More than two years have passed since the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization1 overturned the federal right to abortion, ignoring the legal precedent set by Roe v. Wade.2 During this time, abortion access in the United States has faced dire challenges. As it stands, thirteen states have totally banned abortion care and twenty-eight states currently restrict abortion care based on gestational duration.3

Although millions of people have been impacted by these abortion bans and restrictions, the harm is still disproportionately felt by Black women and birthing people.4 More than half of all Black women in the United States live in states that have already banned or are likely to ban abortion care.5 Abortion bans exacerbate racial and socioeconomic inequities in reproductive and  maternal health outcomes.6 Black women are three times more likely to die7 from pregnancy-related causes than white women and more likely to experience maternal morbidity8 or severe maternal morbidity. 

It’s no surprise that, as attacks on abortion access increase, maternal health outcomes in the United States continue to worsen,9 with Black women and birthing people once again being most at risk of dying during and after childbirth and experiencing adverse health outcomes.10 These unacceptable disparities in reproductive and maternal health experiences and outcomes are multifactorial and reflect the impact of historical and ongoing individual and institutional racism. 

Attacks on abortion care are rooted in a long legacy of systemic oppression designed to increase births by white women and control Black people’s reproduction to achieve the goals of the false ideology of white supremacy.11 This report explores the multiple causes for inequities in reproductive and maternal health, and the need for multidimensional, cross-sectoral solutions. 

Abortion Is Safe, Essential, and Necessary Health Care

About one in four women in the United States will seek abortion care in their lifetime.12 While medication abortion is the most common method (accounting for 63 percent of all abortions in the United States in 2023), all forms of abortion care, including procedural abortion, are safe, essential health care.13 Only 2 percent of all abortions result in serious complications.14 As laws restricting access to abortion care become more pervasive, clinicians and pregnant people may turn to medication abortion, which can be prescribed virtually and taken at home.

About one in four women in the United States will seek abortion care in their lifetime.

The vast majority of medication abortions performed in the United States are done using a combination regimen of the medications mifepristone and misoprostol. Both are extremely safe medications compared to most drugs approved by the U.S. Food and Drug Administration (FDA), such as Tylenol and penicillin, and have minimal side effects. The FDA approved the use of mifepristone for medication abortion in 2000, after years of rigorous testing.

Since then, more than 100 studies have affirmed the safety and efficacy of mifepristone.15 This level of safety exists even when medication abortion is provided via telemedicine, providing an alternate pathway to accessing care beyond visiting a clinician’s office.16 Many people in need of abortion care live in rural areas where access to abortion care providers is limited. Telemedicine is a safe, feasible, and cost-effective option for them to access medication abortion. And, it may become more necessary as physical access to abortion procedures declines. 

When people seek abortion care but are unable to obtain it, the result is that they are forced to carry a pregnancy to term, even at risk to their health. Women who were denied abortion care17 are more likely to experience severe complications during pregnancy,18 less likely to escape intimate partner violence,19 more likely to experience anxiety and stress20 shortly after being denied care, and more likely to experience poverty. And while most people will have healthy pregnancies, there are those who have chronic conditions where pregnancy can cause serious health problems. These risks are exacerbated when people are forced to continue these pregnancies.

The landmark Turnaway Study analyzed economic harms to people denied abortion care by following the lives of two groups of women over a period of ten years—one group who wanted an abortion but were unable to get care and a second group who wanted an abortion and were able to get care.21 The study found that those who were unable to get an abortion experienced an increase in household poverty lasting over a period of at least four years.

By many measures, abortion care is safer in the event severe pregnancy complications occur.

Furthermore, research shows that states with higher numbers of abortion restrictions also have the worst maternal health outcomes.22 By many measures, abortion care is safer in the event severe pregnancy complications occur.23 Moreover, because of anti-Black racism in American society as well as the broader health care system, the risk of health complications from childbirth is considerably higher for Black women and birthing people than it is for white women as noted above.  

Access to abortion care is posited as a political issue when, in fact, for some it is a matter of life and death. Black women and birthing people must be able to decide whether or not to continue a pregnancy and have access to the resources to do so safely. Their lives might depend on it.

Restoring, protecting, and expanding access to abortion care is critical to promoting positive individual health outcomes and better well-being overall. The American people know this—the majority of them believe abortion care should remain legal and see it as an individual health care decision.24 

Attacks on Abortion Access Are Rooted in White Supremacy

Since the inception of European colonization, morality politics and territorial legislature have been weaponized to revoke Black women’s reproductive autonomy. This has resulted in the racialization of reproductive slavery, which combines White supremacy, sexual exploitation, and forced labor. —Brianne Posey25

The rise of harmful conspiracies such as the “great replacement theory” are modern examples of the role that white supremacy plays in the fight to ban abortion.26 This debunked theory argues that white people will be outnumbered by people of color and then subjected to subpar standards of living.27 For example, Congresswoman Mary Miller (R-IL) deemed the Dobbs decision a success for “white life.”28 Though these theories are not based in fact or evidence, they play a part in larger political and cultural pressures that have contributed to the end of a federal right to abortion.29

Attacks on abortion care and the mistreatment and neglect of Black birthing people are deeply rooted in the legacy of white supremacy and a desire to control reproduction.30 The anti-abortion movement ultimately aims to limit the population size of and control the reproduction of people of color, while coercing white women to become pregnant and give birth.31

The United States is built on the labor—both work and birth—of enslaved Black people, especially Black women, who historically were forced to conceive and give birth to the enslaved workforce. In order for white supremacy and the system of racial hierarchy that “justified” enslavement to exist, Black people were stripped of their rights to reproductive freedom, denied autonomy over their own bodies, and denied the right to live with dignity and self-determination.

This legacy of reproductive oppression and coercion continued beyond the institution of chattel slavery into the eugenics movement, which asserted that the right to procreate should be determined by “genetic fitness” and “worthiness” based on Eurocentric physical traits and cultural standards.32 

While few would claim to ascribe to eugenic ideology today, the practices promulgated by the movement are still so pervasive throughout the United States and the world that researchers have developed new terminology to define its depths—reproductive slavery.33 Reproductive slavery is not just a relic of time for history books; it is a modern reality that many people face and that many more will confront as abortion care is banned and reproductive health care is further restricted.

In the last decade alone, there have been reports of coerced34 and forced35 contraception, forced sterilization,36 and egregiously neglectful maternal health care that has resulted in severe harm or loss of life for birthing people and infants. Black women, people of color, immigrants,37 and communities that are made vulnerable as a result of a lack of institutional power or social capital—such as those who are incarcerated or living with disabilities—have been and continue to be targeted.38 Black people who choose to give birth in hospitals are still subject to racism, bias, stigma, and neglect. Home births, midwifery care39 and doula care40 are still largely inaccessible or even criminalized.41 And some of the most powerful institutions, such as hospitals, health care systems, and medical schools, refuse to acknowledge, address, and correct the legacy of the white supremacy and anti-Black racism in medicine that continues to plague American society.42

From forced reproduction during chattel slavery to forced sterilization in recent years, white supremacy does not exist without control of bodies and reproduction. Righting the injustice of reproductive slavery and achieving reproductive freedom demands expanded access to abortion care, full access to comprehensive reproductive health care, informed consent for all procedures, and high quality, holistic maternal health care.43 (This report highlights specific policy solutions that may help accomplish this at the end of the document.)

Pregnancy Criminalization Is Part of the Legacy of Slavery

Over the past two years, the constantly shifting health care landscape post-Dobbs has left many women with navigation anxiety as they search for abortion care out-of-state for the first time.44 Patients and health care providers alike are experiencing debilitating fear, confusion, and concern about being criminalized while receiving or providing abortion care.45 In many states, it remains unclear if and when abortion care is legal, including whether patients themselves or anyone who helps them might be civilly or criminally penalized.

Pregnant people have long been subject to criminalization and obstetric racism based on their pregnancy outcomes.46 Criminal justice systems have begun taking legal action against people seeking care for miscarriages, accusing them of attempting to terminate a pregnancy outside of the medical system.47 This was true under Roe and, since Dobbs, there has been increased attention on pregnancy criminalization as states continue to enact abortion bans and restrictions aimed at curbing access to this safe and essential health care.48 A year after the Dobbs decision, there were at least 210 pregnancy-related prosecutions in the United States—the highest number of pregnancy-related prosecutions documented in a single year.49

Instead of being treated with compassion after experiencing miscarriages in Ohio and South Carolina respectively, two Black women—Brittany Watts and Amari Marsh—were arrested after seeking emergency care and faced criminal charges.50 This risk of this harm is heightened for Black and Native American communities disproportionately impacted by the criminal justice system, yielding devastating consequences when abortion care is out of reach. 

