How anti-abortion laws impact the Black community

When the Supreme Court ruled in Dobbs v. Jackson Women’s Health Organization last June, overturning Roe v. Wade and ending federal constitutional affirmation of the right to abortion, medical experts and pro-abortion activists working in the Black maternal health community say, they knew the result could be dire.

According to the Centers for Disease Control and Prevention, Black pregnant people are three times more likely to die from pregnancy-related complications than white pregnant people. And Black infants are nearly four times as likely to die during birth as white infants, the Department of Health and Human Services Office of Minority Health reports.

The CDC says that high death rates of Black pregnant people are largely due to three factors: underlying health conditions such as hypertension, depression, and diabetes; structural racism; and unconscious bias in the health care system.

“Even [Black] women at the highest income levels had their children dying, and they died at rates significantly higher than their poorest white peers,” Dr. Amanda Williams, a clinical adviser at the California Maternal Quality Care Collaborative and adjunct faculty member at Stanford University School of Medicine’s Department of Obstetrics and Gynecology, tells the American Independent Foundation. “We also have had the same sort of data around higher education as well.”

Black pregnant people are the largest group in the U.S. obtaining abortions, according to 2019 data from the CDC, which Williams says is “a really hard piece of data to get our minds and hearts around.”

“But if you flip it on its head and say, you know, in a country where being Black and pregnant is associated with so many poor outcomes for that individual, it makes pregnancy a dangerous undertaking,” Williams adds.

According to a study funded by the National Institutes of Health, pregnancy poses more risks than abortions. A separate report from NIH found rates of maternal mortality in Black pregnant people could increase by 33% in states with complete bans on abortion care.

“Abortion is an order of magnitude safer, is over 10 times safer than it is to have pregnancy. So again, you’re forcing people to put their health on the line,” says Williams, who also runs Mahmee, a membership-based company that provides pregnancy and postpartum care.

“And many of the states that have the strictest abortion bans also do not have excellent support for pregnant people and new families. So those support resources aren’t going to magically appear once they become pregnant,” Williams says.

“Every study that looks at health care stratification shows that people who are the most vulnerable already will experience even more hurdles to stigmatized care like abortion,” Dr. Andrea Becker, a medical sociologist at the University of California San Francisco, tells the American Independent Foundation.

Becker says that low-income patients who live in rural areas have the most difficulty accessing abortion care. That’s where telehealth can play a huge role in helping pregnant people access both maternal care and abortion care.

Becker, an abortion researcher since 2016, says that without access to telehealth, many people will be severely limited in obtaining abortions.

She’s referring to limits on access to medication abortion contained in a recent ruling by the U.S. Court of Appeals for the 5th Circuit. That ruling narrowed a stay handed down by a federal judge in Texas on the Food and Drug Administration’s approval 23 years ago of mifepristone, the primary drug used in over 50% of U.S. abortions.

While the 5th Circuit’s ruling allows mifepristone’s FDA approval to stay in effect, its limits include banning the drug from being sent through the mail after a telehealth appointment, with patients required to have three in-person visits for the procedure: one to take mifepristone; the next to take the second drug, misoprostol; and the third for a physician to examine the patient for any complications. Additionally, the ruling shortened the gestation period after which patients cannot take the medication from 10 weeks to seven.

“It’s abortion exceptionalism,” Becker says about the initial limits imposed on mifepristone. “Can you imagine that requirement for any other drug that is safer than Tylenol?”

On Friday the Associated Press reported that the U.S. Supreme Court had put the ruling that limited the medication on hold temporarily until 11:59 p.m. ET on Wednesday, allowing the justices time to further consider the case.

In 2021 the CDC declared racism “a serious public health threat that directly affects the well-being of millions of Americans.”

Linda Goler Blount, president and CEO of the Black Women’s Health Imperative, told the American Independent Foundation that the overturning of Roe was a direct consequence of “white men being concerned about the changing demographics of this country.”

The history of access to abortion and the Black community goes back to the period of American slavery and its roots in white supremacy. For starters, notes journalist Anna Lekas Miller, Black enslaved women were raped by slaveholders and forced to breed. When emancipated Black people had children that could no longer be considered the property of white slaveowners, a number of considerations induced those in power to introduce restrictive abortion laws.

“There were concerns that these other groups were demographically outpacing white, Anglo-Saxon, Protestant women,” Alex DiBranco, the co-founder and executive director of the Institute for Research on Male Supremacism, told FiveThirtyEight. “And so they thought to limit the bodily autonomy of white women and limit access to contraception in order to force them to have children. That they felt would keep up with the demographic birth rate.”

Blount says: “This is why this battle has been waged and why we’ve seen, for a while, the religious community wasn’t involved in abortions. … Then suddenly, oh, the religious right got into it, because it’s like, ‘Oh, my God, these people of color are going to outnumber us.’ It is the fear of replacement, all the stuff that we’ve seen play out in so many different ways.”

Despite the barriers faced by those seeking abortions in half the states in the nation, experts say they remain hopeful.

“I’ve definitely noticed a shift since last year,” says Becker. “It is heartening, at least, that now people want to talk about it, even though it feels a bit late to start caring about abortion. I’m glad that people are at least open to learning about the science and learning about how interconnected abortion access is to a lot of these other social justice issues,” Becker says.

Oriaku Njoku, executive director of the National Network of Abortion Funds, tells the American Independent Foundation in a statement:

These unconscionable restrictions will certainly harm those who already face unacceptable astronomical barriers and economic injustices, especially Black folks. All of these are tools of white supremacy and designed to stop us from being able to exercise our agency and basic human rights. And quite frankly, I am tired of the compromises we are expected to accept in order to uphold oppressive laws that have a blatant disregard for our humanity. This is certainly a challenging time, and what gives me hope is the power, compassion, and love that abortion funds and Reproductive Justice advocates bring to this fight every single day. We cannot be disheartened by a ‘doom and gloom’ attitude. We, as a collective, must push forward to make our voices heard, build power, experience joy every single day, and believe that together we can achieve true liberation.

Published with permission of The American Independent Foundation.