‘Listen to Black women.’ How we start to fix racial inequities exposed by abortion issue

While white women are lamenting the rights the U.S. Supreme Court removed last month, Black women are reminded of what they’ve felt for decades, even centuries.

Their rights always have been compromised, always threatened, said Dr. Ijeoma Nnodim Opara, assistant professor of internal medicine and pediatrics at Wayne State University School of Medicine.

“This is just another level of what has always been.”

Discrepancies, rooted in and inextricably linked to the nation’s history of white supremacy and anti-blackness, already exist, said Nnodim Opara, founding director of an initiative and curriculum, Health Equity and Justice in Medicine.

Outcomes now, with abortion tenuously legal in Michigan, are worse for Black women compared to white women. A ban, if enforced in the state, would only widen the chasm, causing more maternal and infant death and perpetuating or reinforcing social and economic imbalances, doctors and experts said.

“The playing field has never been level,” said Jerry Barton of Battle Creek, a 53-year-old maintenance worker and father of five who has a Black father, uninvolved in his upbringing, and a white mother.

He was standing downtown with his fiancée Lora Thomas, 48, of Battle Creek, a Black woman who works in a laundry facility. Years ago, pregnant by a man she did not want to make a father, she said she had an appointment to abort her daughter, but, as a Christian, decided it was wrong.

Instead, she raised the girl, now a teenager, and an older son as a single mother. Meanwhile, she handled her own traumas, of childhood abuse, of the shooting death of her dad when she was not yet 2.

“It ain’t been easy. It ain’t been easy, but she loves her daughter,” Barton said.

Both believe women should have the choice, the power to determine their own course.

“Because anything can happen to anybody at any time. And it always seems to be where you don’t expect it,” Thomas said.

In 2021, Black women accounted for 55% of abortion services in Michigan, despite Black residents making up about 14% of the state’s population, according to data from the Michigan Department of Health and Human Services.

Between 2014 and 2018, Black women who continued with pregnancies were 2.8 times more likely to die from pregnancy-related causes than their white counterparts in Michigan, according to the state health department data, and that’s an improvement. From 2007 to 2010, they were five times more likely to perish.

The fate of their babies is similarly in contrast. Five white babies younger than one died per 1,000 live births in 2020 in Michigan. The Black infant death rate was almost 3 times higher with 14 per 1,000 live births, the state health department reported.

“No matter where you kind of want to look at the process of reproduction, women of color, and especially Black women and women who live on low incomes, are disproportionately affected,” said Dr. Lisa Harris, professor of reproductive health, obstetrics and gynecology, and women’s and gender studies at the University of Michigan, where she also directs the fellowship program in family planning.

These groups are least likely to have access to health care to prevent pregnancy, leading to unintended pregnancies, and most unable to travel to another state where abortion is allowed, Harris said. They also might not have the resources – money or credit cards – to attain medications for self-managed abortion, and if they do, chances are probably greater they will be criminalized, detained or prosecuted for it. “Because of the inequities and bias and racism built into how physicians report people who they think did something illegal.”

Finally, if they can’t leave the state or are too fearful to manage their own abortions, they give birth, which they might not survive, not just because of problems exclusive to pregnancy, Harris said, but because they enter pregnancy with elevated rates of cardiovascular disease, hypertension, diabetes, and other chronic concerns.

For Michigan women, these scenarios might not remain hypothetical.

Under a 1931 state law, it is a crime to administer an abortion. The only exception is to save the life of a mother.

The June 24 Supreme Court ruling in Dobbs v. Jackson Women’s Health Organization fell Roe v. Wade and made enforcement of the 90-year-old statute possible for the first time in half a century. Only a court order in a pending Planned Parenthood lawsuit bars its effect, and it is contested by two Republican prosecutors and the Republican-led state state legislature.

RELATED: Abortion is still legal in Michigan. It might not stay that way.

Nnodim Opara said she was not shocked – to those doing justice, equity and anti-racisim work, such a determination was long anticipated – but it saddened her.

A mother of three girls who uses long-term reversible contraception, she wonders about her future family planning. Every pregnancy is different; what will happen if she is again pregnant? Afterword, will she be able to continue using the contraception? To whom will she need to explain her choices?

“And for Black women… it really is a double blow in terms of the dehumanization. Right? Because this is really ultimately founded on that, you know, ‘well, a woman is simply an incubator, not capable of making decisions.’ But also, you have the dehumanization of blackness and the dehumanization of woman-ness all wrapped up in one here.”

