For Black women, the concept of reproductive choice is a privilege they often lack, according to research on abortion in the context of structural racism and reproductive injustice.1
“[This study revealed] the decisions that people take on abortion are contextualized within the circumstances of their lives,” says Katherine Brown, MD, MAS, lead study author and assistant professor of obstetrics, gynecology, gynecologic surgery, and gynecologic subspecialties at the University of California, San Francisco. “Choices have always been a privilege in this country.”
Even after the Roe v. Wade decision made safe and legal abortions accessible to all women, state and federal laws have eroded that access. For instance, the Hyde amendment took away abortion as an insured procedure under Medicaid, Brown says.
“Paying for an abortion out of pocket is very expensive in states that don’t fund abortion care,” she adds. “That’s just one example of not having access, and there are so many restrictions that have been tearing down clinics.”
The gutting of Roe v. Wade has been happening for many years, Brown says. The Supreme Court’s June decision in Dobbs v. Jackson Women’s Health overturned Roe, allowing states to outlaw abortion.
In the larger context of reproductive justice, abortion access has been challenging for many people, especially for Black women. But Black women have faced challenges when seeking other reproductive health services. “Sometimes, going to a medical facility is not easy because people do not listen to you,” Brown says. “They ignore your perspective in the healthcare spaces.”
Historically, Black women have suffered trauma at the hands of physicians, including forced sterilization and painful surgeries. “There is a real history around coercion, and there is coercion that is present, too,” Brown says. “It’s complicated, but the most harmful part of the anti-abortion argument related to Black women is it’s patronizing and the sense we don’t have agency to make decisions for ourselves.”
In the human rights framework that includes reproductive justice, it is crucial to give autonomy to people to have children and raise children in stable communities. “The reproductive justice movement is also about access to prenatal care and the right to have children and to take care of children in communities that are not polluted or have police violence,” Brown says.
Black mothers have been challenged to raise children who are respected as children. Their children are more likely to be incarcerated than are white children for similar transgressions. “The way we normally cherish and uphold children in our society and protect children is not always granted to Black children, and that was reflected in my study,” Brown says. “People talked about having the experience of having their children taken away. We can’t talk about access to abortion without also talking about the opportunities and complex web of what it’s like to live in America today as a Black pregnant person.”
For example, the maternal mortality rate of Black women in America is seven times higher than that of white women.2 “Abortion is not the answer to the Black maternal mortality rate,” Brown says. “The answer is providing access to healthcare, respecting the autonomy of Black women, having Black birthing people, and providing respect in childbirths.”
Black people need access to information and websites that are directed to their own experiences. One example is We Testify, which mainly includes people of color.3 Also, abortion funds are important and integral to people seeking abortion care in states where many people cannot afford an abortion.
“California has expanded Medicaid to cover abortion, so anyone who has MediCal can get an abortion, but that hasn’t been true in most states,” Brown says.
REFERENCES
- Brown K, Plummer M, Bell A, et al. Black women’s lived experiences of abortion. Qual Health Res 2022 May 10;10497323221097622. doi: 10.1177/10497323221097622. [Online ahead of print].
- Hoyert DL. Maternal mortality rates in the United States, 2020. Centers for Disease Control and Prevention. Updated Feb. 23, 2022.
- We Testify. 2022.