When Renee Bracey Sherman had her abortion in Illinois in 2005, she faced few legal or logistical hurdles. She got a ride to a clinic 15 minutes away and paid $350 out of pocket for the procedure and an extra $100 for sedation, nearly maxing out the credit card she saved for emergencies.
Bracey Sherman, then 19, was attending college, working a minimum-wage retail job and stuck in a toxic relationship — but she also “simply didn’t want to be a parent at that time,” she told MarketWatch.
Today, she said, she feels lucky to have avoided restrictive abortion laws that were active in other states at the time and have proliferated over the past decade.
“I’m thankful that I had my abortion, and I’m worried that people won’t be able to live [their] lives as my abortion has afforded me,” said Bracey Sherman, the founder and executive director of We Testify, an organization dedicated to the leadership and representation of people who have abortions.
The now majority-conservative U.S. Supreme Court signaled last month it would hear a challenge to a currently on-hold 2018 Mississippi law that would ban most abortions after 15 weeks of pregnancy. The state has just one remaining abortion clinic and one of the highest poverty rates in the country.
Lower courts had struck down the ban, given Supreme Court precedent that states can’t prohibit people from terminating their pregnancies before viability. A fetus is typically “viable,” or able to survive outside the womb, around 24 weeks.
The news alarmed abortion-rights supporters who feared the nation’s highest court could reverse or severely undermine the landmark 1973 decision Roe v. Wade. A Supreme Court decision limiting abortion access could hit people of color and people with lower incomes particularly hard during a time when they’ve borne the brunt of the pandemic’s economic fallout, advocates say.
(Cisgender women are not the only people who seek abortions, and transgender and nonbinary people often face challenges to accessing abortion care.)
“This particular law at issue would have a huge impact on the people of Mississippi, but there are certainly national implications,” said Heather Shumaker, the director of state abortion access for the National Women’s Law Center, which supports abortion access. “There would be a huge impact for pregnant people all across the country, particularly those who are struggling to make ends meet and who already face barriers to care.”
‘Now [there are] increasing barriers that are forcing people earlier in their pregnancy to figure out: Are they going to pay rent? Or are they going to have to travel in state or out of state for care?’
— Quita Tinsley Peterson, co-director of Accessing Reproductive Care – Southeast
The anti-abortion National Right to Life Committee applauded the announcement. Marjorie Dannenfelser, the president of the anti-abortion Susan B. Anthony List, called it “a landmark opportunity for the Supreme Court to recognize the right of states to protect unborn children from the horrors of painful late-term abortions.”
Days after the Supreme Court’s announcement, Texas Gov. Greg Abbott, a Republican, signed into law a bill prohibiting abortion once cardiac activity is detected in the embryo, as early as six weeks into pregnancy. Because many people are unaware they’re even pregnant at that point, the bill, set to take effect in September, translates to a near total ban on abortion.
Supporters of such measures, which have passed in several states in recent years and remain challenged by courts, call them “heartbeat” bills, a term whose accuracy many healthcare professionals have criticized.
The abortion rate has declined in recent years, largely due to a decrease in pregnancies and births, experts say.
Abortion restrictions disproportionately impact people of color and people with low incomes
Thanks in part to pop-culture portrayals of abortion that skew heavily white, Bracey Sherman, a biracial Black woman, didn’t realize when she had her own abortion that people of color make up a majority of those who have the procedure done. At the time, the only Black woman she knew of who had had an abortion was the rapper Lil Kim.
“Our stories aren’t necessarily out in the media [or on television],” Bracey Sherman said. “That leaves people thinking that they’re alone; they’re one of the only people of color or person who looks like them who’s had an abortion.”
In fact, Black patients accounted for 28% of abortions and Hispanic patients were 25% in 2014, while white patients accounted for 39%, according to the Guttmacher Institute, a reproductive-health think tank that supports abortion rights. In 2018, Black patients made up 34% of abortions, Hispanic patients 20%, and white patients 39%, according to data reported by 30 states and the District of Columbia.