In May 2024, Louisiana governor Jeff Landry signed into law a bill that adds mifepristone and misoprostol to the state’s list of controlled dangerous substances.51 This state law allows the prosecution of people in possession of medication abortion pills without a valid prescription, leaving them to face up to five years in prison. This law, in stoking fear among the population, will make access to medication abortion even more difficult.

When abortion restrictions and bans are enforced through the criminal justice system, patients ultimately become subjects of investigations and doctors become an extension of law enforcement. As is often the case with the criminal justice system, Black and low-income patients are disproportionately impacted by pregnancy criminalization.52

Policing and criminalization of Black people during and after slavery paved the way for the disproportionate policing and higher risk of criminalization for Black and brown people today. In fact, policing in the United States as we know it today can be traced back to “slave patrols,”53 which was created as a means to sow terror among enslaved people with the purpose of preventing rebellions, runaways, and any efforts enslaved women and girls54 made to defend themselves from sexual violence.55 As the legal landscape changed and Black people gained more rights, the slave patrol evolved into police departments meant to enforce Jim Crow laws,56 which were rooted in racism and white supremacy. In light of this, it is unsurprising that the American criminal and carceral system is also used to inhibit reproductive freedom. These systems use a patchwork of criminal laws to punish pregnant people even when there is no authorizing statute.

Another factor that warrants consideration is the role of health care providers in the criminalization of pregnant people. Medical providers, including providers of color, are still trained in the white supremacist patriarchal approach to medicine as it is practiced in the U.S. health care system, and then find themselves operating within that system. Patriarchy and white supremacy are both directly connected to monitoring and surveillance of people’s actions.57 A report from If When How found that 45 percent of cases investigated or prosecuted for suspicion of self-managed abortion were brought to the attention of law enforcement by care providers or social workers.58 Health care provider reporting of miscarriage, self-managed abortion, substance possession, or substance use disrupts the trust that is meant to be inherent in any patient–provider relationship. 

Addressing pregnancy criminalization requires contending with the rise of so-called “fetal personhood” ideology—the idea that a fertilized egg, embryo, or fetus has the same legal rights as a person.59 This belief is at the root of anti-abortion laws and already has far-reaching consequences as states enact laws that aim to expand rights to fertilized eggs, embryos, and fetuses.60 This is especially true for self-managed abortion. Studies show that pregnant people have been arrested for self-managed abortion care even when no relevant law exists. Prosecutors may attempt to use the laws available61—including those related to child abuse, neglect, endangerment, and homicide crimes—to target and criminalize pregnant people.62 

Progress on abortion care will require a rejection of so-called fetal personhood and radical acceptance of bodily autonomy in tandem with a concerted effort by health care workers to recognize the role they play. Health care providers are essential to ensuring reproductive freedom and positive well-being, and they have a choice in whether they help or harm.

Navigating Abortion Care Takes a Toll

Navigating abortion care by itself can also take a physical and emotional toll on Black women.63 Planning to travel for out-of-state abortion care (and possible contingency plans) can be extremely expensive and lead to adverse health outcomes for pregnant women. Furthermore, women who rely on family members and friends to serve as a support system may need to disclose information in order to secure child care or transportation assistance.64 As a result, steps to ensure privacy protection (for example, removing family access to mobile tracking apps) may be necessary to avoid criminalization when seeking out-of-state abortion care.

In November 2022, Candi Miller—a Black woman who lived with chronic conditions—sought abortion care to avoid developing severe pregnancy complications. After a medication abortion, Miller experienced a rare complication and needed emergency care to remove the remaining fetal tissue she didn’t expel to prevent sepsis, a painful and life-threatening blood infection.65 Were she in another state, this procedure would be considered routine and safe, but fearing criminalization at nearby hospitals in Georgia, Miller did not seek care after experiencing complications and subsequently passed away.

According to the 2024 Kaiser Family Foundation Women’s Health Survey, nearly a quarter of Black women who have ever been pregnant and wanted or needed an abortion did not get it.66 Over a third of Black women (33 percent) report that if they wanted or needed an abortion in the near future, they wouldn’t know where to find information. This information gap is worse for women with lower incomes and women living in rural areas. 

Abortion Restrictions Limit Access to Broader Reproductive Health Care

In states with abortion bans and restrictions, people experiencing a miscarriage (also known as spontaneous abortion) are unable to access treatment because abortion care services are no longer available.67 In many cases, Black women presenting to the emergency room for spontaneous abortion or another pregnancy emergency are outright denied care.68

In 2023, Kaitlyn Joshua narrowly survived a life-threatening miscarriage69 in Baton Rouge, Louisiana after being told to wait twelve weeks for her first prenatal appointment because of Louisiana’s abortion ban.70 After experiencing heavy bleeding and labor-like pains, she sought care at two separate emergency rooms (ERs), but both times she was sent home without a clear understanding of whether she was miscarrying or of her treatment options. Ultimately, her experience with specialists and hospital care led her and her husband to decide to hold off on any plans to add to their family.

In December 2022, Anya Cook nearly died after experiencing a pregnancy complication in Florida during her second trimester—preterm premature rupture of the membranes (PPROM)—which led to a miscarriage.71 When she arrived at the hospital, she initially did not receive attention or treatment, despite her visible hemorrhaging. Cook only received treatment after she passed out from blood loss, sustaining damage that limits her chances of becoming pregnant again in the future. 

Since June 2022, wait times for abortion care appointments have increased at nearly 30 percent72 of clinics across North Carolina, Virginia, Maryland, and Washington, D.C.—the areas closest to Georgia and Florida (states that ban abortion after six weeks)—according to data from a May 2024 survey of clinics.73 North Carolina experienced the sharpest increases, with wait times rising in half of the state’s sixteen clinics. 

In August 2022, Amber Thurman sought abortion care in North Carolina, given that her home state of Georgia had already enacted a six-week abortion ban.74 After standstill traffic prevented her from making her appointment, the clinic offered her prescriptions for a medication abortion and additional abortion care counseling. Unfortunately, Thurman experienced rare complications—severe cramping and hemorrhaging—and sought emergency care to remove the remaining tissue. After waiting twenty hours for doctors to operate, Thurman passed away.

The examples above are just a few of the most drastic experiences that happened to make it into the news. There are likely many more of varying severity, affecting people of all backgrounds. LGBTQIA+ people and people living with chronic conditions or disabilities experience barriers to health care that are often compounded by abortion bans and restrictions.75 

Geographical Barriers Limit Access to Abortion Care

Geographical barriers have disproportionately affected Black women seeking abortion care, especially in states with the highest proportions of Black, Latinx, and Indigenous women—those in the South and the Midwest.76 For women living in Georgia and Florida seeking abortion care, the closest state offering abortions after six weeks of pregnancy is North Carolina, which has a twelve-week abortion ban and requires counseling and a seventy-two-hour waiting period before appointments. In 2023, more than 171,000 patients traveled out-of-state for abortion care.77 

Women living in the South, where thirteen states have banned or restricted abortion care, have had to drive as much as six times farther than people in other states to end a pregnancy.

Women living in the South, where thirteen states have banned or restricted abortion care, have had to drive as much as six times farther than people in other states to end a pregnancy, which poses time and financial burdens.78 Out-of-state travel for abortion care (including medication abortion) has more than doubled between 2019 and 2023.79 In Texas, Louisiana, Mississippi, and Alabama, the distance to the nearest health care provider offering out-of-state abortion care services (with available appointments within three weeks) can be as far as 350 to 400 miles. 

Nearly 6.7 million Black women (57 percent of all Black women ages 15–49) live in the twenty-six states that have banned or restricted abortion care.80 More than 14,000 Texas patients crossed the border into New Mexico for an abortion last year.81 An additional 16,000 patients left Southern states bound for Illinois and—similar to Amber Thurman—nearly 12,000 more patients traveled north from South Carolina and Georgia to North Carolina.

Many clinics are overbooked, leaving people to travel even further to find a clinic with an opening, spend more money on safe lodging, and, possibly, receive abortion care much later in pregnancy. Longer driving distances have decreased the likelihood patients will receive abortion care, especially women with limited resources, who may struggle with the costs and complications of longer journeys.82 According to the ongoing Myers Abortion Appointment Availability Survey of more than 700 abortion care facilities, eleven states had median appointment wait times of more than five business days and four states had waits of at least eight business days, not counting weekends or holidays.83 Because restrictions may be based on gestational timing, this means the need to travel may prevent access to abortion care altogether.

