Tight restrictions on abortion have already placed the procedure out of reach for many Black women in America — obstacles that will grow even more daunting if the landmark Roe v. Wade is overturned.
Across the Black Belt — the Southern states where the echoes of slavery reverberate in legislation that perpetuates political and social inequities — women have long confronted overwhelming costs and logistical obstacles in seeking reproductive health care.
Earlier this week a leaked draft of a Supreme Court opinion signaled the end of abortion rights nationally, which would leave an already marginalized group, who seek abortion care at a higher rate, with less access to family planning services, resulting in poor health, education and economic outcomes, according to researchers, experts in family planning and advocates for reproductive justice.
“Women are going to die,” said Dalton Johnson, who owns an abortion clinic in Huntsville, Alabama. “It might not be as many as it was in the ’70s because we have medication abortions. There are groups that are going to have access to those — whether legally or illegally. But everybody’s not going to be able to do that and women are going to die.”
If Roe falls, many women in the South will turn to a network of grassroots organizations and advocacy groups led by Black women that has emerged out of necessity to fill gaps in health care coverage and the social safety net. These groups have already been helping women who struggle to compile the cash — and coordinate the time away from work, child care and transportation — that are necessary to get the procedure.
Laurie Bertram Roberts, the executive director of the Yellowhammer Fund, an Alabama-based nonprofit that offers funding and support for women who have abortions, recalls a woman who received financial aid after having to choose between paying her electric bill and paying for her abortion.
“One time, it was bailing somebody out of jail to get their abortion,” she said.
Roberts and other reproductive rights advocates and leaders of small abortion funds across the South said that while they’re not ready for the challenge of Roe being overturned, they are as prepared as they can be.
“We’ve been planning for this possibility for several years,” Roberts said. “This isn’t a new threat, but it’s a larger threat. So many states could lose abortion access at once. Like 2,300 to 3,000 people get abortions at the clinic in Jackson, Mississippi, a year. How do you reroute 3,000 people out of state?”
Nearly two dozen states are likely to ban or severely restrict abortion access if Roe is overturned, and 13 have “trigger laws” to ban abortion immediately, according to an NBC News analysis of data from the Center for Reproductive Rights, which support abortion access. Advocates, organizers and experts all agree that Black women in the South will bear the brunt of these restrictions.
Black people make up about 38 percent of Mississippi’s population, according to recent Census data, but they accounted for 74 percent of abortions in the state in 2019, according to the nonpartisan Kaiser Family Foundation. Alabama’s figures are similar, with Black people accounting for about 27 percent of the state’s population but 62 percent of abortions.
Johnson pointed out that low-income patients and people of color already have to navigate a health care system that can be inattentive and discriminatory. But people with work obligations, financial struggles and lack of transportation also simply have a more difficult time getting to abortion providers in other states. This, organizers said, means they would be even less likely to get an abortion if Roe is overturned — worsening a cycle that perpetuates poverty for Black people.
Research shows that unintended pregnancies hold people back from completing their education and getting and keeping jobs and can lead to poor health and economic outcomes for their children. People denied abortions are more likely to live in poverty, with economic instability and poor physical health. “It’s people who have been pushed to the margins,” said Monica Simpson, the executive director of SisterSong, a Georgia-based reproductive justice organization that serves people of color. “It’s those living in states where access has been completely obliterated, they’re going to be impacted most — that’s people of color, low-income folks, queer, trans and gender-nonconforming folks.”
Black organizers have argued that Roe has always been “insufficient” for Black people who lack resources. So, they have resolved that the work after Roe will look a lot like the work they’ve been doing to fight for reproductive justice for decades — but intensified.
‘Every dollar counts so much’
For two weeks in April, the New Orleans Abortion Fund, which primarily assists patients in Southern states, had to inform callers and clinics that it was out of money for the month.
Although the fund is back up and running, A.J. Haynes, the board chair, expressed concerns last month that the nonprofit would be unable to raise enough money to help every caller in need.
Many of the callers the fund supports live in states where the choice to have an abortion is more fatiguing than workable. Mississippi and Louisiana have the nation’s highest poverty rates, and residents make deep sacrifices to scrape up enough for their appointments.
In 2021, most of the nonprofit’s callers were Black. More than half asking for help already had at least one child and received health insurance through Medicaid. Under the Hyde Amendment, people on Medicaid cannot access federal funding for abortion care.
“Every dollar counts so much here,” Haynes said. “Every dollar is gas in someone’s tank. Every dollar is literal food in someone’s mouth.”
Across the Deep South, access to abortion care is already buckling, said Johnson, the Alabama clinic owner. The fallout from a Texas law banning abortions after six weeks of pregnancy has spilled over into surrounding states as clinics like Johnson’s serve an influx of new patients. Women in Mississippi, where the only abortion clinic in the state provides treatment up to 16 weeks of pregnancy, might travel hundreds of miles to the Alabama Women’s Center if they need a procedure further into their second trimester.
In 2020, abortion funds gave more than $10 million to support more than 400,000 people, according to the National Network of Abortion Funds, which includes Yellowhammer along with some 88 funds across the country — a majority of them in the South — and three international funds.