Higher rates of unintended pregnancy among people of color may be related to disparities in consistent contraception access and use, which are often rooted in structural inequities like poverty and racism, research suggests. Some 42% of unintended pregnancies in the U.S. in 2011 ended in abortion, one 2016 study found.
Meanwhile, about 75% of abortion patients in 2014 were poor or had low income, Guttmacher said. The average cost of a surgical abortion at 10 weeks that year was $508, while the average early medication abortion at 10 weeks cost $535, according to the think tank. But costs vary widely, and a state’s abortion-policy climate and laws requiring multiple clinic visits can raise the price tag.
Abortion-policy restrictions currently on the books “overwhelmingly impact people of color and low-income folks,” said Quita Tinsley Peterson, the co-director of Access Reproductive Care – Southeast, an organization that provides financial and logistical support for abortions in Alabama, Florida, Georgia, Mississippi, South Carolina and Tennessee.
Many people who identify as Latina or Latinx live in underserved communities and work multiple jobs that don’t provide sick days or health insurance.
A sample of more than 9,500 callers seeking abortion-fund assistance from ARC – Southeast from 2017 to 2019 largely identified as Black (81%), ages 18 to 34 (84%) and having public or no insurance (87%), according to a journal article co-authored by Tinsley Peterson, who uses the pronouns they and them.
Over the past year, they added, the abortion fund has heard from many people impacted by pandemic-induced job loss or reduced hours who are struggling to pay bills, navigate parenting and balance child-care costs with the financial realities of an abortion.
“Now [there are] increasing barriers that are forcing people earlier in their pregnancy to figure out: Are they going to pay rent? Or are they going to have to travel in state or out of state for care?” Tinsley Peterson said.
Many people who identify as Latina or Latinx live in underserved communities and work multiple jobs that don’t provide sick days or health insurance, added Lupe Rodríguez, the executive director of the National Latina Institute for Reproductive Justice, in an email interview.
“They don’t have the time or money to travel to access abortion care, if the state they call home has added baseless restrictions and requirements to provide care,” Rodríguez said. “Many may not be able to travel at all, due to barriers around their im/migration status or that of a loved one or household member, particularly as our communities are reeling from this pandemic.”
Asked about the broader implications of the Supreme Court case for people of color and people with low incomes seeking abortions, Laura Echevarria, a spokesperson for the National Right to Life Committee, said “the abortion industry targets people of color and Black Americans.” (Abortion-rights supporters dispute this claim.)
“We in the pro-life movement want to see all babies welcomed in life and protected in law,” she said.
Chuck Donovan, the president of the Charlotte Lozier Institute, the Susan B. Anthony List’s research arm, said in a statement that while “abortion advocates argue low-income and minority women need access to abortion for family planning and as part of ‘healthcare,’” those assertions were untrue.
“Permissive abortion policy frustrates and distracts from women’s real needs in rural states for prenatal care and family support,” Donovan said. “If minority women and their children are to benefit, their real need lies in providing better prenatal care and coverage options that reduce the state’s underperformance in maternity care — not ending the lives of children in the womb.”
He pointed to a recent study, published in the peer-reviewed Journal of Primary Care and Community Health and authored by researchers at Charlotte Lozier and other anti-abortion groups, that found Medicaid-eligible women in states that covered abortion services seldom used the procedure to space out children.
People who seek abortions often have intersecting and complex reasons. In one study, those included not feeling financially prepared, bad timing, concerns related to their partner, a need to focus on other children, interference with future educational or job opportunities, lack of mental or emotional preparation and health concerns.
Meanwhile, being denied a wanted abortion is associated with negative socioeconomic consequences — including higher odds of poverty and greater likelihood of receiving public assistance, according to a 2017 American Journal of Public Health study.
Biden spikes the Hyde Amendment
Abortion-rights supporters found some cause for celebration last month when President Biden, fulfilling a campaign promise, omitted from his 2022 budget proposal the Hyde Amendment, which bars the use of federal funds for abortions except in cases of rape, incest and life-threatening conditions. Hyde could still be reinstated as Congress negotiates a spending bill.