Abortion Restrictions Cost Lives and Money

There is no doubt that increasing abortion restrictions costs lives. Researchers have found that, if abortion is banned throughout the United States, the overall number of maternal deaths would rise by 24 percent.84 This number is even worse for Black women, whose deaths would rise by 39 percent. 

Abortion restrictions can also be costly, reducing the quality of life for families who have attempted to access care. When traveling to seek care, many people often shoulder the financial burden of covering abortion care, safe lodging, transportation, and food costs for the duration of their episode of care.85 Some do this while arranging and paying for child care, health insurance premiums, and other out-of-pocket health care costs for their children and families. When people do not have the resources to implement their reproductive decisions, other aspects of their lives are affected. 

The average cost of abortion care during a patient’s first-trimester abortion in the United States is about $550—nearly 50 percent of the monthly income for people living with incomes below the federal poverty line threshold.

According to survey data from the Kaiser Family Foundation, about half of U.S. adults don’t have the cash to cover an unexpected $500 health care bill.86 The average cost of abortion care during a patient’s first-trimester abortion in the United States is about $550—nearly 50 percent of the monthly income for people living with incomes below the federal poverty line threshold.87 The costs associated with abortion care are higher in the second trimester compared to the first trimester (about $775), given the limited availability and complexity of the hospital and specialty care needed to safely provide abortion care further along in a pregnancy.88

In 2023, a couple living in Texas seeking abortion care took $4,000 out of their savings to cover airplane tickets, a rental car, three nights of lodging, and out-of-state abortion care.89 Given the increased costs of accessing abortion care through an out-of-state provider, people with fewer resources may be more likely to choose to self-manage their abortion care or continue the pregnancy.

It is worth noting here that medical debt is also a financial problem affecting women who have recently given birth.90 In a sample of more than 12,000 women, giving birth in the past year was associated with a 31 percent increased risk of having medical debt, and one in five postpartum women carries medical debt. Data also shows racial inequities in medical debt—28 percent of Black households carry medical debt compared to 17 percent of white households. Among pregnant and parenting women who are uninsured or have chronic conditions, such as asthma or gestational diabetes, rates of medical debt were more than doubled.91

About 21 percent of Black women in households that make less than $25,000 per year may not have the support to cover medical expenses in the event of an unexpected illness.92 Occupational segregation continues to keep affordable, employer-sponsored health coverage out of reach for Black women and families. Black women are overrepresented in lower-paying occupations and underrepresented in higher-paying jobs, resulting in wage gaps and limited opportunities to access and afford high-quality health insurance that might cover abortion care.

But it’s not just Black women that are harmed. The Institute for Women’s Policy Research found that since the fall of Roe v. Wade, abortion restrictions have cost the U.S. economy $68 billion per year.93 This economic loss can be attributed to drops in labor force participation, fewer work hours, and lower earnings. 

Restricting Abortion Access Contributes to Provider Shortages and Lack of Diversity

Without a diverse, equitably compensated, well populated, and culturally responsive health care workforce that has been educated on racial disparities and the role of institutionalized racism in medical practice, many of the adverse health outcomes experienced by communities of color, especially by Black women and birthing people, are likely to continue.

The current U.S. health care system was not built with the well-being of Black women and birthing people in mind. Efforts by hospital systems,94 medical schools,95 and research institutions96 in the early twentieth century resulted in the vilification and exclusion of Black midwives,97 preventing women and families from benefiting from the midwifery model of care.98 Throughout the twentieth century, segregation in health care settings99 and academia100 pushed quality health care further out of reach101 for Black women and families and maintained discriminatory practices to prevent physicians,102 nurses,103 and midwives of color104 from providing care. Currently, Black people in the United States make up only 6 percent of the nurse midwifery workforce105 and only 5 percent of the physician workforce,106 despite making up 12 percent of the general population.

However, research shows that patient–provider racial and cultural concordance is a mitigating factor against adverse health outcomes.107 When patients have a health care provider of the same racial or ethnic background as themselves, they have higher ratings of trust, satisfaction, and intention to adhere to medical advice and treatment, resulting in better outcomes. Racial disparities in the health care workforce make patient–provider racial and cultural concordance108 a real challenge, especially in parts of the country that are already experiencing provider shortages in general, irrespective of racial background. When considering the current maternal health crisis, this is a major issue. In 2017, half of all counties in the United States already lacked an obstetrician-gynecologist (OB-GYN). 

The ripple effect of this OB-GYN exodus does not only impact those seeking abortion care. Abortion bans are also putting the future maternal and reproductive health care workforce at risk. Fewer medical students are applying to residency programs in states where there are abortion bans or restrictions, according to a recent study from the Association of American Medical Colleges (AAMC).109 To avoid criminalization, many health care providers have left states in the Midwest and the South to continue their careers in states that have preserved access to reproductive rights and essential health care.

For medical students who applied for residency programs shortly before the Dobbs decision, seeking abortion care training out-of-state has been prohibitively expensive and created new logistical challenges.110 Without housing and financial assistance, abortion care training has been pushed out of reach.111

Nearly half of all the OB-GYN residency and training programs in the country are operating under abortion bans.112 Many medical school faculty have expressed that they are deeply concerned  that the new legal landscape will drive future doctors away from states that have bans, reducing access to physicians for millions of people.113 Many health care providers who have left states with abortion bans and restrictions to practice in these spaces also provide prenatal care; manage labor and delivery, miscarriage treatment, and pregnancy loss; provide counseling for contraceptive care and prescribe medications; and offer reproductive cancer screenings and other preventive services. 

Beyond improving nurse and physician workforce diversity,114 ensuring diversity within the midwifery and doula care workforce115 has been shown to improve maternal health outcomes, as well as clinical and nonclinical support for those seeking abortion care.

State and Federal Policy Recommendations

The false and hypocritical framing of anti-abortion policies as “pro-life” and “pro-woman” is diametrically opposed to the lack of funding support for people who carry their pregnancies to term and parent their children—especially Black women and birthing people of color as well as American families struggling to make ends meet.116 

As noted previously, states with more restrictive abortion policies tend to have the worst maternal health outcomes due to systemic racism,117 fewer supportive policies in place for parenting people and their families,118 and troubling histories of reproductive control and oppression.119 These states are also largely concentrated in the regional South where there are higher concentrations of poverty and where more than half of Black Americans live. It is disingenuous to posit oneself as pro-life and pro-family while simultaneously promoting and passing policies that worsen outcomes for individuals and their families. Clearly, abortion restrictions are not about protecting women’s health or promoting anyone’s well-being. 

While state governments play a significant role in perpetuating this harm, they also possess the power to correct it. Organizations like Guttmacher and the Center for Reproductive Rights have outlined the variety of options states have to protect the right to abortion and expand access to abortion care that are well worth consideration.120 These options include:

  • enacting statutory protections for abortion care;
  • enacting statutory protections for clinics, abortion providers, and people seeking abortion care;
  • strengthening legal protections for people who self-manage abortion and those that support them;
  • amending the state constitution to explicitly protect the right to abortion care;
  • repealing the wide variety of existing restrictions;
  • eliminating the Hyde Amendment and expanding Medicaid coverage of abortion care to not only cover abortion care in cases of life endangerment, rape, or incest, but to cover all medically necessary abortion procedures as well;
  • requiring state-regulated private health insurance plans to cover abortion care; and
  • defunding and regulating anti-abortion centers also known as crisis pregnancy centers.

The federal government also has a responsibility to take action to protect the right to abortion. Currently, there are multiple bills sitting in Congress that would have a positive impact on abortion access and would improve maternal health outcomes for Black women and birthing people.

The Equal Access to Abortion Coverage in Health Insurance (EACH) Act would reverse the Hyde Amendment and related abortion coverage restrictions, having a significant impact on abortion care access for those working to make ends meet.121

The Abortion Justice Act, first introduced to Congress in 2023, acknowledges that even when Roe was the law of the land, abortion care remained out of reach for many due to other insurmountable restrictions.122 This comprehensive legislation would reduce the threat of criminalization, ensure equitable coverage for abortion care, advance major investments in abortion care and related services for community-based organizations, fund improvements to physical and digital infrastructure, provide ancillary services including travel and childcare, and more.

