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How Black women will be especially affected by the loss of Roe

With higher maternal mortality, more problem pregnancies, worse health care and less insurance, Black women especially need reproductive autonomy.

An abortion-rights activist wears tape reading “2nd Class Citizen” on their mouth as they protest outside the Supreme Court on June 24 in Washington. (Jacquelyn Martin/AP)
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On Friday, the Supreme Court’s ruling in Dobbs v. Jackson overturned the right to an abortion previously established under Roe v. Wade. By permitting more restrictive abortion policies, the ruling will disproportionally hurt the reproductive health of African American women for generations.

Many state-level abortion restrictions have been in place, waiting for Roe to be overturned. As these take effect, they will now limit women’s autonomy to make decisions on their reproductive care. That will hit Black women especially hard, since they start with worse health outcomes because of the detrimental health effects of racism. In addition, some Black women have lower incomes, lack insurance and lack access to quality health care.

Black women seek abortions at higher rates, partly because of lower contraceptive access and partly because, their pregnancies are more likely to have more dangerous complications. Because they disproportionately live in states that will ban abortion, they will be more likely to suffer illness and mortality without the right to the full range of reproductive health care. Here’s what we know.

Racial disparities in health care worsen pregnancy and maternal risks for Black women

Where a woman lives determines whether she can find accessible, safe and legal health-care services within a reasonable distance. Black women are more likely to live in “contraception deserts” where they cannot readily find reproductive health care or contraception. Even with Roe in place, that could include a lack of access to abortion. In the Deep South, states such as Mississippi only have one abortion clinic. Black people account for over 37 percent of the state’s population.

According to 2019 data from the Centers for Disease Control and Prevention (CDC), U.S. Black women are five times more likely to have abortions than White women, while Latina women are twice as likely. For Black women, the loss of that option will have harsher consequences than for White women.

While maternal mortality has increased among all races of U.S. women over the past 20 years, recent CDC data shows that U.S. Black women are three times more likely to “die from a pregnancy-related cause” than their White counterparts. Studies show that even when Black and White women have similar incomes, prenatal care and other health indicators, Black women have a higher risk of pregnancy-related death.

Some abortions are performed to save lives in cases of dangerous and complicated pregnancies. Now some state laws will make this illegal. For instance, an antiabortion law introduced in Missouri in March proposed outlawing abortion to end an ectopic pregnancy, in which the egg implants outside the uterus and cannot come to term, but its growth threatens the woman’s life. These pregnancies are the fifth leading cause of maternal death for Black women. A 2014 study shows that among Medicaid recipients, rates of ectopic pregnancy are higher in Black reproductive-age women than among others. Language referencing ectopic pregnancies was stripped from the bill before it passed in the Missouri House Committee.

Women of color want reproductive justice, not just abortion rights

Black women have more health risks, less insurance coverage, and therefore, worse maternal health

Researchers find that the stress of living in and coping with a race-conscious society “weathers” Black people, aging them, and leading to earlier health declines. Exposure to racism is an explanation for early health decline among many Black Americans. This affects maternal health as well. Studies show that encounters with racism are associated with Black women’s high rates of preterm births and low birth weights of babies, even among highly-educated, working-class women.

A 2019 report from the National Partnership for Women & Families found that over 14 percent of Black women are uninsured, compared with 8 percent of White women. Black women in the South have the lowest rates of health insurance coverage among all Black women. That makes it harder to seek necessary health care, including for reproductive and maternal health.

The cost of privately provided medical services and prenatal care is likely to discourage lower-income and uninsured women from seeking care. When they do seek health care, Black women face racism and discrimination in the U.S. health-care system. In numerous public health studies, Black patients report that medical professionals dismiss their symptoms and complaints, misdiagnose their conditions, fail to prescribe proper medication and treatments, and do not refer them to medical specialists for care. Further, medical professionals assume Black patients are more likely to abuse drugs and fail to administer enough pain medication to Black women.

Black patients face several kinds of discrimination among medical professionals and institutions. A 2021 Pew Research Center/Ipsos poll of over 3,500 Black Americans found that 56 percent of Black Americans have had at least one negative experiences with a medical professional. More than 34 percent of Black women reported not having their “women’s health concerns taken seriously.”

In addition, among the six types of grievances assessed in the poll, younger Black women — who are more likely to need contraception or pregnancy care — were more likely to experience issues with health-care providers than older Black women. The study also found that a 63 percent majority of Black Americans say that “less access to quality medical care” is the major reason Black people in the United States have worse health outcomes.

If the Supreme Court undermines Roe, contraception could be banned

Many Black women will soon be living under some of the nation’s most restrictive abortion laws.

Already, Black women insured through federal and state Medicaid may not use public funds to terminate pregnancies because of rape, incest or any reason other than to save her life, as per the 1977 Hyde Amendment. One in four Black women are covered by Medicaid. The rates of uninsured Black women are highest in the South.

In May, Oklahoma Gov. Kevin Stitt (R) signed a six-week abortion ban, one of the nation’s strictest bans. In 2019, the abortion ratio for Black women in Oklahoma was highest at 179.5 abortions per 1,000 live births compared with other women, while Black people account for only 7.8 percent of the population.

In a 2021 study using data on births and abortions from 2014-2017, sociologist Amanda Stevenson found that denying all wanted induced abortions in the United States would increase pregnancy-related deaths by about 7 percent in the first year and 21 percent in subsequent years. Given the factors above, however, for Black women, the analysis predicts that an abortion ban would produce a 12 percent increase in deaths in the first year and a 33 percent increase in the following years.

What can be done?

Historically, Black women’s reproductive needs have been sidelined by mainstream feminist and civil rights groups. However, some advocates are trying to address them now. Democratic legislators — specifically members of the Black Maternal Health Caucus — have introduced the Black Maternal Health Momnibus Act of 2021 to direct federal government resources to health disparities that directly impact Black women and children. But given all the health disparities and their many sources, we can expect the Supreme Court’s decision to overturn Roe to hit Black women in the United States harder than others.

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Christine M. Slaughter (@cmslaughter) is a postdoctoral research associate in the department of politics at Princeton University.

Chelsea N. Jones (@sojournerchels) is a PhD candidate in the department of political science at the University of California at Los Angeles.

Read more:

Women of color want reproductive justice, not just abortion rights

Half of Americans support abortion on demand

If the Supreme Court undermines Roe v. Wade, contraception could be banned

Evangelicals opposed abortion long before their leaders caught up

Conservative Republican women have led the fight to restrict abortion

The Supreme Court might overturn Roe. It took decades of scorched-earth conservative politics to get here.

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