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Black women will suffer the most without Roe

Black women seek abortions at the highest rate and will face greater rates of maternal mortality without the right to choose.

A Black woman and a white woman sit together on the steps of the Supreme Court, the white woman’s head resting on the Black woman’s shoulder. Both have the words “my body” painted on the skin of their chest.
Abortion rights activists protest outside the US Supreme Court on June 24, after Roe v. Wade was overturned.
Stefani Reynolds/AFP via Getty Images
Fabiola Cineas covers race and policy as a reporter for Vox. Before that, she was an editor and writer at Philadelphia magazine, where she covered business, tech, and the local economy.

The United States is now a country without a legal right to an abortion. In this new reality, Black women will suffer the most.

Black women are more likely to live in areas where it’s harder to access contraception. They get abortions at the highest rates compared to women of other races, due to high rates of unintended pregnancy.

The factors that lead some Black women to seek abortions are present from the day they are born, passed down from mothers who faced similar plights. Those born into poverty are less likely to have access to health care, let alone reproductive or maternal health care; when some Black women are able to seek care, they face medical racism. For centuries, Black women have fought for autonomy over their bodies, against government-sanctioned abuse and abuse from intimate partners. The end of a constitutional right to legal abortion makes the fight harder.

State-level abortion restrictions have already taken effect in at least eight states, and in total, 22 states have laws that impose very strict restrictions on abortions. Those states are home to 39 percent of the total US population, but 45 percent of Black women and girls under age 55.

The consequences will be dire. The end of legal abortion will trap Black women in cycles of poverty. The consequences will also be deadly. Black women have the highest rates of maternal mortality and pregnancy complications, and those risks will only increase if more Black women have to carry unwanted pregnancies to term. Here are the numbers that show how alarming the situation is.

Black women are nearly four times more likely to have an abortion than white women

Black women make up the largest percentage of all abortions performed and have the highest abortion rate, according to 2019 data from the Centers for Disease Control and Prevention, the most recent year for which the CDC reported this information.

Out of 629,898 abortions reported to the CDC for 2019, Black women accounted for 38.4 percent of them. By comparison, white women made up 33.4 percent of those abortions.

Abortion rates were 3.6 times higher among Black women when compared to white women. The disparity can be explained by inequities in rates of unintended pregnancies, as well as other factors: unequal access to quality family planning services, economic disadvantage, and distrust of the medical system.

Black women are more likely to live in “contraception deserts” and less likely to have access to health care

Black people are less likely to receive comprehensive sex education, a key factor in preventing unwanted pregnancies. Evaluations of sex education programs have found that they can help young people delay the onset of sexual activity, reduce the number of partners, and increase contraceptive use. One study found that teens who received comprehensive sex education were 50 percent less likely to report a pregnancy than those who received abstinence-only education.

According to one report, Black youth, low-income youth, and youth from single-parent households were less likely to get formal sex ed, and Black youth were more likely to receive abstinence-only education, “which is ineffective and stigmatizing.” This is despite the fact that another survey found that most Black people favor comprehensive sex education for young adults.

Access to contraception like birth control and condoms also reduces the rate at which women have unplanned pregnancies and seek abortions. Yet Black women are more likely to live in “contraception deserts,” areas where barriers to purchasing contraceptives are higher. As a result, Black women ages 15 to 49 are less likely than other racial groups to use birth control regularly. They are also less likely to use prescription contraception, such as birth control pills and long-acting reversible contraceptives (like an IUD or a birth control arm implant), the most effective forms of birth control after abstinence and permanent sterilization. Those between 18 and 24 tend to prefer condoms, which are a less effective way to prevent pregnancy.

The racial gap in contraception access and use is rooted in social and structural racism and discrimination. For one, it’s difficult to access prescription birth control without health insurance. Black women and girls are uninsured at roughly twice the rate of white women and girls, according to data from 2020.

Black women in the South, where a number of abortion bans will take effect, have the lowest rates of health insurance coverage among all Black women. Some Southern states like Mississippi have refused to expand Medicaid coverage, which has prevented Black women in those states from having better health outcomes. Black women in Medicaid expansion states have experienced fewer maternal deaths than those in non-expansion states.

Overall, Black women have less access to quality health care, and less trust in medical professionals who might recommend birth control. The medical profession has a history of pressuring Black women and other women of color to limit their family sizes and consider tubal sterilization. After all, the American “father of modern gynecology” experimented on enslaved Black women in the 19th century without anesthesia. More than one-third of Black women in a 2005 survey believed that “medical and public health institutions use poor and minority people as guinea pigs to try out new birth control methods.”

Researchers in a 2019 study found that Black women tend to live near pharmacies that “impede the purchase of contraception.” The obstacles are many: limited hours, fewer female pharmacists, fewer patient brochures on contraception, condoms that are difficult to access, and fewer self-checkout options.

And when they obtain contraception, it’s more likely to fail: Another report found that Black women and women with low socioeconomic status also have higher rates of contraceptive failure than white and high socioeconomic status women, even when using more effective forms of contraception.

Black women have high rates of unintended pregnancy

In 2011, the latest year for which data is available, 48 percent of all pregnancies in the United States were unintended, meaning they were unplanned, mistimed, or unwanted at the time of conception. Black women are disproportionally at risk for unintended pregnancy: 63 percent of all pregnancies for Black women were unintended, compared to 42 percent for white women.