The HEAL for Immigrant Families Act would enable many immigrants to obtain health coverage through Medicaid or from the state health insurance marketplaces.123 If we truly seek to improve reproductive health outcomes for pregnant and parenting people, our approach must be holistic. In addition to abortion-related legislation, there are also a number of intersectional maternal health bills focused on increasing access. Within the Black Maternal Health Momnibus Act of 2023, three bills in particular would address some of the challenges described above in this brief: The Kira Johnson Act, the Perinatal Workforce Act, and the Justice for Incarcerated Moms Act.124

The Kira Johnson Act establishes grants to improve maternal health outcomes for racial and ethnic minority groups and other underserved populations.125 Specifically, the bill would allocate funding to the U.S. Department of Health and Human Services to award grants for community-based programs to improve maternal health outcomes for Black pregnant and postpartum individuals, as well as individuals in other underserved groups; training for health care providers and others who work in maternity care settings on reducing and preventing racism, bias, and discrimination; and respectful maternity care compliance programs in specified health care facilities.

The Perinatal Workforce Act establishes grants for eligible education programs to grow and diversify the perinatal workforce with respect to nurses, physician assistants, and other specified health workers, and otherwise addresses issues related to the maternal health workforce and care delivery models.126 The bill also dictates that the U.S. Department of Health and Human Services would have to disseminate guidance on respectful maternal care delivery that covers, among other topics, recruiting and retaining maternity care providers from diverse backgrounds and incorporating trained midwives, and other perinatal workers in maternity care teams.

The Justice for Incarcerated Moms Act provides funding to promote care for pregnant and postpartum people who are incarcerated.127 The bill also commissions a comprehensive study to understand the scope of the maternal health crisis among incarcerated people and to make recommendations to prevent maternal mortality and severe maternal morbidity in American prisons and jails. Finally, the bill ties federal funding for state and local prisons and jails to prohibitions on the use of restraints for incarcerated pregnant people to end the practice of shackling.

The Impact of the U.S. Supreme Court

The U.S. Supreme Court is tasked with interpreting the meaning of laws and measuring them against the protections guaranteed by the U.S. Constitution—a task they have pursued again and again when it comes to sexual and reproductive health care, specifically abortion. Therefore, it is necessary to understand the impact of each Court decision that affects the legal landscape regarding abortion access because each one has critical implications for reproductive health due to the established relationship between access to abortion care and maternal health. Simply put, more abortion restrictions are associated with increased maternal mortality and poorer maternal health outcomes.

The Court’s decision in Griswold v. Connecticut128 in 1965 established a right to contraception; Roe v. Wade in 1973 famously established a constitutional right to abortion; and Planned Parenthood of Southeastern Pennsylvania v. Casey in 1992 was one of the first cases to begin chipping away at abortion access by upholding Pennsylvania’s parental consent law, thereby paving the way for additional restrictions on abortion.129

Over the years, many states passed laws aimed at restricting abortion access and many of these laws were subsequently challenged in higher courts, with varying outcomes. Ultimately, the 2022 decision in Dobbs overturned Roe and stripped away the national right to abortion. In 2024, the Supreme Court of the United States issued decisions in two additional cases that significantly impacted the provision of abortion care across the United States.130

The cases of Food and Drug Administration v. Alliance for Hippocratic Medicine and Danco Laboratories v. Alliance for Hippocratic Medicine asked the Court to weigh in on the FDA’s approval of mifepristone, one of two medications used in medication abortion. Any restrictions on mifepristone would have devastating impacts on abortion access in the United States. On June 13, 2024, the Supreme Court dismissed the case on standing, ensuring that mifepristone continues to remain available as is. The consolidated cases of Idaho v. United States and Moyle v. United States asked the Court to take up the issue of the conflict between Idaho’s abortion ban and the Emergency Medical Treatment and Active Labor Act (EMTALA), which requires all hospitals receiving Medicare funds to provide emergency care to anyone seeking it.

Conclusion

Without unfettered access to abortion care, our health care system is failing all women, but most especially Black women and birthing people of color. Restrictions on abortion care have far reaching consequences, deepening existing inequities and worsening health outcomes for pregnant and birthing people. Abortion restrictions also have an economic cost that ripples out from individual circumstances to society at large. Protecting and expanding access to abortion care is imperative. Fortunately, there are policymaking tools available to change course to one that values holistic well-being and supports reproductive freedom over oppression.

Additional Resources

Related Research

This report was created by the Black Maternal Health Federal Policy Collective. Primary contributors include Vina Smith-Ramakrishnan, Adrienne Ramcharan, Elizabeth Dawes, Dr. Jamila Perritt, and Ijeoma Egekeze.

The Black Maternal Health Federal Policy Collective, founded by Dr. Jamila Taylor in February 2021, leads the strategic advancement of Black maternal health through federal policy, from inception to implementation. The Collective is a go-to resource for policymakers, advocates, the press, and the public. We aim to ensure that the voices and needs of Black mothers, femmes, and birthing people are heard and central to the policymaking process. The Collective works tirelessly to illuminate the critical issues at the heart of Black maternal health, fostering an environment of understanding, action, and change. Our vision beyond policy change is that of a transformative shift in the societal and systemic structures that contribute to maternal health disparities. Through collaboration, advocacy, and relentless pursuit of justice, the Collective seeks to not only influence policies but also to inspire a culture that embraces and prioritizes the health and well-being of all birthing people. Please direct inquiries to [email protected].