Dr. Cindy Agu, who did her pediatric residency in Detroit and recently completed her neonatology training there, talked of two women, a cousin and a friend, who recently died in pregnancy or shortly after childbirth. One baby survived. The other did not.

Her cousin has other children too. “And her 3-year-old is always asking for her now, like where is she?”

The news made Detroit Dr. Jannel Lee-Allen think about all the women who have been in positions of unwanted pregnancies due to rape, young age, human trafficking, incest, life-threatening heath conditions, dire socio-economic conditions, domestic violence or even addiction or prostitution. “Not only is that woman trying to cope for herself, but she is also trying to figure out, well, if I can’t protect my own self, how can I protect the child?”

Lee-Allen, an internal medicine physician and gastroenterology and hepatology fellow, is co-founder of Young Black Physicians, a group of Michigan-trained multispecialty doctors “seeking to educate, elevate, and enlighten patients, communities, and organizations through consulting and health equity training.” She and Agu, also co-founder, spoke to a reporter last week.

Lee-Allen, citing a 2013 article Harris co-authored, said to focus only on the abortion disparity misses the global view, and ignores important solutions addressing key causes, among them racism and poverty.

Nnodim Opara began the conversation with history. “We can’t talk about the present if we don’t understand how we got here.” Black women in the United States not only were used for labor, they reproduced labor, she said.

As Black Americans made gains, through, for example, the integration of schools, the anti-abortion movement swelled in response, to reinforce the racial hierarchy, Nnodim Opara said.

Race is not itself a risk factor, she said, Black health disparities exist because of the structuring of resources, disinvestment in Black communities, higher rates of exposure to environmental toxins, and decreased access to healthy, nutritious and affordable foods and safe and supportive health care.

Racism, when it plays out on an individual level, causes stress, Lee-Allen said, and this can contribute to many health problems, including obesity and high-blood pressure.

“Because of mistreatment, because of injustice, because of racial violence that continues even to today, we have mistrust of institutions, mistrust of the health care systems that are around you. We all see this as physicians.”

She mentioned U.S. tennis star Serena Williams. When she believed post cesarean-section, she had a blood clot in her lungs, as she had previously experienced, she was initially told she was talking “crazy,” Williams wrote in Elle magazine this year, and she is a woman of means and influence.

Many women are not.

Studies have shown a top reason women seek abortion is financial and about half of U.S. women who received abortions in 2014 were at the federal poverty level, according to the Guttmacher Institute, a policy and research organization concerned with sexual and reproductive health.

Paula Lantz, professor of public policy and health management and policy at the University of Michigan, cited findings of the famous Turnaway Study, conducted at the University of California, San Francisco and looking at 1,000 women from clinics in 21 states. Some were “turned away” for abortions and some received abortions. Women who went on to give birth experienced an increase in household poverty lasting at least four years relative to those who received an abortion, according to the much reviewed and cited study. The odds they stayed tethered to abusive partners also increased.

Years after an abortion denial, women were more likely to lack sufficient money to cover basic living expense, and their children are more likely to live below the federal poverty level than children born from subsequent pregnancies to women who received abortions.

In the United States, Black children born into poverty are much less likely to escape it, Lantz said. “It’s all about social mobility,” she said, and studies show it is easier for white people to do attain a higher level of education, a greater income and other measurable successes.

The Turnaway study also found children born from unwanted pregnancies experienced poorer maternal bonding. The parent was more likely to raise the child alone.

Any resulting or related adverse childhood experiences, early potentially traumatic events such as abuse, neglect and household challenges of parental separation or substance abuse, are linked to increased risk of developing chronic diseases and behavioral challenges, including depression and alcoholism. The greater the number of experiences, the greater the risk for negative outcomes, according to research that began in the 1990s by the U.S. Centers for Disease Control and Prevention and not-for-profit health plan provider Kaiser Permanente.

“If you don’t have someone protecting you when you are a child, things happen, and scar you, and you grow up with those scars,” said Thomas, the Battle Creek woman, speaking carefully and with clear emotion.

“I still turned out to be a good person. Because at a very young age, that’s when I drew closer to my heavenly father.”

To find solutions, Nnodim Opara says there must be honest conversations.

Are people ready to have those conversations?

“When we talk about people, we have to be clear about “who people?” White people are not. Black people have been having the conversation since 1619.”

Later, she clarified. There are some, enough even, but they need to bring others along.

“How do we, you know, get out of this mess? I’d say: ‘Listen to Black women.’”

Reporter Justin P. Hicks contributed to this story.

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