachments to power and hierarchies and ‘the way things have always been done’ in abortion care—that has to go. It’s life or death. Actual lives and safety and freedom are depending on our ability to grow and learn and be better, now more than ever.”

A counterpoint to the danger abortion doulas are facing is the love they are being enveloped in online and in person. Volunteer applications are also rolling into collectives, along with requests for abortion doula trainings as community members are eager to expand local systems of support. Many abortion doulas and collectives are also being inundated with donations—so much in fact that they are funneling them to less visible, underfunded grassroots organizations or abortion funds in states with trigger laws.

But mass mobilization around an issue also comes with challenges.

The Roe news lit a fire under some people who haven’t been very tuned into the fight for abortion rights over the last decade. When they jump into movement work, their efforts can perpetuate harmful dynamics, like erasing the leadership and experiences of women of color. Frustratingly, time is also wasted on recreating long-established work. Some abortion doulas reported encountering newcomers who thought they were “inventing” abortion funds, for example. There have also been repeated instances in which people create abortion information databases that contain inaccurate, misleading, and unvetted information. Not only is this confusing and harmful to pregnant people in need of help, but databases outlining support networks and state abortion laws and restrictions already exist.

Of course, nobody owns the fight for abortion rights, and decentralized organizing can be a good thing. But if you’re new to abortion care work, Matthews said to consider some guiding questions: who has created this space, who is maintaining it, who has been doing this work already? Who is the expert here, and who should I be speaking with and listening to? Giving money directly to abortion funds or abortion seekers, supporting independent clinics instead of national organizations, and finding out what the reproductive justice needs are in your community—along with who the leaders are that you could invest in, learn from, and support—are also good places to start, she said.

Lue has complicated feelings about newcomers to abortion work. There is wariness—can they be trusted with this sacred work? There is concern—can they do this work without harm? And of course, there is anger. So much anger because of years of silence and inaction.

But Lue doesn’t let the anger eat her up, and theoretically she knows that if there were ever a time for a unified fight, that time is now. Each day when she wakes up to “a new dumpster fire”—another abortion ban, another mass shooting, another transphobic law—Lue takes a moment to breathe, to center herself, and to remind herself why she continues to do this work.

“Do you know what gives me hope?” Lue asked. “It is my network. It’s that feeling you get when you sit with people who get it. People who work toward harm reduction in tangible ways; people who work in humility; people who work in the shadows because they understand the most beautiful things in life are not always visible to other people. I have learned to have hope in moments, not in movements.”

If you or anyone you know needs assistance self-managing a miscarriage or abortion, please call the Miscarriage + Abortion Hotline at (833) 246-2632 for confidential medical support or the Repro Legal Helpline at (844) 868-2812 for confidential legal information and advice.

Prism is an independent and nonprofit newsroom led by journalists of color. We report from the ground up and at the intersections of injustice.

Tina Vásquez is the editor-at-large at Prism. She covers gender justice, workers' rights, and immigration.

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