Notes

  1. Dobbs v. Jackson Women’s Health Organization, 142 S. Ct. 2228 (2022).
  2. Roe v. Wade, 410 U.S. 113 (1973)
  3. “State bans on abortion throughout pregnancy,” Guttmacher Institute, 2024, https://www.guttmacher.org/state-policy/explore/state-policies-abortion-bans.
  4. Camille Kidd, Shaina Goodman and Katherine Gallagher Robbins, “State Abortion Bans Threaten Nearly 7 Million Black Women, Exacerbate the Existing Black Maternal Mortality Crisis,” National Partnership for Women and Families, May 15, 2024, https://nationalpartnership.org/report/state-abortion-bans-threaten-black-women.
  5. Camille Kidd, Shaina Goodman and Katherine Gallagher Robbins, “State Abortion Bans Threaten Nearly 7 Million Black Women, Exacerbate the Existing Black Maternal Mortality Crisis,” National Partnership for Women and Families, May 15, 2024, https://nationalpartnership.org/report/state-abortion-bans-threaten-black-women.
  6. Dovile Vilda, Maeve E. Wallace, Clare Daniel, Melissa Goldin Evans, Charles Stoecker, and Katherine P. Theall, “State abortion policies and maternal death in the United States, 2015‒2018,” American Journal of Public Health 111, no. 9 (2021): 1696–704, https://ajph.aphapublications.org/doi/epdf/10.2105/AJPH.2021.306396.
  7. “Working Together to Reduce Black Maternal Mortality,” Centers for Disease Control and Prevention, 2024, https://www.cdc.gov/womens-health/features/maternal-mortality.html.
  8. Eugene Declercq and Laurie Zephyrin, “Severe maternal morbidity in the United States: A primer,” Commonwealth Fund, October 28, 2021, https://www.commonwealthfund.org/publications/issue-briefs/2021/oct/severe-maternal-morbidity-united-states-primer.
  9. Jamila Taylor and Anna Bernstein, “The Worsening U.S. Maternal Health Crisis in Three Graphs,” The Century Foundation, March 2, 2022, https://tcf.org/content/commentary/worsening-u-s-maternal-health-crisis-three-graphs.
  10. Jillian McKoy, “Racism, Sexism, and the Crisis of Black Women’s Health,” Boston University School of Public Health, October 31, 2023, https://www.bu.edu/articles/2023/racism-sexism-and-the-crisis-of-black-womens-health.
  11. Michele Goodwin, “She’s So Exceptional,” The University of Chicago Law Review 91, no. 2 (2024): 593–632, https://live-chicago-law-review.pantheonsite.io/sites/default/files/2024-03/13_Goodwin_SYMP.pdf.
  12. Rachel K. Jones, “An estimate of lifetime incidence of abortion in the United States using the 2021–2022 Abortion Patient Survey,” Contraception 135 (2024): 110445, https://doi.org/10.1016/j.contraception.2024.110445.
  13. Rachel K. Jones and Amy Friedrich-Karnik, “Medication Abortion Accounted for 63% of All US Abortions in 2023—An Increase from 53% in 2020,” Guttmacher Institute, March 19, 2024, https://www.guttmacher.org/2024/03/medication-abortion-accounted-63-all-us-abortions-2023-increase-53-2020.
  14. Sajadi-Ernazarova, Karima, Martinez, Christopher, “Abortion Complications,” StatPearls, May 16, 2023, https://www.ncbi.nlm.nih.gov/books/NBK430793.
  15. “The Safety of Medication Abortion Care (Fact Sheet),” Expanding Medication Abortion Access Project, February 24, 2022,  https://emaaproject.org/wp-content/uploads/2022/02/Fact-Sheet_Safety-of-Medication-Abortion-Care_2-24-22.pdf.
  16. Upadhyay, Ushma D., Leah R. Koenig, Karen Meckstroth, Jennifer Ko, Ena Suseth Valladares, and M. Antonia Biggs, “Effectiveness and safety of telehealth medication abortion in the USA,” Nature Medicine 30, no. 4 (2024): 1191–198, https://www.nature.com/articles/s41591-024-02834-w.
  17. “The Harms of Denying a Woman a Wanted Abortion: Findings from the Turnaway Study,” Advancing New Standards In Reproductive Health, April 22, 2020, https://www.ansirh.org/sites/default/files/publications/files/the_harms_of_denying_a_woman_a_wanted_abortion_4-16-2020.pdf.
  18. Treder, Kelly M., Ndidiamaka Amutah-Onukagha, and Katharine O. White, “Abortion bans will exacerbate already severe racial inequities in maternal mortality,” Women’s Health Issues 33, no. 4 (2023): 328–32, https://www.whijournal.com/article/S1049-3867(23)00098-1/pdf.
  19. Maeve E. Wallace, Charles Stoecker, Sydney Sauter, and Dovile Vilda, “States’ Abortion Laws Associated With Intimate Partner Violence–Related Homicide Of Women and Girls in the US, 2014–20,” Health Affairs 43, no. 5 (2024): 682–90, https://iowans4healthliberty.com/content/uploads/2024/05/wallace-et-al-2024-states-abortion-laws-associated-with-intimate-partner-violence-related-homicide-of-women-and-girls.pdf.
  20. Londoño Tobón, Amalia, Eileen McNicholas, Camille A. Clare, Luu D. Ireland, Jennifer L. Payne, Tiffany A. Moore Simas, Rachel K. Scott, Madeleine Becker, and Nancy Byatt, “The end of Roe v. Wade: Implications for Women’s mental health and care,” Frontiers in Psychiatry 14 (2023): 1087045, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10196497/pdf/fpsyt-14-1087045.pdf.
  21. Diana Greene Foster, The Turnaway Study: Ten Years, a Thousand Women, and the Consequences of Having—or Being Denied—an Abortion (New York: Scribner, 2020).
  22. Dovile Vilda, Maeve E. Wallace, Clare Daniel, Melissa Goldin Evans, Charles Stoecker, and Katherine P. Theall, “State abortion policies and maternal death in the United States, 2015‒2018,” American Journal of Public Health 111, no. 9 (2021): 1696–704, https://ajph.aphapublications.org/doi/epdf/10.2105/AJPH.2021.306396.
  23. “Abortion Access Fact Sheet,” American College of Obstetricians and Gynecologists,  https://www.acog.org/advocacy/abortion-is-essential/come-prepared/abortion-access-fact-sheet.
  24. Shannon Schumacher, Ashley Kirzinger, Audrey Kearney, Isabelle Valdes, and Liz Hamel, KFF Health Tracking Poll March 2024: Abortion in the 2024 Election and Beyond,” Kaiser Family Foundation, March 7, 2024, https://www.kff.org/womens-health-policy/poll-finding/kff-health-tracking-poll-march-2024-abortion-in-the-2024-election-and-beyond.
  25. Brianne M.  Posey, “Reproductive slavery: Historical and present-day discussions of the Black female body as a condition of confinement,” Women’s Studies International Forum 98 (May–June 2023), https://www.sciencedirect.com/science/article/abs/pii/S0277539523000687.
  26. Dustin Jones, “What is the ‘great replacement’ and how is it tied to the Buffalo shooting suspect?” NPR, May 16, 2022, https://www.npr.org/2022/05/16/1099034094/what-is-the-great-replacement-theory.
  27. “The ‘Great Replacement’ Theory, Explained,” National Immigration Forum, 2021, https://immigrationforum.org/wp-content/uploads/2021/12/Replacement-Theory-Explainer-1122.pdf.
  28. Jasmine Aguilera and Abigail Abrams, “What the Buffalo Tragedy Has to Do With the Effort to Overturn Roe,” TIME Magazine, May 21, 2022, https://time.com/6178135/buffalo-shooting-abortion-replacement-theory.
  29. Becky Sullivan, “A GOP congresswoman said the end of Roe is a ‘historic victory for white life’,” NPR, June 26, 2022, https://www.npr.org/2022/06/26/1107710215/roe-overturned-mary-miller-historic-victory-for-white-life.
  30. Michele Goodwin, “The Racist History of Abortion and Midwifery Bans,” ACLU, July 1, 2020, https://www.aclu.org/news/racial-justice/the-racist-history-of-abortion-and-midwifery-bans.
  31. See Erin Blakemore, “How U.S. abortion laws went from nonexistent to acrimonious,” National Geographic, April 11, 2023, https://www.nationalgeographic.com/history/article/the-complex-early-history-of-abortion-in-the-united-states., and Alex Samuels and Monica Potts, “How The Fight To Ban Abortion Is Rooted In The ‘Great Replacement’ Theory,” FiveThirtyEight, July 25, 2022, https://fivethirtyeight.com/features/how-the-fight-to-ban-abortion-is-rooted-in-the-great-replacement-theory.
  32. “Eugenics and Scientific Racism,” National Human Genome Research Institute, May 18, 2022, https://www.genome.gov/about-genomics/fact-sheets/Eugenics-and-Scientific-Racism.
  33. Posey, “Reproductive slavery: Historical and present-day discussions of the Black female body as a condition of confinement,” (2023).
  34. Alana Samuels, “‘I Don’t Have Faith in Doctors Anymore.’ Women Say They Were Pressured Into Long-Term Birth Control,” TIME, May 13, 2024, https://time.com/6976918/long-term-birth-control-reproductive-coercion.