But the locally run funds — many launched by Black organizers — can face an uphill battle in securing resources, even as donations flood Planned Parenthood and other national groups.
“They will have to raise more money,” said Marcela Howell, president and CEO of the National Black Women’s Reproductive Justice Agenda. “This will intensify their work. They will need more money to actually achieve what they’re trying to do. They’ll have to build their existing systems up to higher levels.”
A movement grounded in history
Conservative activists and anti-abortion protesters shouting outside of clinics often try to position the racial disparity in who seeks abortions as a form of genocide.
In the draft Supreme Court opinion on Roe, Justice Samuel Alito wrote: “It is beyond dispute that Roe has had that demographic effect. A highly disproportionate percentage of aborted fetuses are Black.”
This line of argument infuriates many Black activists.
“I’m so sick and tired of folks using that and talking about Black genocide when it comes to abortion,” said Michelle Colon, the co-founder of SHERo (Sisters Helping Every Woman Rise and Organize) Mississippi, a nonprofit that supports abortion rights. “Our law enforcement killing Black people — that’s Black genocide. The fact that this government is working so vigorously and successfully in disfranchising the Black vote — that’s Black genocide.”
Another part of the nation’s fraught history over how much control a woman should have over her reproductive health is the agency that Black Americans and their descendants have fought for since slavery, when Colon says they were forced to “breed more free labor” and had no say as their families were destroyed.
That sense of history grounds the current efforts of Black women to support one another in retaining autonomy over their bodies and reproductive health, Colon said.
For Colon, that activism involves opening up her wallet to help women pay for abortions and distributing emergency contraception. She stocks up on ginger candy that can help relieve camps, as well as menstrual pads and pain relievers to make sure SHERo clients have them on hand after their abortion.
Looking ahead, she also wants to launch an abortion fund that can help patients pay for treatment or additional costs like making child care arrangements.
She sees this as a continuation of the work Black women have always had to do in the face of societal and government neglect.
“When you look at movements in this country, Black and brown women have always been a part of them,” Colon said. “We have not necessarily been invited, we have not necessarily been accepted, but we’ve always been in this fight. And we’ve always made our own way, in spite of not being invited, respected or even appreciated.”
Roberts said the Yellowhammer Fund plans to reach out to communities across the country, and recruit volunteers who will provide assistance with everything from driving people to clinics to opening their homes to people seeking abortions in other states.
“It can be cultivating community members to be abortion doulas,” she said.
Pushing for policy changes
While reproductive rights activists see abortion pills as one way of circumventing new abortion laws, at least 33 states, including Mississippi, have placed restrictions on the pills, according to the Kaiser Family Foundation.
That has raised concerns among abortion rights advocates that if Roe is overturned, there could be a wave of charges against women who try to end abortions on their own — not just through pills, but also through other means. About 7 percent of women in the U.S. report having attempted a self-managed abortion in their lifetime, according to research published by the American Public Health Association.
Since Roe was decided in 1973, about 1,600 women across the U.S. have been arrested or otherwise detained on pregnancy-related suspicions3, according to a report from the National Advocates for Pregnant Women. This includes women who had miscarriages, abortions, stillbirths and neonatal losses.
Meanwhile, poor people of color are more likely to be arrested for suspected drug use while pregnant, according to a report from Amnesty International. And at least 38 states have laws that criminalize pregnant people for everything from not wearing a seatbelt to falling down stairs, the report states. In 2019, Marshae Jones was charged with manslaughter after her fetus died when she was shot in the stomach during an altercation in Alabama. Several reproductive justice groups protested the charge and prosecutors ultimately dropped the case.
Colon worries that Black women are more vulnerable to being investigated after pregnancy loss.
“They will be the ones that someone will say, ‘Oh, I think this is someone who self-induced their abortion,’” she said. “They’re the ones that the police will be called upon for.”
To that end, Colon and other advocates are focusing not just on direct aid for pregnant women, but also on influencing policies. One of SHERo’s strategies will be talking with prosecutors to discourage bringing charges against people who try to end their pregnancies.
On the policy front, reproductive rights advocates will face an uphill battle in states where Republican politicians see the overturn of Roe as just the first step in cracking down on other types of reproductive health care.
In Georgia, a bill that was recently defeated would have required pregnant people to see a doctor and have an ultrasound before accessing abortion pills.
“An overturn of Roe would empower anti-abortion advocates to bring back similar or even worse legislation,” said K Agbebiyi, the Georgia policy and movement building director for Unite for Reproductive & Gender Equity. “Any limit on abortion access will impact the most marginalized of abortion-seekers in ways differently than people who have money, race or class privilege.”
Colon, an Illinois native, reflected that once again Black women face having to “migrate” north for rights not available in the South. But just as not everyone was able to flee during the Great Migration of the early 20th century, many Black women will remain in the South without access to abortions.
And Colon remains determined that, as they always have, Black organizers will resist.
“We decide our destiny, not the Supreme Court,” she said.