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.”