  35. Brenna Evans, “The long scalpel of the law: How United States prisons continue to practice eugenics through forced sterilization,” Minnesota Journal of Law and Inequality (June 7, 2021),https://lawandinequality.org/2021/06/07/the-long-scalpel-of-the-law-how-united-states-prisons-continue-to-practice-eugenics-through-forced-sterilization.
  36. “New NWLC report finds over 30 states legally allow forced sterilization,” NWLC, January 25, 2022, https://nwlc.org/press-release/new-nwlc-report-finds-over-30-states-legally-allow-forced-sterilization.
  37. Maya Manian, “Immigration detention and coerced sterilization: History tragically repeats itself,” ACLU, Septembe 29, 2020,  https://www.aclu.org/news/immigrants-rights/immigration-detention-and-coerced-sterilization-history-tragically-repeats-itself.
  38. Kings Floyd and Vina Smith-Ramakrishnan, “Why Connecting Disability Justice and Reproductive Justice Matters,” The Century Foundation, May 24, 2024, https://tcf.org/content/commentary/why-connecting-disability-justice-and-reproductive-justice-matters.
  39. Anna Bernstein, “This Black Maternal Health Week, Let’s Expand Access to Midwifery Care,” The Century Foundation, April 5, 2022, https://tcf.org/content/commentary/this-black-maternal-health-week-lets-expand-access-to-midwifery-care.
  40. Vina Smith-Ramakrishnan, “Working to Expand Doula Coverage This Black Maternal Health Week,” The Century Foundation, April 11, 2023, https://tcf.org/content/commentary/working-to-expand-doula-coverage-this-black-maternal-health-week.
  41. Natalie Krebs, “As home births rise in popularity, some midwives operate in a legal gray area,” NPR, April 5, 2022, https://www.npr.org/sections/health-shots/2022/04/05/1089927028/midwives-home-births.
  42. Tsai, Jennifer, Edwin Lindo, and Khiara Bridges, “Seeing the window, finding the spider: applying critical race theory to medical education to make up where biomedical models and social determinants of health curricula fall short,” Frontiers in Public Health 9 (July 2021): 653643, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8313803/pdf/fpubh-09-653643.pdf.
  43. “Setting the Standard for Holistic Care of and for Black Women,” Black Mamas Matter Alliance, 2018,  https://blackmamasmatter.org/wp-content/uploads/2018/04/BMMA_BlackPaper_April-2018.pdf.
  44. Rachel Litchman, “Navigation Anxiety: The Administrative Burdens of Being Poor and Disabled,” The Century Foundation, July 26, 2023, https://tcf.org/content/commentary/navigation-anxiety-the-administrative-burdens-of-being-poor-and-disabled.
  45. Alice Miranda Ollstein and Megan Messerly, “Patients are being denied emergency abortions. Courts can only do so much.,” POLITICO, April 23, 2024, https://www.politico.com/news/2024/04/23/doctors-abortion-medical-exemptions-00153317.
  46. See Dmowska, Amelia, Priya Fielding‐Singh, Jodi Halpern, and Ndola Prata, “The intersection of traumatic childbirth and obstetric racism: A qualitative study,” Birth 51, no. 1 (2024): 209–17,
  47. Carter Sherman, “‘I didn’t know what I was supposed to do’: US women who miscarry are in dangerous legal limbo post-Roe,” Guardian, January 24, 2024, https://www.theguardian.com/society/2024/jan/24/us-miscarriage-laws-abortion-rights-options.
  48. Jolynn Dellinger and Stephanie K. Pell, “The criminalization of abortion and surveillance of women in a post-Dobbs world,” Brookings Institution, April 18, 2024, https://www.brookings.edu/articles/the-criminalization-of-abortion-and-surveillance-of-women-in-a-post-dobbs-world.
  49. Wendy Bach and Madalyn K. Wasilczuk, “Pregnancy As a Crime: A Preliminary Report on the First Year After Dobbs,” Pregnancy Justice, September 24, 2024, https://www.pregnancyjusticeus.org/wp-content/uploads/2024/09/Pregnancy-as-a-Crime.pdf.
  50. See Julie Carr Smyth, “A Black woman was criminally charged after a miscarriage. It shows the perils of pregnancy post-Roe,” Associated Press, December 16, 2023, https://apnews.com/article/ohio-miscarriage-prosecution-brittany-watts-b8090abfb5994b8a23457b80cf3f27ce, and Lauren Sausser, “She Was Accused of Murder After Losing Her Pregnancy. SC Woman Now Tells Her Story,” KFF Health News, September 23, 2024, https://kffhealthnews.org/news/article/pregnancy-loss-criminalization-homicide-south-carolina-college-student.
  51. Daniella Silva and Natalie Obregon, “Louisiana governor signs bill classifying abortion pills as controlled dangerous substances,” NBC News, May 24, 2024, https://www.nbcnews.com/news/us-news/louisiana-law-abortion-pills-controlled-dangerous-substances-rcna153937.
  52. Purvaja Kavattur, Somjen Frazer, Abby El-Shafel, Kayt Tiskus, Laura Laderman, Lindsey Hull, Fikayo Walter-Johnson, Dana Sussman, and Lynn Paltrow, “The Rise of Pregnancy Criminalization: A Pregnancy Justice Report,” Pregnancy Justice, September 19, 2023, https://www.pregnancyjusticeus.org/wp-content/uploads/2023/09/9-2023-Criminalization-report.pdf.
  53. “The Origins of Modern Day Policing,” NAACP,  2024, https://naacp.org/find-resources/history-explained/origins-modern-day-policing.
  54. Sydney Trent, “She was raped by the owner of a notorious slave jail. Later, she inherited it.” Washington Post, February 1, 2020, https://www.washingtonpost.com/history/2020/02/02/lumpkin-slave-rape-richmond-jail.
  55. Michele Goodwin, “Involuntary Reproductive Servitude: Forced Pregnancy, Abortion, and the Thirteenth Amendment,” University of Chicago Legal Forum (2022): 191, https://legal-forum.uchicago.edu/sites/default/files/2023-03/Involuntary%20Reproductive%20Servitude-%20Forced%20Pregnancy%2C%20Abortion%2C%20and%20the%20Thirteenth%20Amendment.pdf.
  56. Jason Silverstein, “Jim Crow Laws Are Gone But They’re Still Making Black People Sick,” Vice News, April 26, 2018, https://www.vice.com/en/article/health-effects-jim-crow-laws-cancer.
  57. See Sarah St. Vincent, “What Do Patriarchy and Surveillance Have in Common?” Human Rights Watch, December 25, 2017, https://www.hrw.org/news/2017/12/25/what-do-patriarchy-and-surveillance-have-common, and Sidney Fussell, “How Surveillance Has Always Reinforced Racism,” Wired, June 19, 2020, https://www.wired.com/story/how-surveillance-reinforced-racism.
  58. Laura Huss, Farah Diaz-Tello, and Goleen Samari, “Self-Care, Criminalized: August 2022 Preliminary Findings,” If, When, How, June 22, 2023, https://ifwhenhow.org/wp-content/uploads/2023/06/22_08_SMA-Criminalization-Research-Preliminary-Release-Findings-Brief_FINAL.pdf.
  59. “When Fetuses Gain Personhood: Understanding the Impact on IVF, Contraception, Medical Treatment, Criminal Law, Child Support, and Beyond,” Pregnancy Justice, August 17, 2022, https://www.pregnancyjusticeus.org/wp-content/uploads/2023/05/fetal-personhood-with-appendix-UPDATED-1.pdf.
  60. Anna North, “Fetal personhood laws, explained,” Vox, March 4, 2024, https://www.vox.com/policy/24090347/alabama-ivf-ruling-fetal-personhood-abortion-embryos.
  61. Laura Huss, Farah Diaz-Tello, and Goleen Samari, “Self-Care, Criminalized: The Criminalization of Self-Managed Abortion from 2000 to 2020,” If/When/How, 2023, https://ifwhenhow.org/wp-content/uploads/2023/10/Self-Care-Criminalized-2023-Report.pdf.
  62. Deidre McPhillips, “Post-Roe, pregnant women face growing risk of criminal prosecution for charges much broader than abortion,” CNN, September 24, 2024, https://www.cnn.com/2024/09/24/health/criminal-charges-during-pregnancy-increase/index.html.
  63. Katrina Kimport, and Maryani Palupy Rasidjan, “Exploring the emotional costs of abortion travel in the United States due to legal restriction,” Contraception 120 (2023): 109956, https://www.contraceptionjournal.org/article/S0010-7824(23)00009-4/pdf.
  64. Kimport, “Exploring the emotional costs of abortion travel in the United States due to legal restriction,” (2023).
  65. Kavitha Surana, “Afraid to Seek Care Amid Georgia’s Abortion Ban, She Stayed at Home and Died,” ProPublica, September 18, 2024, https://www.propublica.org/article/candi-miller-abortion-ban-death-georgia.
  66. Ivette Gomez, Karen Diep, Brittni Frederiksen, Usha Ranji, and Alina Salganicoff, “Abortion Experiences, Knowledge, and Attitudes Among Women in the U.S.: Findings from the 2024 KFF Women’s Health Survey,” Kaiser Family Foundation, August 14, 2024, https://www.kff.org/womens-health-policy/issue-brief/abortion-experiences-knowledge-attitudes-among-u-s-women-2024-womens-health-survey.
