It started out as a small, personal quest. A handful of women came together around a shared need: Each had ended a pregnancy with an abortion — or knew someone well who had — and discovered there was no one without an agenda to whom she might talk about the experience.

The women were not looking for someone who would turn their decision into an opportunity for religious evangelization, conversion or condemnation.

Neither did they want someone who, fearing the loss of legal protections for abortion, refuses to entertain the idea that a woman who has an abortion can harbor afterthoughts about her choice.

That was in 2000, and the handful of women formed a San Francisco Bay Area telephone talk line called “Exhale.” Free of charge and confidential, the program was created to fill “the void for many women who find themselves stuck in the middle of the ideological and politicized battle around abortion,” said its executive director, Aspen Baker.

Rather than proselytize or politicize, Exhale’s counselors were trained to listen, not preach, to support, not judge. Above all, they wanted to convey a sense of safety and respect for women and teenagers who had an abortion and for the friends and relatives — female and male — who cared about them.

The void turned out to be a large one. A few months ago, Exhale went national, not because of ambition but demand. In 2005, more than 2,000 people — three-quarters of whom were women who’d had an abortion — called the help line. It is now available seven days a week with counselors who speak English and Spanish and, when requested, Chinese.

“We never thought we would become a national hotline,” said Baker, by telephone this week from California. “We thought we might help other organizations in other communities set up something like Exhale. But it’s one thing to say, ‘I want to do something in my community,’ and another thing to do it. There was clearly a demand … and we were really positioned to help.”

One of the many ironies of abortion in the United States is that a decision and act that could not be more intimate and personal is invariably appropriated as ammunition — by one side or the other — for the public shouting match we euphemistically call the abortion “debate.”

While it is sometimes difficult in the din to remember, abortion has existed since ancient times, whether it has been legal and medically safe or illegal and a threat to the lives and bodies of women who cannot pay to circumvent law. The first recorded formula for an abortifacient dates to 2600 B.C.

Today in this country, about half of all pregnancies are unintended and about half of those end in an abortion. Each year, approximately 1.3 million legal abortions are performed, making the procedure one of the most common gynecological treatments sought by American females.

As context, the number is more than twice that of tubal ligations and of hysterectomies. It is nearly three times the estimated number of vasectomies performed each year on men.

More than a million women a year is a lot. But — another irony — the angry war over abortion has created “this hostile political climate in which women continue to have abortions,” Baker said, but are also “held hostage in their experience. They’re isolated and stigmatized.”

An individual’s or couple’s decision to end a pregnancy is often one-dimensionalized by strangers as either murder or mere choice.

Women who have an abortion are expected to line up on one side of the war or the other. If they dare talk publicly about their decision, they usually must choose one of two labels: the sorry, repentant sinner, now working for the overthrow of Roe vs. Wade, or the unambiguous champion of a relatively simple medical procedure who views acknowledgment of emotional complexities as a threat to abortion rights.

“The two sides are so intense on justifying their positions, they sort of collided with each other and created this terrain of unacceptable emotion,” said Baker. “They ended up working together in ways they never planned.”

Exhale does not draw lines, apply labels or offer a two-sizes-fit-all scenario. Its Web site explains:

“Women have abortions for a number of reasons, and while many women’s reasons are similar, each experience, just like each person is unique … Women often experience feelings such as sadness, happiness, empowerment, anxiety, grief, relief and/or guilt. There is no ‘right’ way to feel. Feelings are different for everyone and they often change over time.”

Exhale counselors undergo more than 50 hours of training adapted from rape crisis help line models. Their approach is to accept every caller as a “whole, complex person” whose belief system “[social, cultural, political and religious]” is to be respected. If a caller has a support system in place, a counselor will work to extend it. If there is none, the counselor will help a caller build one.

Since Exhale was launched, its governing members have sought a clear way to communicate what the organization is about. They’ve found it in the term “pro-voice.”

“As we were carving out a space for ourselves, we were constantly being asked, ‘Which side are you on?’ People were putting words in our mouth, telling us that if we said one thing, didn’t it mean this or that?” said Baker. “I felt like it always took an hour to explain what we do.”

Exhale’s founders “looked at other social justice movements” for guidance. They noticed the recurring desire to provide “a voice” for people who are marginalized by society.

“When marginalized people get a voice, it gives them authority and legitimacy,” said Baker.

Helping women, their partners and family members feel legitimate and in authority after an abortion is exactly what Exhale aims to do.

So far the group has staged two-day seminars for health-care providers, therapists, counselors and clergy in Boston, Atlanta and Chicago. The workshops are not training sessions but provide a deeper look at Exhale’s approach to after-abortion counseling.

Exhale does not offer pre-abortion or “options” pregnancy counseling.

Most of the women and the few men (about 8 percent of callers) who contact the talk line want to discuss a recent abortion. But women who chose an abortion years ago also call, often explaining they never had an opportunity to discuss their decision in a nonjudgmental environment. Nearly 75 percent of callers are between age 20 and 39.

Most people find out about Exhale through family planning centers and abortion services. Some hear of it from a minister or therapist. A growing number discover it when they search the Internet for something besides a lecture, prayer circle or guilt trip.

Exhale counselors are available, Monday through Friday, 8 p.m. to 1 a.m., EST; Saturday and Sunday, 3 p.m. to 1 a.m., EST. The free help line is 1-866-4-EXHALE (1-866-439-4253). The Web site is www.

Stephanie Salter can be reached at (812) 231-4229 or

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