Facing higher teen pregnancy and maternal mortality rates, Black women will largely bear the brunt of abortion limits

An examination room in Alamo Women’s Reproductive Services in San Antonio on June 14, 2022. (Credit: Kylie Cooper/The Texas Tribune)

Linda Goler Blount, president and CEO of the Black Women’s Health Imperative, says she grew up with the ability to make choices about her body because her mother’s generation fought for the right to abortion care.

She laments the same won’t be true for the Black children who will mature into womanhood without that access and worries about the effects that looming abortion restrictions across the country will have on them.

“The state is telling them that they’re not valuable, that they can’t be trusted to make the best health care decisions for themselves, that they’re not worthy of being able to make these choices,” Blount said.

The U.S. Supreme Court ruled last week to overturn Roe v. Wade, eliminating the constitutional protection for abortion and allowing states to set their own laws regarding the medical procedure. Last year, Texas passed a “trigger law” that would go into effect if Roe were repealed and make it illegal for patients to get an abortion with few exceptions. The trigger law is set to go into effect in about two months.

Lawmakers and reproductive rights advocates like Blount say Texas’ abortion ban will disproportionately affect women of color, particularly Black women, who already face higher risks of health complications or death related to pregnancy or childbirth. Taking away the right to abortion care will likely lead to an even higher risk of health complications and mortality, higher teen pregnancy rates and increased financial burdens.

State Rep. Jasmine Crockett, D-Dallas, said the justices and lawmakers who supported last week’s ruling have the privilege of wealth and class that will make it unlikely they’ll ever have to feel the effect of these laws — but Black women will.

Black women face greater health risks

In addition to Texas, 25 other states are certain or likely to ban abortion now that Roe v. Wade has been overturned, according to the Guttmacher Institute. Blount said it won’t be long in the coming weeks and months before the U.S. begins to see the long-term effects of those bans on Black women.

Black women in the U.S. are more likely to die from pregnancy or childbirth than women in any other race group, according to a 2018 report from the National Partnership for Women and Families. Black women are three to four times more likely to experience a pregnancy-related death than white women, and the risk spans income and education levels.

Black women are also more likely than other racial groups to experience maternal health complications throughout the course of their pregnancies. And hospitals that predominantly serve Black communities provide lower-quality maternal care, performing worse than others on 12 out of 15 birth outcomes, including elective deliveries, nonelective cesarean births and maternal mortality, according to the report. About 75% of Black women give birth at hospitals that predominantly serve Black patients.

There’s a variety of reasons why these statistics are higher for Black women, Blount said. Black women often lack access to proper prenatal care. If you’re Black with low income and living in rural areas, you just don’t have the access, she said.

In addition, Black women in the U.S. are more likely than their white counterparts to be obese, which can increase the risk of gestational diabetes, hypertension, preeclampsia and other pregnancy complications, Blount said. Weight gained and kept after giving birth, along with limited leisure-time physical activity, may especially contribute to obesity among Black women, according to the National Library of Medicine. Black women also appear to be particularly susceptible to cultural, psychosocial and environmental factors that can promote weight gain.

Because of high chronic stress and race-based trauma and fear, the majority of Black women produce about 15% more cortisol, a stress hormone, than white women, which in turn raises the risk of pregnancy complications, according to the National Library of Medicine.

“And so literally, the combination of poor health, lack of income, lack of access and the stress of being Black in this country causes premature mortality,” Blount said.

And when Black women are ready to deliver, they are often devalued and dismissed in medical rooms during and after the delivery, Blount said.

Blount mentioned the experience tennis star Serena Williams had shortly after the birth of her daughter, Alexis Olympia. Williams said in a 2018 interview with Vogue that she had extreme shortness of breath after her daughter’s cesarean birth and was concerned because of her history of pulmonary embolisms, a condition in which one or more arteries in the lungs become blocked by a blood clot. She told a nurse that she needed a CT scan and IV heparin right away, but her requests were dismissed because the nurse thought her medications were making her confused.

As access to abortion becomes more limited across the country, Blount said she anticipates Black maternal mortality rates to increase by 30% or more and Black poverty rates to increase by up to 20%. As mortality rates increase, so will rates of morbidity, or suffering caused by a disease or medical condition, she said. Many Black women will be left permanently disabled or sick long enough that they will lose their jobs, which will make caring for their families much more difficult. Black women are often the sole breadwinners in their household, but they also help take care of broader family and community networks. When a Black woman becomes sick or unable to work, it causes a ripple effect through their community, Blount said.

All these factors contribute to Black women being the largest demographic of abortion-seekers in the U.S., Blount said. Black women account for 38.4% of abortion patients, the largest share among other racial and ethnic groups, according to 2019 data from the Centers for Disease Control and Prevention. That year, white women had the lowest abortion rate (6.6 abortions per 1,000 women), and Black women had the highest (23.8 abortions per 1,000 women).

In Texas, 18 out of every 1,000 Black women of child-bearing age received abortions in 2019. Black Texans have consistently had the highest rates of abortion in the last decade compared with other groups, with rates five to six times those of white Texans and double those of Hispanic Texans. Black Texans make up about 12% of the population.

