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An abortion rights demonstrator raises their fist, painted in red, in the air while yelling during a rally in front of the US Supreme Court in Washington, D.C., on June 25, 2022, a day after the Supreme Court released a decision on Dobbs v Jackson Women’s Health Organization, striking down the right to abortion. | Source: ROBERTO SCHMIDT / Getty

June 24 marks one year since the United States Supreme Court’s ruling in Dobbs vs. Jackson Women’s Health, which eliminated the constitutional right to abortion. For most women, the case represented another attempt by far-right conservatives to limit reproductive choice. For Black women, the case was the latest in a string of assaults on our right to reproductive health.

Certainly, the decision paved the way for states to ban abortion – in some cases as early as six weeks when few women even know they’re pregnant. As of Jan 20, 2023, the Kaiser Family Foundation found that “Since the Dobbs decision, 23 states have tried to implement a complete ban or a pre-viability ban.” The results have been as disastrous, as were predictable. In an April 2023 paper, Human Rights Watch found that “Women and girls in need of reproductive healthcare are being met with systematic refusals, onerous financial burdens, stigma, fear of violence, and criminalization. Thousands are being forced to remain pregnant against their will.”

But I don’t think we appreciate the extent of devastation this ruling has had and will have. As we near the one-year mark of Dobbs, I want to highlight three ways Black women are particularly vulnerable.

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1. Many Black women live in states that have refused Medicaid expansion or only recently accepted it.

The South is home to the greatest share of Black people, with over half of the Black population living in the South as of 2019. Also in 2019, about 46.8 million people in the U.S. identified as Black, according to Pew Research Center. The South also tends to have the greatest share of states that have not accepted Medicaid expansion. For instance, South Carolina, Texas, Tennessee, Mississippi, Georgia, Florida and Alabama have not accepted Medicaid expansion.

That means that many Black women are living in states that have not expanded Medicaid, and they may themselves lack access to quality health care. To be clear, the Affordable Care Act’s (ACA) expanded Medicaid coverage to nearly all adults with incomes up to 138% of the federal poverty level ($20,120 for an individual in 2023). It also provided funds for rural hospitals. States simply had to accept the funds.

States that have not expanded Medicaid under the ACAhave seen the most rural hospital closures. Medicaid expansion helps keep hospitals afloat by increasing the number of adults with low incomes who have health insurance. Black women who live in states that have yet to expand or have delayed in expanding Medicaid may suffer poorer health outcomes. They may struggle to afford care or live in areas where they are not proximate to care.

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2. Many Black women in the South are not proximate to hospitals or OB-GYNs, let alone Black physicians.

In Georgia, where I live, 26 rural hospitals have closed. Thatmeans that some women must travel hours to receive care. It is not atypical for a woman in Georgia to travel more than 70 to 100 miles just to get to an OB-GYN physician. And only half of Georgia’s counties have OB-GYNs. If a person lacks reliable transportation, a job that offers paid time off or child care, they cannot easily access medical care – preventative or otherwise.

What’s more, when a woman experiences a health emergency or pregnancy-related crisis, doctors may not have hours to spare. For instance, a year after I had my third child, I got pregnant unexpectedly and suffered a blighted ovum. My husband and I went the OB-GYN, and I received misoprostol, a medication to manage a miscarriage. I took the medication at home and almost hemorrhaged to death. We went back to the doctor’s office, and before we could leave, there was so much blood that it looked like a murder scene. I was rushed to the hospital, had a blood transfusion, and was told I couldn’t get a dilation and curettage procedure because of extreme blood loss. At the time, I had three small children (ages 7, 4 and 1). We were living in Durham, North Carolina, which is a metropolitan area. If I lived in a rural area or an area in which there were no hospitals, I would have died. Fortunately, my doctor was right up the road, and the hospital was 2 miles away. Had I experienced a delay, I would have died. If a woman were in a similar set of circumstances today, living in Georgia, the hospital board would have been convened to ensure it wasn’t running afoul of the law and was safeguarded from litigation. The board would have to ensure the doctor was safeguarded from potentially being charged with a crime. The woman would have been sent home as that transpired. I can’t tell you the psychological damage that does to a woman to be sent home when she has a nonviable fetus inside her. What policymakers must appreciate is that these are not flip decisions women make on a whim; they are painful and potentially deadly.

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3. Black women continue to experience racism in medicine.

Even in situations where hospitals and medical centers are proximate, Black women continue to experience racism in medicine from being misdiagnosed to being ignored to having their concerns disregarded. That has ledto higher maternal mortality, especially for Black mamas. The Associated Pressreported on data from the U.S. Centers for Disease Control and Prevention (CDC) thatconfirmed what we already knew: “Black women in the U.S. are nearly three times more likely to die during pregnancy or delivery than any other race.” The same article, citing CDC data, noted, “Black women have the highest maternal mortality rate in the United States — 69.9 per 100,000 live births for 2021, almost three times the rate for white women, according to the Centers for Disease Control and Prevention.”

The misnomer that Black women do not feel pain at the same rate as others is insane. We generally aren’t afforded the same care as others. And when we are given care, it’s usually when we are on the brink, instead of being offered preventative care. Too often, Black mothers must make two or three trips to the hospital before they are treated. For instance, my colleague Jennifer R. Farmer, who supports the Black Southern Women’s Collaborative as a public relations consultant, made multiple trips from her home in Fairfax, Virginia, to the hospital in Alexandria, Virginia(about 18 miles away) when she was pregnant with her youngest child. The nurses on duty repeatedly told her all was well and that she was just dehydrated, even though she had been drinking enough water and was experiencing contractions. It wasn’t until her doctor, a Black woman – Dr. Alice McKnight – was on duty as the attending physician (and after Farmer’s second or third trip to the hospital) that Farmer delivered her child via cesarean section.

The Dobbs decision will only continue to make racism in medicine worse. It will subject Black mothers to criminalization and stigma for seeking care when they should be met with open arms. Even when we hold for socioeconomic status, racism in medicine impacts us all.

What is ironic is that the same people who are making it harder for women to care for themselves – including accessing abortions – have the means to fly their aunt, daughter or niece to a state like New York or Massachusetts to get the care they need. They are insulated. People with limited or no means are the ones who are suffering. The job of organizers and justice-loving people job is to ensure that all women, including Black women, can access the care they need.

Kendra Cotton is the executive director of the New Georgia Project and a member of the Black Southern Women’s Collaborative.


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