The study found that women who experience unintended pregnancy have a significant risk of sickness and death. They are also more likely to be poor and to have inadequate access to reliable and affordable contraception.

A majority of women seeking legal abortion services in states with bans are Black

The 13 states with trigger bans — locations where abortion will be prohibited within 30 days of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health, which overturned 1973’s Roe v. Wade — are mostly located in the South, where nearly half of the country’s Black population resides.

In Mississippi, the state that filed Dobbs, Black women got 74 percent of abortions provided in 2019. In Alabama, where an abortion ban went into effect the day the decision came down, it was 62 percent; in Georgia, where abortions after six weeks may soon be banned if a judge grants the state’s request to allow a 2019 law to take effect, 65 percent.

Black women are also less likely to have the financial means to afford out-of-state travel for a time-sensitive abortion. Four in 10 Black women ages 18 to 44 could not afford more than $10 for birth control, according to a 2017 survey, while 46 percent of Black mothers of children under 18 said they could afford $10 or less.

Black women are three times more likely to die from pregnancy-related causes than white women

Black women have the highest maternal mortality rate in the United States — 55.3 per 100,000 live births for 2020, according to CDC data — which means they are more likely to die while pregnant, during delivery, or in the postpartum period. That year, Black women were 2.9 times more likely to die from a pregnancy-related issue than white women.

And the rate has only increased in recent years, growing from 37.3 per 100,000 births in 2018 to 55.3 in 2020. The CDC attributed Black women’s high maternal mortality rate to factors like access to care, quality of care, prevalence of chronic diseases, structural racism, and implicit biases.

Pregnancy complications are the sixth leading cause of death among Black women ages 20 to 44, while pregnancy complications do not rank in the top 10 causes of death for any group of white women. Black women of all education and income backgrounds face the threat of dying in pregnancy and childbirth. A 2016 report found that Black college-educated moms were more likely to suffer severe complications in pregnancy and childbirth than white women who never graduated from high school.

A full abortion ban could increase Black maternal deaths by 33 percent, compared to a 21 percent increase for the overall population, according to a recent study.

Mississippi has some of the worst maternal mortality and infant mortality rates in the United States. The state’s maternal mortality rate is 33 maternal deaths per 100,000 live births. For Black women, that number is 51.9 deaths per 100,000 live births, nearly three times the number for white women, 18.9.

And when Black women don’t die from pregnancy, their pregnancies have riskier complications. This is why some abortions are performed to save lives, though some anti-abortion activists want these exceptions removed from legislation. Rates of ectopic pregnancies — pregnancies in which the egg does not make it to the uterus and instead implants somewhere outside of it, like in a fallopian tube — are higher for Black women, and are the fifth top cause of maternal death.

Black women are disproportionately victims of sexual violence

Black women face some of the highest rates of domestic abuse and violence, a factor that contributes to sexual and reproductive coercion — behaviors related to reproductive health that a partner uses to control the relationship. In one survey, 20 percent of Black women reported that they were made to have sex without a condom when they did not want to. The figure rose to 26 percent for Black mothers.

The inability of Black women to get abortions can lead to greater intimate partner violence. One study found that homicide is the leading cause of death among pregnant and postpartum people and that Black women were at greatest risk.

Black women had a “threefold higher partner rate of partner homicide victimization” than white women, a researcher told The Lily, and pregnant Black women were “eight times more likely to be killed by their intimate partner than non-pregnant Black women.” Researchers explained that Black women’s high rate of unwanted pregnancy is linked to “partner conflict, stress, and violence.”

The landmark decade-long Turnaway Study, which studied women who wanted abortions but were unable to obtain them, found that women who were “turned away” from abortions were more likely to experience continued domestic violence.

On top of this, Black women are less likely to report abuse since they are less likely to be believed, causing psychological trauma. Medical professionals also tend to systematically undertreat them for pain due to medical biases.

Abortion restrictions will trap Black women in a cycle of poverty

Unintended pregnancies that lead to unwanted births create cycles of disadvantage for Black women. Since the pregnancies and births are unplanned, these women are often “forced to make compromises in education and in employment opportunities that subsequently lead to poverty and lower education attainment.”

Being denied an abortion leads to an increase in financial distress that persists for years, according to a recent study.

More than 80 percent of Black mothers are breadwinners, which means they are either the sole earners or earning at least 40 percent of their household’s income. Black women are twice as likely as white women to be the sole breadwinners for their families.

Nearly one in four Black women lives in poverty and, though they make up only 12.8 percent of all women in the US population, represent 22.3 percent of women in poverty. The gender wage gap, the gender wealth gap, and segregation into low-paying jobs all limit their employment opportunities.

The cycle affects their children. The infant mortality rate for Black babies is twice that for white babies. Pregnant Black women are more likely to receive inadequate or delayed prenatal care, and to have poor health outcomes such as low infant birthweight. Their children are also more likely to face developmental delays, poverty, poorer relationships with their mother, neglect, behavioral problems, and lower educational achievement.

States with abortion restrictions tend to have fewer policies that support parents raising children. While the US ranks near the bottom compared to peer countries for many of these measures, states with abortion restrictions in particular tend not to have paid family leave legislation, to rank especially low on women’s income, to have a lot of uninsured women, and to lack quality child care. These trends are sure to worsen the intergenerational cycles of disadvantage that many Black women are stuck in.

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