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Since the Supreme Court struck down Roe v. Wade this summer, women seeking abortions are navigating legal gray areas in states with abortion bans, like Ohio, Arizona, and Louisiana, among others. Not only do the bans hinder immediate, lifesaving pregnancy-related treatment, but they also amplify existing health disparities, disproportionally impacting women of color, in places where abortion was already difficult to obtain. Now, organizations working on a grassroots level are centering reproductive justice in marginalized communities and striving toward a more equitable health care in the post-Roe world.
As states individually decide on which bans to implement, creating a patchwork of restrictions on abortion, the ability to get the procedure now depends largely on where you live and which political party is in control, leaving women’s health in the hands of lawyers, politicians, and judges who lack the medical training to understand that not all pregnancies are equal.
Author, activist, and cultural critic Mikki Kendall explored the health disparities often ignored in Black and Latino communities in her book Hood Feminism: Notes from the Women That a Movement Forgot. For her, it’s not just about the right to choose, but also about having access to health care choices at every stage. Kendall wrote, “Problems are amplified by unconscious biases that are embedded in the medical system, affecting quality of care in stark and subtle ways ranging from experiences like mine, where the pregnancy was not viable but there was plenty of judgment about what I should have done, to situations where motherhood is a death sentence because no one gets it together in time.”
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Abortion bans tend to impact vulnerable populations in low-income, rural communities. A Pew Research Center study found that Black women accounted for 38% of all women who had abortions in 2019, while white women accounted for 33%, and Hispanic women were 21% of abortion patients.
According to a 2018 report from the National Partnership for Women & Families, Black women are also more likely to experience maternal health complications throughout their pregnancies. Additionally, hospitals serving mostly Black communities provide lower-quality care, performing worse on 12 out of 15 types of birth outcomes, including elective deliveries, non-elective cesarean births, and maternal mortality. Additionally, the same report finds that Black women experience higher rates of diabetes, hypertension, and cardiovascular disease, which can negatively impact their maternal and infant health outcomes. Compared with white women, Black women are also more likely to be uninsured, more likely to face greater financial barriers to care, and less likely to access prenatal care.
Imani Gandy, senior editor of Law and Policy for Rewire News Group, believes that anti-abortion “foot soldiers” failed to really understand what their fight entailed and underestimated the broader impact. “[Republicans] didn’t think about the person who’s 22 weeks pregnant, who has a fetal anomaly, or the person who has an ectopic pregnancy,” Gandy says. “I think the conversation is shifting in terms of how abortion is seen, as an actual health care need, as opposed to something frivolous.”
Pro-life activists typically have unsubstantiated concerns for “late-term” abortions (93% of abortions occurred during the first trimester), a misleading term they created to rile up fear. They seem to ignore the “fourth trimester,” between birth and 12 weeks postpartum, when the mother and baby need critical postpartum care to have healthy outcomes. In practice, Republicans oppose passing social programs to support new parents, like protected family leave and an extended child tax credit. States with abortion bans have a higher percentage of residents living in maternity care deserts, and typically receive little cash assistance.
During the 2021–2022 session, Democratic Sen. Mia McLeod of South Carolina introduced the Pro Birth Accountability Act, taking into account the post-birth economic and health disparities that mothers and children may face. The bill would make pregnant women automatically eligible for benefits, such as food stamps and cash assistance (without having those benefits reduced or suspended before the child reaches 18), health care during all phases of pregnancy, a College Savings Plan, and child support if the biological father is absent.
Although McLeod’s bill is unlikely to pass in South Carolina’s Republican-controlled state legislature, it expands the conversation for social programs in relation to reproductive justice, especially for minorities disproportionately impacted by abortion bans.
When viewed through the lens of intersections between race, gender, and sexuality, access to abortion and postpartum care becomes more complex, requiring systematic solutions that go beyond legality. “The more intersectional approach [to abortion] lends itself to having conversations about what pregnancy and child rearing is, as opposed to [it] just ending as soon as the child exits [the womb],” Gandy says. “I think that the reproductive justice framework inherently lends itself to local intersectional activism, because so much falls under that umbrella.”
Sharp distinctions along lines of race and class are common elements. For example, Mississippi’s recent water crisis, where massive flooding damaged a water treatment plant, has forced the majority-Black capital of Jackson to go without clean water. As of September 2022, an estimated 150,000 residents lacked access to clean water, likely impacting Black mothers and their reproductive health.
Black patients accounted for 74% of all abortions in Mississippi in 2019, above the national average of 38%, according the Centers for Disease Control and Prevention. Additionally, 23.5% of the Mississippi population lives in a maternal care desert. “Pregnant women right now are drinking dirty water, and Mississippi is saying, ‘Well, you have to give birth to these kids, but we’re not going to make sure they have clean water,’” Gandy says.
The post-Roe era demands a grassroots intersectional activism that accounts for barriers facing Black, Indigenous, and people of color, LGBTQ people, and young people. One example is the National Network of Abortion Funds (NNAF), which has 80 member organizations that help women pay for abortions through local abortion funds, including travel, lodging, child care, and language interpretation, among other services. In partnership with its members, NNAF uses its collective power to center people impacted by structural barriers to abortion. It also works to change laws and culture that make abortion difficult to obtain.