  67. Usha Ranji, Alina Salganicoff, and Laurie Sobel, “Dobbs-era Abortion Bans and Restrictions: Early Insights about Implications for Pregnancy Loss,” Kaiser Family Foundation, May 2, 2024, https://www.kff.org/womens-health-policy/issue-brief/dobbs-era-abortion-bans-and-restrictions-early-insights-about-implications-for-pregnancy-loss.
  68. Amanda Seitz, “Emergency rooms refused to treat pregnant women, leaving one to miscarry in a lobby restroom,” Associated Press, April 29, 2024, https://apnews.com/article/pregnancy-emergency-care-abortion-supreme-court-roe-9ce6c87c8fc653c840654de1ae5f7a1c.
  69. Rosemary Westwood, “Bleeding and in pain, she couldn’t get 2 Louisiana ERs to answer: Is it a miscarriage?” NPR, December 29, 2022, https://www.npr.org/sections/health-shots/2022/12/29/1143823727/bleeding-and-in-pain-she-couldnt-get-2-louisiana-ers-to-answer-is-it-a-miscarria.
  70. Rosemary Westwood, “Bleeding and in Pain, a Pregnant Woman in Louisiana Couldn’t Get Answers,” Kaiser Health News, January 12, 2023, https://kffhealthnews.org/news/article/bleeding-and-in-pain-a-pregnant-woman-in-louisiana-couldnt-get-answers.
  71. Poppy Noor, “’They forced me to carry my baby to the end’: women of color on being denied abortion post-Roe,’” The Guardian, June 22, 2023, https://www.theguardian.com/us-news/2023/jun/22/post-roe-abortion-women-of-color.
  72. Caitlin Gilbert, Caroline Kitchener, and Janice Kai Chen. “How Florida’s Abortion Law Is Affecting East Coast Abortion Clinics.” Washington Post, May 24, 2024, https://www.washingtonpost.com/nation/2024/05/24/abortion-clinics-wait-time-florida-law.
  73. Caitlin Meyers, Abortion Access Dashboard (2024), Middlebury College, (2024), https://experience.arcgis.com/experience/6e360741bfd84db79d5db774a1147815/page/Page/?views=Dashboard—October-10.
  74. Kavitha Surana, “Abortion Bans Have Delayed Emergency Medical Care. In Georgia, Experts Say This Mother’s Death Was Preventable.,” ProPublica, September 16, 2024, https://www.propublica.org/article/georgia-abortion-ban-amber-thurman-death.
  75. Kings Floyd and Vina Smith-Ramakrishnan, “Why Connecting Disability Justice and Reproductive Justice Matters,” The Century Foundation, May 24, 2024, https://tcf.org/content/commentary/why-connecting-disability-justice-and-reproductive-justice-matters.
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  77. Molly Cook Escobar, Amy Schoenfeld Walker, Allison McCann, Scott Reinhard, and Helmuth Rosales, “171,000 Traveled for Abortions Last Year. See Where They Went.” New York Times, June 13, 2024, https://www.nytimes.com/interactive/2024/06/13/us/abortion-state-laws-ban-travel.html.
  78. People living in states with abortion bans or restrictions had to travel an average of 276 miles each way to access abortion care in parts of the United States where abortion remains legal (about six times farther than before). See Mathieu Benhamou, Kelsey Butler and Chloe Whiteaker, “Americans in 26 States Will Have to Travel 552 Miles For Abortions,” Bloomberg News, June 24, 2022, https://www.bloomberg.com/graphics/2022-supreme-court-abortion-travel/?leadSource=uverify%20wall.
  79. Molly Cook Escobar, Amy Schoenfeld Walker, Allison McCann, Scott Reinhard, and Helmuth Rosales, “171,000 Traveled for Abortions Last Year. See Where They Went.” New York Times, June 13, 2024, https://www.nytimes.com/interactive/2024/06/13/us/abortion-state-laws-ban-travel.html.
  80. Camille Kidd, Shaina Goodman and Katherine Gallagher Robbins, “State Abortion Bans Threaten Nearly 7 Million Black Women, Exacerbate the Existing Black Maternal Mortality Crisis,” National Partnership for Women and Families, May 15, 2024, https://nationalpartnership.org/report/state-abortion-bans-threaten-black-women.
  81. Molly Cook Escobar, Amy Schoenfeld Walker, Allison McCann, Scott Reinhard, and Helmuth Rosales, “171,000 Traveled for Abortions Last Year. See Where They Went.” New York Times, June 13, 2024, https://www.nytimes.com/interactive/2024/06/13/us/abortion-state-laws-ban-travel.html.
  82. See Amy Schoenfeld Walker, Allison McCann and Ava Sasani, “U.S. Abortion Landscape (Interactive Map),” New York Times, June 24, 2022, https://www.nytimes.com/interactive/2022/06/24/upshot/dobbs-roe-abortion-driving-distances.html, and Cunningham, Scott, Jason M. Lindo, Caitlin Myers, and Andrea Schlosser, “How far is too far? New evidence on abortion clinic closures, access, and abortions,” National Bureau of Economic Research, April 2017, https://www.nber.org/system/files/working_papers/w23366/revisions/w23366.rev2.pdf?sy=366.
  83. Caitlin K. Myers, “Myers Abortion Facility Database,” OSF, September 4, 2024, doi:10.17605/OSF.IO/8DG7R.
  84. See Stevenson, Amanda J., Leslie Root, and Jane Menken. 2022. “The Maternal Mortality Consequences of Losing Abortion Access,” SocArXiv, June 29, 2022, https://osf.io/preprints/socarxiv/7g29k. See Treder, Kelly M., Ndidiamaka Amutah-Onukagha, and Katharine O. White, “Abortion bans will exacerbate already severe racial inequities in maternal mortality,” Women’s Health Issues 33, no. 4 (2023): 328–32, https://www.whijournal.com/action/showPdf?pii=S1049-3867%2823%2900098-1.
  85. Salma Elakbawy and Emme Rogers, “The Economic Fallout of Reproductive Rights Restrictions on Women’s Futures,” Institute of Women’s Policy Research, March 1, 2024, https://iwpr.org/the-economic-fallout-of-reproductive-rights-restrictions-on-womens-futures.
  86. Lunna Lopes, Alex Montero, Marley Presiado, and Liz Hamel, “Americans’ Challenges with Health Care Costs,” Kaiser Family Foundation, March 1, 2024, https://www.kff.org/health-costs/issue-brief/americans-challenges-with-health-care-costs.
  87. Elizabeth Harned and Liza Fuentes, “Abortion Out of Reach: The Exacerbation of Wealth Disparities After Dobbs v. Jackson Women’s Health Organization,” Guttmacher Institute, January 25, 2023, https://www.guttmacher.org/article/2023/01/abortion-out-reach-exacerbation-wealth-disparities-after-dobbs-v-jackson-womens.
  88. Attia Taylor, “How much does it cost to get an abortion?” Planned Parenthood (Blog Post), November 2022, https://www.plannedparenthood.org/blog/how-much-does-it-cost-to-get-an-abortion.
  89. See Laura Ungar, “It’s taking longer to get an abortion in the US. Doctors fear riskier, more complex procedures,” Associated Press, December 9, 2023, https://apnews.com/article/abortion-care-wait-times-us-roe-dobbs-7b0a328bb34b0acb3d37e359a63712fc.
  90. Cahn, Jordan, Ayesha Sundaram, Roopa Balachandar, Alexandra Berg, Aaron Birnbaum, Stephanie Hastings, Matthew Makansi, et al. “The Association of Childbirth with Medical Debt in the USA, 2019–2020,” Journal of General Internal Medicine 38, no. 10 (2023): 2340–346. https://link.springer.com/article/10.1007/s11606-023-08214-3.
  91. See Noam N. Levey, Aneri Pattani, Bram Sable-Smith, Megan Kalata, Anna Back, Margaret Ferguson, Amber Cole, Yuki Noguchi, Robert Benincasa, Nick McMillan, and Anna Werner, “Diagnosis: Debt,” KFF Health News and NPR, June 16, 2022, https://kffhealthnews.org/diagnosis-debt, and Cynthia Cox and Gary Claxton, “Medical Debt Among New Mothers,” Kaiser Family Foundation, May 9, 2024, https://www.kff.org/health-costs/issue-brief/medical-debt-among-new-mothers.
  92. “Black Women Experience Pervasive Disparities in Access to Health Insurance,” National Partnership for Women and Families, April 1, 2019, https://nationalpartnership.org/wp-content/uploads/2023/02/black-womens-health-insurance-coverage.pdf.
  93. “2024 Analysis: Cost of Reproductive Health Restrictions,” Institute for Women’s Policy Research, June 20, 2024, https://iwpr.org/2024-analysis-costs-of-reproductive-health-restrictions.
  94. Largent, Emily, “Public health, racism, and the lasting impact of hospital segregation,” Public Health Reports 133, no. 6 (2018): 715–20. https://journals.sagepub.com/doi/epub/10.1177/0033354918795891.
  95. Nguemeni Tiako, Max Jordan, Victor Ray, and Eugenia C. South, “Medical schools as racialized organizations: how race-neutral structures sustain racial inequality in medical education—a narrative review,” Journal of General Internal Medicine 37, no. 9 (2022): 2259–266, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9202970/pdf/11606_2022_Article_7500.pdf.