Amanda Matos, the senior director of constituency campaigns at the Planned Parenthood Federation of America, which supports access to abortion, called the proposal “much-needed given that access to safe, legal abortion is hanging by a thread.”
“Eliminating the Hyde Amendment — a cruel and unjust law that disproportionately impacts people of color and low-income folks — in this budget is a clear statement from the administration that abortion is essential health care and should never be treated as anything less,” Matos said.
Abortion opponents, meanwhile, assailed the prospect of what they called “taxpayer-funded abortion.” “By eliminating the Hyde Amendment from their proposed budget, the Biden-Harris administration endangers the lives of minorities, and wants to force taxpayers to be complicit,” added Mallory Quigley, the SBA List’s vice president of communications.
Hyde restricts federal funding for abortion for enrollees in Medicaid, Medicare, the Indian Health Service and the Children’s Health Insurance Program. Medicaid beneficiaries in 34 states and D.C. have limited abortion coverage due to Hyde, while 16 states use their own funds for abortions under Medicaid.
Some six in 10 women live in states with policies ‘hostile’ to abortion rights.
Several states also restrict abortion coverage in private insurance plans, health-insurance exchange plans, and/or public employees’ health plans.
While Roe’s legalization of abortion “initiated a new chapter in our fight for equity,” Rodríguez said, “it did nothing to guarantee access to care for our communities.”
“That is why we are fighting not just for reproductive rights and health, but for reproductive justice,” Rodríguez said. “For so many of us Latinas/xs and other people of color who don’t have the means to access abortion care, reproductive rights are a meaningless concept.”
What happens if Roe falls?
In the absence of Roe v. Wade, 22 states have laws that could be used to restrict abortion’s legal status, according to the Guttmacher Institute, including 10 states in which the overturning of the landmark decision would trigger post-Roe laws banning all or or almost all abortions.
But even with Roe as the law of the land, people in many areas still encounter obstacles to abortion access, including mandatory in-person counseling before the procedure and waiting periods that necessitate multiple trips, regulations on abortion clinics, and widespread clinic closures.
“Folks in places like the South and the Midwest are already living in the crumbling of Roe,” Tinsley Peterson said.
Some six in 10 women live in states with policies “hostile” to abortion rights, according to Guttmacher. As of mid-May, at least 549 abortion restrictions had been introduced in 47 states this year, including 165 abortion bans. Sixty-nine restrictions, among them nine bans, had been enacted.
When abortion was illegal before Roe, people who had the means and who lived in certain parts of the country were still able to access “a patchwork of abortion availability,” said Shumaker of the National Women’s Law Center. “We still see that now.”
What is different now compared to the pre-Roe era, Bracey Sherman said, “is that we have more medical technologies, like medication abortion pills.” If Roe were overturned or gutted, Bracey Sherman said, “we’re going to see a lot of what we already actually see right now, just at hyperspeed.”
“Right now people, particularly folks of color, are already being criminalized for self-managing their abortions because there’s no clinic near them, they can’t afford the procedure [or] they can’t get multiple days off work,” she said.
Some states may “regulate abortion out of existence,” prompting the need for more people to travel out of state for the procedure, Bracey Sherman added, and more people may have to manage their own abortions.
A handful of states have laws criminalizing self-managed abortion, and “even in states that have no such laws, politically motivated police and prosecutors may try to misuse other criminal laws to target people who self-manage abortion,” according to If/When/How, an advocacy nonprofit that provides free legal information and advice about self-managed abortion.
Whatever the future holds, there is at least one thing that won’t change, said Bracey Sherman.
“All of us who are on the ground, who are doing this work — whether we’re sharing our stories, opening our homes to people who are traveling for their abortions, or putting up our money to ensure everyone is able to afford the abortion they need — I know we will continue to do that,” she said. “That’s what community looks like.”