For Crockett, a Democrat lawmaker from Dallas who last year voted against the state’s law barring abortions after about six weeks into pregnancy, bans on the procedure are personal. As a Black woman of childbearing age herself, she worries about the scary reality of not having safe, legal abortion access.

However, Crockett said if she were to have an unplanned pregnancy, she could afford to travel out of the state to seek an abortion if she needed. The same won’t be true for so many socio-economically disadvantaged people of color in her district, she said.

She expects to see Black teen pregnancy and Black mortality rates skyrocket as women seek out illegal abortion access. If there are women willing to risk their lives for cosmetic surgeries like Brazilian butt lifts, Crockett said, other women will certainly be willing to take the risk of getting an illegal abortion for more significant issues like unwanted pregnancies.

Black maternal mental health and financial burden

Kay Matthews, founder of Shades of Blue Project, said the abortion ban will also negatively impact Black maternal mental health. Her organization focuses on mitigating the mental health issues Black women face, and she has already seen an increase in demand since Senate Bill 8, which banned abortion after about six weeks of pregnancy.

“We are seeing the impact in a huge, huge way,” Matthews, 43, said. “We’re seeing this blanket effect of what’s already been happening.”

Almost 40% of Black people who give birth experience maternal mental health conditions, according to a 2021 report from the Maternal Mental Health Leadership Alliance. Compared to white women, Black women are twice as likely to experience maternal mental health conditions but half as likely to receive treatment for them. Such conditions include depression, anxiety disorders, obsessive compulsive disorder, post-traumatic stress disorder, bipolar illness, substance use disorders and postpartum psychosis in rare cases, according to the report.

Matthews said she doesn’t think lawmakers have considered the long-term effects of forcing people to keep pregnancies that they don’t want. It’s “mentally debilitating” to have to keep a child that you felt you weren’t ready or prepared for, she said.

These days, life is expensive even for a single adult, Matthews said. Adding another person to take care of makes it so much more expensive, especially when the U.S. is facing a diaper and baby formula shortage. She said many people think it’s easy to combat those shortages, particularly the formula shortage, by simply breastfeeding. But that doesn’t account for women who aren’t able to produce breast milk or who have past trauma associated with their breasts, which is frequent among Black women.

“It seems like everything is falling apart and just our basic rights to make our own decisions about our bodies are now being taken away from us,” Matthews said. “It’s hard, and folks are struggling.”

Even those who aren’t pregnant and may not become pregnant soon are still being mentally taxed. Just the thought of “what if it does happen” is causing panic for many women, especially Black women, Matthews said. That can cause both a physical and mental toll.

For Black women, Blount said the underlying messaging of the Supreme Court’s opinion and the looming abortion bans across half of the country is that their bodies aren’t valuable and that they can’t make decisions about their health care by themselves. This alone, she said, will undoubtedly cause long-term trauma among young Black girls as they become adults.

“I’m really concerned about this repeated trauma from this incessant messaging that young girls in Texas and other southern states are going to get over and over and over again,” Blount said. “So in 15 [or] 20 years when they’re adults and out in the workforce, what is this going to mean for them and their emotional well-being?”

As it is for Black women, stress and panic are facts of life, Matthews said. Black women have learned to push through and persist against countless barriers. This is another thing they will have to overcome. For now, the only thing they can do is collectively band together and share resources for support, she said.

What advocates and politicians can do

Abortion experts and advocates say Texas and other states outright banning abortion should increase education and resources relating to pregnancy and childbirth to prepare people for the reality of forced childbirth. But some have very little hope the state will do so.

Instead, Matthews said she believes help will come from community leaders and organizers who work to share information and resources with the Black community.

Blount said organizations like hers will need to come together to fund abortion funds and find resources to help Black women. Her organization is currently working on plans to make abortion medication and Plan B readily and safely available to Black women in the south.

She said state lawmakers should make birth control and Plan B widely and easily available. Plus, they should expand Medicaid and provide better prenatal health care for Black women, and medical providers should listen to and trust feedback from Black women when following up on any health complications.

“There are steps that can be taken to reduce maternal mortality rates, but they start with valuing the very lives of these people who are giving birth,” Blount said.

But one of the biggest things that not just Black women need to be focused on is voting, Blount said. The next election cycle will be highly focused on reproductive justice, and people who want to reinstate bodily autonomy must show up to the polls.

Crockett said she personally wants to ensure that pro-abortion organizations trying to assist abortion-seekers have the funds they need to do so. Plus, she hopes to see other Texas Democrat lawmakers expand resources for Black women.

“It is incumbent upon every elected official who gives a damn to at least make sure that they start going and meeting women where they are and making sure that if there are resources available, that we are educating them on what their options are and what those resources look like,” Crockett said.

Historically, that hasn’t happened, she said, and she has “no faith” that anything will be done on the state level to assist abortion-seekers.

“What can Texas do? A lot,” Crockett said. “What will Texas do? Nothing.”