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Black Organizers Are Finding Ways to Expand Reproductive Justice Post-“Roe”

The political landscape has spiraled into widespread fear among Black families around what it means to seek care.

Demonstrators hold signs and shout slogans in front of the Supreme Court which is hearing arguments related to FDA v. Alliance for Hippocratic Medicine, on March 26, 2024, in Washington, D.C.

Unknowns loom, and uncertainty lingers.

It’s been two years since the U.S. Supreme Court overturned Roe v. Wade, striking down the federal right to an abortion, limiting access in many states, and potentially exacerbating disparities in who’s most likely to suffer severe complications in maternal health and die.

Women wonder whether their doctors should know when they see traces of blood or believe they might be having a miscarriage. Would my doctor know how to treat me? they worry. What treatments can I have? What’s illegal? Who can help?

“We’re not even really sure where we can get an answer,” said Marsha Jones, executive director of the Afiya Center, a reproductive justice organization in Dallas.

It’s hard to know how to maneuver the landscape and understand what type of assistance can be provided, she said. Her state was among the first to pass one of the most extreme restrictions on access to care. Senate Bill 8, signed by Gov. Greg Abbott in 2021, barred physicians from performing abortions after six weeks in pregnancy.

Since, similar policies have cascaded into law across the country, particularly after the 2022 Dobbs decision that left it up to state legislatures to decide the fate of abortion access. And the implications have been far reaching, from the ability to receive medication to the debates around in-vitro fertilization. The Supreme Court remains in the throes of pivotal abortion care decisions. Last week, the high court unanimously struck down a lawsuit seeking to restrict nationwide access to mifepristone, one of two drugs that can be used to end pregnancies or manage miscarriages.

Later this month they’re expected to rule on whether pregnant patients have the constitutional right to an abortion when their health is severely at risk.

Many of the restrictions are largely concentrated in the South, where over half of the country’s Black population resides and the maternal mortality crisis continues to devastate local communities.

“We already were in a health care crisis in this country,” said Monica Simpson, the executive director of SisterSong, an Atlanta-based reproductive rights organization. With federal protections overturned, “it drove us further into crisis.”

Residents are leaving to get care in states where abortion is legal, and in turn, facing economic, travel, and child care barriers. Still, amid the urgency that maternal health care folks feel, there’s a sense of hope. There’s a space where fear flirts with faith and anger brushes up against optimism. This moment requires creativity and innovation, they say.

It calls for a return to their roots, which looks like a celebration of 30 years of the reproductive justice movement, which was developed in Chicago during the 1990s to include the perspectives of marginalized communities. It also means honoring the pivotal moments in civil rights history.

“I have seen our people do the impossible over and over and over again,” Simpson said.

The Gaps Have Been Magnified

Jones remembers one woman who had gotten pregnant shortly after Texas passed Senate Bill 8. In the midst of the uncertainty, a doctor refused to give a sonogram, worried about what the implications of treating a miscarriage could be. Because they weren’t sure what treatment would look like, she went to another state. There, appointments were full. So she sought care in yet another state, where she fell sick and ended up in the hospital.

“She was afraid,” Jones said. “She was scared.”

A few years removed, the family wants to try again for a baby but isn’t sure. The woman worries that, given the state of access and maternal mortality statistics, she might not make it.

“So much harm could happen,” Jones said. “We can’t step away from the dangers of birthing as a Black person, especially in the South. It is real.”

Maternity care deserts make it hard to reach physicians. And, advocates and experts say that many of these states’ refusal to expand Medicaid is contributing to the Black maternal death rate. With more people having to take their pregnancy full term, what does that mean for the number of folks who are suffering severe complications and dying in childbirth?

“The Dobbs decision has really magnified the gaps that are there and increased them with no solution,” Jones said.

In Florida, a six-week ban on abortion access took effect on May 1, and the final decision on whether to protect abortion in the state’s constitution will be left up to residents through an amendment on the November ballot.

State Rep. Angie Nixon describes it as a “crisis of epic proportions,” but perspectives vary among her constituents in Jacksonville. Many residents are older and conservative. Often, she finds herself sharing more about the tenets of reproductive justice and what’s at stake when access to abortion shrinks. She’s worried about the number of OB-GYNs who are choosing to leave the state to practice elsewhere because they’re worried about criminalization.

“It’s tough and I’m scared,” Nixon said. “Black women and brown women will die.”

There’s Room for Hope

When Regina Davis Moss found out she was pregnant with her son, she reveled in the moment. She was excited about the first prenatal care visit. The nine months that followed were filled with wonder and curiosity, she said. She could read about all the miraculous developments happening in her belly without too much worry about a contingency plan.

She’s heartbroken that the political landscape of maternal health care access has spiraled into widespread fear among Black families around what it means to be pregnant and seek medical care.

“It makes me very angry,” Moss said. The idea that many are anxious throughout pregnancy is unsettling for her. Pregnancy, she said, should be a joyful experience. Instead, many must be vigilant about how they’re going to survive. The added stress itself frustrates her. Research shows that living in a constant state of hypervigilance and chronic stress has a poor impact on both physical and mental health outcomes.

Moss fears that when her son goes on to have children, the birth outcomes for his generation may be worse than hers. Black maternal mortality rates have been spiking, thrown off slightly by a significant uptick in deaths during the coronavirus pandemic. The most recent data available shows the numbers are returning to pre-pandemic levels. Still, the maternal mortality rates in the U.S. far surpass other high-income countries.

But, in the mix, Moss leaves room for hope.

She lives in Washington, D.C., and is the president and CEO of In Our Own Voice, a national reproductive justice organization. “To engage in this work, you have to be a believer,” she said. “I am always hopeful.”

She and many others are looking at the past three decades of a reproductive justice movement for inspiration. Jones, who runs the Afiya Center in Texas, had always been clear about why she founded her organization to address HIV rates and support reproductive health care for Black women: It was figuring out how to put the pieces in motion that stumped her. She said she found the answers she was looking for by studying the founders of the reproductive justice movement.

Central to the movement is the idea that no piece of one’s identity needs to be suppressed. It asks folks to come unapologetically with all aspects of their identity, including race, gender, sexuality, and everything else.

“The goal is human rights,” Jones said.

Simpson is also studying history to guide her current efforts. Images of Harriet Tubman and the Montgomery Bus Boycott flash through her mind. “They literally had to think outside of what was in front of them,” she said. From there, she has teased out lessons. We have to be “willing to make ourselves uncomfortable in order to see something better than what’s in front of us.”

The urgency is being met with inspiration, opportunity to envision something new, and courage to speak up. “We really won’t stop,” Jones said.

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