Another grassroots effort is The Feminist Front, a youth of color organization that has been hosting workshops for 15-to-35-year-olds on the origins of reproductive justice, oppression, and the intersection of white supremacy and abortion. In anticipation of the Supreme Court’s abortion decision, the group earlier this year decided to support reproductive justice groups in the Southwest and realized that many feminist organizations in Southern California, Arizona, New Mexico, and Texas were not connected to one another, explains Sophia Armen, co-chair of The Feminist Front. Her group began working with others, like Black Phoenix Organizing Collective, Generation Ratify, and Desert Star Family Planning, an independent Black-owned abortion clinic—all of which are doing important work at the intersection of health care and gender justice.
“What we really wanted to do was build out our power, and we knew that social media is oftentimes deceptive,” says Armen, who understands the value of having in-person action. “And what we need is actual built relationships with each other that are based in trust, that are not going to disappear.”
Activism within the reproductive justice movement also means civil disobedience. In August, youth organizers from The Feminist Front held a sit-in outside the offices of Sen. Kyrsten Sinema in Phoenix, Arizona, demanding she stop blocking legislation to codify abortion rights, voting rights, gun control, and the Equal Rights Amendment (ERA). “Our generation is the one who’s most impacted. We’re of reproductive age,” Armen says. “It’s people who are Gen Z and millennials who are directly in the line of fire.”
To add to the confusion, in September, an Arizona judge had approved a territorial-era law, dating back to 1864, that banned abortion with no exceptions for rape or incest and criminalized providers. The law was originally considered invalid by the 1973 Roe v. Wade ruling, but Arizona’s attorney general had asked the court to allow it to take effect. Recently, the Arizona Court of Appeals put a temporary hold on the territorial ban until a full appeal is heard. This means abortions can resume again, though likely following the 15-week abortion ban already in place.
The Feminist Front also works with One Arizona, an anti-voter-suppression organization building civic engagement and democratic participation to address voter identification laws that make it harder for Black and Brown voters to participate in elections, as self-proclaimed white supremacists are winning elections in state government. “It’s very clear that they’re targeting immigrant, BIPOC communities as a way of using abortion rights as a form of control,” adds Armen. “And this is about politicians trying to control our lives, and keep us in cycles of poverty, which I think oftentimes gets erased from this conversation.”
The New York-based National Latina Institute for Reproductive Justice has also documented disparities in access to abortions among vulnerable immigrant populations. In Texas, strict anti-immigrant laws in combination with the fall of Roe have made it exceedingly difficult for immigrants to cross state lines to get the procedure, according to Lupe M. Rodríguez, the organization’s executive director. “It has made it virtually impossible for individuals who are undocumented, or for whatever reason that don’t have documentation, or who just might be afraid to go through the checkpoints,” she says. Immigrants face an additional fear of encountering law enforcement and being deported, because of their mixed legal status.
“What we’re examining right now are these internal immigration checkpoints that exist in border states like Texas, that are within the boundaries of the state,” says Rodríguez. “Like up to 100 miles north of the border, folks there on major thoroughfares in the state, that would need to travel to be able to leave the state for care.”
The Latina Institute works through an intersectional lens that focuses on immigrant rights and economic and racial justice as part of reproductive justice, with offices in Florida, Texas, Virginia, and New York. It also advocates for a just and comprehensive immigration policy on a federal level and pays close attention to the plight of migrants in detention centers. Those migrants remain protected by federal policy even if the facility is located within states where abortion is banned. Though the Hyde Amendment prohibits patients from using federally funded insurance (Medicaid) to pay for abortions, under the Biden administration, the Immigration and Customs Enforcement agency has allowed detained immigrants to have full access to the procedure. This could easily change under a future administration.
The Latina Institute is also responding to what Rodríguez says is the “immediacy of the situation” by providing updated information to non-English speakers and others, so people can understand their rights beyond the headlines. The group hosts in-person and virtual educational programming on policy, abortion funds, and other resources to help people travel to out-of-state-clinics. “We’ve stepped in to ensure that folks understand the nuances of the laws and where folks can still get care and connect them to support and services,” Rodríguez says.
Although it was seen as a sacrosanct judicial precedent, Roe v. Wade faced criticism for being insufficient. Even the late Supreme Court Justice Ruth Bader Ginsburg believed Roe “wasn’t woman-centered, it was physician-centered.” Instead, advocates like Armen look to the Equal Rights Amendment (ERA) to fundamentally address many issues not covered by Roe. Although the ERA does not cover “all the ways that gender discrimination happens in this country,” she explains, “it has the ability to impact so many parts of society, which is why everybody, from insurance companies to white supremacists [to] evangelists, never [wants] it to come to fruition.” Not only would the ERA ban discrimination on the basis of sex, but it would also prohibit discrimination in access to health care, including abortion and other aspects of reproductive health.
According to grassroots pro-abortion groups, an equitable future in post-Roe America is achievable if society can address systemic health care issues impacting women in different states, from rural to urban, covering marginalized communities. “If you’re in a state like California or New York, of course, you might feel insulated, but the problem is that it doesn’t stop at just the state restrictions, right?” says Rodríguez. “Even if we’re living in different states and are fractured in terms of [bans] right now, it really affects us all, what happens to our sisters and brothers in other parts of the country.”
Cynthia Via is a writer based in D.C., covering the outdoors, gender, and culture through reported articles and personal essays. She also explores themes of being a young immigrant, gender identity, and solitude within nature in her short stories and poems. Her work has appeared in Diversify Outdoors, Hip Camp, Broad Street Review, among others. During off hours, she likes to hike, spy on birds, and do cartwheels. She can be reached on Instagram: @nekoenlaluna