  96. Nuriddin, Ayah, Graham Mooney, and Alexandre IR White, “Reckoning with histories of medical racism and violence in the USA,” The Lancet 396, no. 10256 (2020): 949–51, https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2932032-8.
  97. Lauren Fung and Leandra Lacy, “A Look at the Past, Present, and Future of Black Midwifery in the United States,” Urban Institute, May 18, 2023, https://www.urban.org/urban-wire/look-past-present-and-future-black-midwifery-united-states.
  98. Robert Foreman, “Midwifery Review: Adding Care by Midwives Improves Birth Outcomes,” Yale University School of Medicine, August 15, 2023, https://medicine.yale.edu/news-article/the-value-of-midwives-during-prenatal-care-and-birth.
  99. “Segregation in Health Care,” AMA Journal of Ethics 25, no. 1 (January 2023): E1–87,  https://journalofethics.ama-assn.org/sites/joedb/files/2023-02/joe-2301.pdf.
  100. Harriet A. Washington, “How Does Racial Segregation Taint Medical Pedagogy?” AMA Journal of Ethics 25, no. 1 (January 2023): 72–78, https://journalofethics.ama-assn.org/sites/joedb/files/2022-12/msoc1-2301.pdf.
  101. Amutah, Christina, Kaliya Greenidge, Adjoa Mante, Michelle Munyikwa, Sanjna L. Surya, Eve Higginbotham, David S. Jones et al., “Misrepresenting race—the role of medical schools in propagating physician bias,” New England Journal of Medicine 384, no. 9 (2021): 872–78. https://www.nejm.org/doi/pdf/10.1056/NEJMms2025768.
  102. Anna Flagg, “The Black Mortality Gap, and a Document Written in 1910,” New York Times, August 30, 2021, https://www.nytimes.com/2021/08/30/upshot/black-health-mortality-gap.html.
  103. Iheduru‐Anderson, Kechi, “Barriers to career advancement in the nursing profession: Perceptions of Black nurses in the United States,” Nursing Forum 55, no. 4 (2020): 664–77, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7689724/pdf/NUF-55-664.pdf.
  104. Mehra, Renee, Amy Alspaugh, Jennie Joseph, Bethany Golden, Nikki Lanshaw, Monica R. McLemore, and Linda S. Franck, “Racism is a motivator and a barrier for people of color aspiring to become midwives in the United States,” Health Services Research 58, no. 1 (2023): 40–50, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9836944/pdf/HESR-58-40.pdf.
  105. Jodie Katon, Daniel Enquobahrie, Kate Jacobsen, and Laurie  Zephyrin, “Policies for Reducing Maternal Morbidity and Mortality and Enhancing Equity in Maternal Health: A Review of the Evidence,” Commonwealth Fund, November 2021, https://doi.org/10.26099/ecxf-a664.
  106. Jacqueline Howard, “Only 5.7% of US doctors are Black, and experts warn the shortage harms public health,” CNN News, February 21, 2023, https://www.cnn.com/2023/02/21/health/black-doctors-shortage-us/index.html.
  107. Okpa, Adaora, Miatta Buxton, and Marie O’Neill, “Association between provider-patient racial concordance and the maternal health experience during pregnancy,” Journal of Patient Experience 9 (2022): 1–6,  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8829722/pdf/10.1177_23743735221077522.pdf.
  108. Gonzalez, Dulce, Genevieve M. Kenney, Marla McDaniel, and Claire O’Brien, “Racial, ethnic, and language concordance between patients and their usual health care providers,” Robert Wood Johnson Foundation, March 1, 2022,  https://www.rwjf.org/en/insights/our-research/2022/03/racial-ethnic-and-language-concordance-between-patients-and-their-usual-healthcare-providers.html.
  109. See Kendal Orgera and Atul Grover, “States With Abortion Bans See Continued Decrease in U.S. MD Senior Residency Applicants,” AAMC Research and Action Institute, May 9, 2024, https://www.aamcresearchinstitute.org/our-work/data-snapshot/post-dobbs-2024, and Julie Rovner and Rachana Pradhan, “Medical residents are starting to avoid states with abortion bans, data shows,” KFF Health News, May 9, 2024, https://www.npr.org/sections/health-shots/2024/05/09/1250057657/medical-residents-starting-avoid-states-abortion-bans.
  110. Carter Sherman, “US doctors struggle to get basic abortion training two years after fall of Roe,” Guardian, June 24, 2024, https://www.theguardian.com/world/article/2024/jun/24/abortion-training-doctors-ban-roe.
  111. Tara Law, “Residents Already Need to Travel for Abortion Training. Experts Fear Roe’s End Will Make It Even Harder,” TIME Magazine, May 23, 2022, https://time.com/6178686/abortion-training-medical-residents-difficulties.
  112. Laura Kurtzman, “Many Residents Won’t Get Abortion Training if Roe Is Overturned,” University of California San Francisco, April 28, 2022, https://www.ucsf.edu/news/2022/04/422741/many-residents-wont-get-abortion-training-if-roe-overturned.
  113. Maryn Mckenna, “States With Abortion Bans Are Losing a Generation of Ob-Gyns,” Wired, June 28, 2023, https://www.wired.com/story/states-with-abortion-bans-are-losing-a-generation-of-ob-gyns.
  114. Rotenstein, Lisa S., Joan Y. Reede, and Anupam B. Jena, “Addressing workforce diversity—a quality-improvement framework,” New England Journal of Medicine 384, no. 12 (2021): 1083–86. https://www.nejm.org/doi/pdf/10.1056/NEJMp2032224.
  115. “Doulas and Midwives Are Key Partners in Improving Maternal and Infant Health Outcomes,” National Advisory for State Health Policy, December 23, 2022, https://nashp.org/doulas-and-midwives-are-key-partners-in-improving-maternal-and-infant-health-outcomes.
  116. Amanda Roberti, “Pro-Life and Pro-Woman? Republican Women and Antiabortion Legislation,” The Gender Policy Report, University of Minnesota, July 21, 2022, https://genderpolicyreport.umn.edu/pro-life-and-pro-woman-republican-women-and-antiabortion-legislation.
  117. Dovile Vilda, Maeve E. Wallace, Clare Daniel, Melissa Goldin Evans, Charles Stoecker, and Katherine P. Theall, “State abortion policies and maternal death in the United States, 2015‒2018,” American Journal of Public Health 111, no. 9 (2021): 1696–704, https://ajph.aphapublications.org/doi/epdf/10.2105/AJPH.2021.306396.
  118. “Evaluating Abortion Restrictions and Supportive Policy Across the United States (Interactive Map),” Ibis Reproductive Health and Center for Reproductive Rights, 2024, https://evaluatingpriorities.org.
  119. Jamila K. Taylor, “Structural racism and maternal health among Black women,” The Journal of Law, Medicine & Ethics 48, no. 3 (2020): 506–17, https://journals.sagepub.com/doi/epub/10.1177/1073110520958875.
  120. See Elizabeth Nash and Isabel Guarnieri, “Eight Ways State Policymakers Can Protect and Expand Abortion Rights and Access in 2023,” Guttmacher Institute, January 12, 2023, https://www.guttmacher.org/2023/01/eight-ways-state-policymakers-can-protect-and-expand-abortion-rights-and-access-2023, and“After Roe Fell: Abortion Laws by State (Interactive Map),” Center for Reproductive Rights, July 25, 2022, https://reproductiverights.org/maps/abortion-laws-by-state.
  121. H.R.561 – 118th Congress (2023-2024): EACH Act of 2023, February 21, 2023,  https://www.congress.gov/bill/118th-congress/house-bill/561.
  122. H.R.4303 – 118th Congress (2023-2024): Abortion Justice Act of 2023, September 25, 2023, https://www.congress.gov/bill/118th-congress/house-bill/4303.
  123. H.R.5008 – 118th Congress (2023-2024): HEAL for Immigrant Families Act of 2023, July 28, 2023, https://www.congress.gov/bill/118th-congress/house-bill/5008.
  124. H.R.3305 – 118th Congress (2023-2024): Black Maternal Health Momnibus Act, May 19, 2023, https://www.congress.gov/bill/118th-congress/house-bill/3305.
  125. H.R.3310 – 118th Congress (2023-2024): Kira Johnson Act. May 19, 2023. https://www.congress.gov/bill/118th-congress/house-bill/3310.
  126. H.R.3523 – 118th Congress (2023-2024): Perinatal Workforce Act, May 19, 2023, https://www.congress.gov/bill/118th-congress/house-bill/3523.
  127. H.R.3344 – 118th Congress (2023-2024): Justice for Incarcerated Moms Act. May 15, 2023. https://www.congress.gov/bill/118th-congress/house-bill/3344.
  128. Griswold v. Connecticut, 381 U.S. 479, 1964.
  129. “U.S. Supreme Court Case Summaries: Griswold and Leading Abortion Cases,” Center for Reproductive Rights, July 1, 2009, https://reproductiverights.org/u-s-supreme-court-case-summaries-griswold-and-leading-abortion-cases.
  130. Anna Bernstein, “Supreme Court to Hear Two Key Cases on Abortion Access,” The Century Foundation, March 17, 2024, https://tcf.org/content/commentary/supreme-court-to-hear-two-key-cases-on-abortion-access.

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