As we mark the 45th anniversary of Roe v. Wade, two facts about the current abortion patient population in the U.S. are especially striking. First, that patients are disproportionately poor, with half living below the official poverty line and another 25 percent classified as low income. And second, that these patients are also disproportionately women of color, as African American and Latina women together make up more than half of all abortion patients, despite comprising just 29 percent of the total U.S. population. The overrepresentation of poor and minority women is due largely to their lack of regular and supportive primary care, through which contraceptive options would be offered. Specifically, one of the most effective contraceptive options currently is Long Acting Reversible Contraception (LARCs), such as IUDs or hormonal implants, which, if not subsidized by insurance, can cost as much as $1,000. As of this writing, the Trump Administration’s efforts to remove contraception, including LARCs, from the list of approved preventive services, is in the courts. (At the same time, some advocates and clinicians are concerned that LARCs are pushed too enthusiastically on minority women by some health professionals.)
These demographic factors affect the provision of abortion in various ways. The poverty of so many patients means these women need help not only paying for their procedures (around $550 for a first trimester abortion), but also for travel to the clinic, and for a hotel in states that have a waiting period or when the procedure has to be done over two days, as is common with some second trimester abortions. These difficulties are compounded by the fact that the Hyde amendment prevents federal dollars for being used for abortions except in very limited circumstances, and only 15 states permit their Medicaid funds to pay for abortions. The small number of patients who require abortions in the third trimester require the most help if they are poor: abortions at later gestations can cost thousands and patients typically need help in reaching the only three clinics in the country—in Maryland, New Mexico, and Colorado—that perform abortions at that stage.
The provider community has tried to respond to the financial realities of their patients by offering sliding scale, if not free, abortions as much as is feasible, and the larger pro-choice movement has worked assiduously to raise money for subsidized abortions through national and local funds. Nevertheless, each year, many people who want abortion simply can’t get them. And as the landmark Turnaway Study, performed by my colleagues at the University of California, San Francisco, has shown in just-published data, women who don’t get the abortions they seek—in this case because their pregnancies have advanced past the gestational limit in their state—face considerable economic consequences.
The racial composition of abortion patients has led to renewed attempts by the anti-abortion movement, including some Black social conservatives, to capitalize on this fact. Accusations of “Black genocide” have emerged among both Black and White abortion opponents, as well as a billboard campaign in several major cities, with messages like “the most dangerous place for a black child is in his mother’s womb.” These tactics have been forcefully rebutted by reproductive justice activists in the African American community, who argue that Black women should be trusted to make their own decisions about their pregnancies. But at abortion clinics, patients’ race is often highlighted in even more disturbing ways. Numerous clinic staff have told me of largely White protestors screaming at Black women as they arrive, “Don’t murder your baby! You may be killing the next Barack Obama [or Martin Luther King]!”
The overrepresentation of women of color as both abortion patients and those who need the most support affording abortion and contraception, leads to an intriguing puzzle. U.S. history is replete with examples of hostility to reproduction among certain populations. In 1905, President Theodore Roosevelt condemned as “race suicide” the lower birth rates of citizens with Northern European backgrounds compared to the higher birth rates of immigrants from Southern and Eastern Europe. In the first part of the 20th Century, the eugenics movement was very much part of mainstream U.S. culture, including the 1927 Buck v. Bell Supreme Court decision that permitted the sterilization of the “unfit.” By the 1960s, this hostility became increasingly focused on Black and brown people, as in the notorious sterilizations of Latinas in California and African Americans in the South—a procedure that became so common that the operations were nicknamed “Mississippi appendectomies.” More recently, consider the calls in the early 1990s to make receiving the contraceptive implant Norplant a condition of receiving welfare, or reduced jail time.
Given this long history of conservative fears about minority population growth—today expressed in the raging battles over immigration and particularly DACA—some might be puzzled by the Trump administration’s and many Red states’ legislatures’ fervent opposition to abortion and contraception. These services, after all, would limit the number of children born to people of color—children, who, much to the frustration of anti-immigrant forces, would receive U.S. citizenship. To be sure, it is not as if reproduction among these groups is supported. The U.S. has the worst rate of maternal mortality in the developed world, particularly among African American women, and similarly abysmal infant and children’s health services.
Poor people of color who are neither supported in their attempts to control their fertility nor to have healthy pregnancies and healthy children, are victims of incoherent but highly punitive policies.
Poor people of color who are neither supported in their attempts to control their fertility nor to have healthy pregnancies and healthy children, are victims of incoherent but highly punitive policies. Besides the current attacks on abortion and contraception, these women (as well as some White ones) are subjected to arrest and incarceration for drug use during pregnancy, rather than receiving rehabilitation services. Women in labor have been arrested for not agreeing to doctors’ demands that they undergo Caesarean sections during childbirth. As clinic abortions become less accessible for many, self-induced abortion will increasingly be another yet another area in which the behavior of women of color—the group least able to access abortion facilities—will be closely scrutinized. Already some 17 women have been arrested for attempting their own abortions.
It has never been easy to be a low-income woman of color in the U.S. and to live out the vision of the Reproductive Justice movement as articulated by activists in the early 1990s—to have children or not, and to be able to adequately parent the children one has. But this always-elusive goal will only recede further in the Trump-Pence administration.