Alexis Bay lives in Texas’s Rio Grande Valley. To her, it already feels like a “post-Roe world”.
Last year a state law criminalised abortion after the point at which a heartbeat can be detected, which often happens before women even realise that they are pregnant. Bay’s non-profit, the Frontera Fund, helps low-income women of colour to access the procedure, usually by sponsoring their travel across state lines.
Before connecting with her organisation, Bay said, some of the women she worked with had gone to desperate lengths to try to end their pregnancies: spending $900 purchasing black-market abortion pills at flea markets, or attempting dangerous self-administered abortions at home.
“People get into really vulnerable situations when they do not have access to abortion healthcare,” she said. “It just keeps people who are marginalised further marginalised.”
Such experiences could be about to become much more common in the US. Earlier this month, a leaked opinion from the Supreme Court showed that it was on the brink of overturning Roe vs Wade, the landmark 1973 decision that established the constitutional right to abortion.
According to advocates and healthcare providers, black women in conservative, southern states — some of which have limited constraints on abortion but rarely as strict as Texas’s — will be most affected by the court’s decision.
Black women get abortions at rates more than three times higher than their white counterparts, according to data from the Centers for Disease Control. There were 23.8 abortions per 1,000 black women in 2019, compared to 6.6 per 1,000 white women.
If Roe vs Wade were reversed, this disparity would be compounded by the fact that abortion access will be disproportionately impacted in the south of the US, where more than half of the nation’s black population lives.
Most southern states, which typically lean conservative, have either put in place “trigger laws” that will automatically restrict abortions if Roe falls, or are almost certain to pass new bans.
Many have also severely limited abortions even with Roe in place; it was a lawsuit over a Mississippi rule curtailing abortion after 15 weeks that triggered the Supreme Court’s review of Roe.
Meanwhile because of racial disparities in wealth, people in these states are also less likely to be able to afford to travel across state lines to get an abortion.
“We already have seen what Covid has done to this community,” said Kecia Gaither, an obstetrician for NYC Health and Hospitals in the Bronx borough of New York City. “So to have that and then not have the opportunity to have any reproductive options? Black women are going to be up in arms.”
Health experts trace the relatively high rates of abortion among black women to structural disparities in access to healthcare. Contraceptives and other types of reproductive healthcare are less available in underserved communities, contributing to inordinately high maternal mortality rates for black women, which are comparable to those in developing countries.
However abortion is not without controversy within the black community. Some 46 per cent of black Americans argue that abortion is morally acceptable, compared to 43 per cent of non-black Americans. But some black leaders compare the procedure’s prevalence in their communities to eugenics.
“You can’t tell me that losing millions of individuals is an aggregate good for the black community,” said Monique Chireau, an obstetrician and senior fellow at the University of Notre Dame.
“All of those people who were aborted, what could they have contributed to the community?” she added.
For others, however, the fight over Roe is a continuation of the civil rights demonstrations sparked by the murder of George Floyd by a police officer in Minneapolis two years ago.
Years after being turned away from an abortion clinic in Illinois at the age of 18, Laurie Bertram Roberts founded the Mississippi Reproductive Freedom Fund to organise transportation and other services for women who want to end their pregnancies.
“I can’t even calculate the harm,” she said, referring to the possibility that Roe could be overturned.
Both Roberts and Bay say their organisations will continue to fund abortions. But Bay said that increased demand for limited appointments at remaining clinics, as well as rising costs from the longer journeys needed to reach them, mean that far fewer women will ultimately be able to access the procedure.
“I honestly think a lot of folks always thought that the courts were going to save us because that’s what’s happened in red states for a long time,” Roberts said. “Our leaders would write these ridiculous laws but Scotus would just swat it back down. And now they realised that was a very, very bad idea.”
