Supporters of abortion rights have reason to worry. Texas’s SB 8, which effectively bans abortion after six weeks of pregnancy, is still in force, despite legal challenges to the blatantly unconstitutional law. And the conservative supermajority on the Supreme Court is expected to overturn Roe v. Wade in its ruling on Mississippi’s 15-week ban in the coming months, opening the door for more abortion bans nationwide.
Many supporters of abortion rights have responded with calls to “Protect Roe.” Yet, while these new laws—and the prospect of similar bans in other states—surely mean that pregnant people will be forced to continue their pregnancies when they do not want to, this has already been happening.
People have always struggled to access abortion even with Roe in place, a fact reproductive justice activists and abortion funds have long called attention to. The rallying cry to “Protect Roe” is insufficient to ensure that people in the United States have the right to abortion. To achieve reproductive freedom, we must address the structural barriers that prevent people from accessing their right to an abortion, including systemic poverty and racism, alongside codifying Roe through federal legislation such as the EACH Act and the Women’s Health Protection Act.
Right now, existing federal and state restrictions make it impossible for some pregnant people to choose abortion. But these laws don’t operate on their own. Existing abortion restrictions leverage other inequalities, particularly race and class inequalities, to put abortion out of reach.
The experience of Tyler (a pseudonym), a 26-year-old Black woman in Louisiana I interviewed for my recent book No Real Choice, shows how. From 2015 to 2017, I interviewed pregnant women who considered but did not obtain an abortion to understand why they were continuing their pregnancies. Tyler and many others explained that they wanted an abortion but the barriers to obtaining one were insurmountable.
At the time she discovered her pregnancy, Tyler was a single parent of two elementary school-age children and working an hourly wage job. She knew right away that she wanted an abortion. And right away, she faced obstacles.
Of the many abortion restrictions in Louisiana, two were important for Tyler. Tyler relied on Louisiana’s public health insurance (i.e., Medicaid), which prohibits coverage of abortion care in most cases. Thirty-two other states have similar Medicaid bans on abortion coverage thanks to the federal Hyde Amendment, which Congress first passed three years after the Roe decision, and state-specific versions of Hyde. Because of this ban, Tyler would have to pay for an abortion out-of-pocket. Finances were tight for Tyler, but she was able to scrape together the money for a first-trimester abortion (which averages around $644 in the United States), seemingly surmounting that obstacle.
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But that was not the only obstacle to abortion she faced. As in 25 other states, abortion patients in Louisiana are required to make two separate visits to their abortion provider before they can have an abortion. The two-visit requirement was hard for Tyler to meet. With no option for paid sick leave or vacation days, when Tyler didn’t work, she didn’t have an income. Losing two days of income was financially risky, especially given how much she already had to spend on the abortion. Plus, she worried that if she asked for too much time off, her boss would retaliate by cutting back her hours. She needed that job. By the time she was able to negotiate multiple days off from work, she was in the second trimester of pregnancy. The cost of abortion increases after the first trimester—and Tyler could no longer afford it. She could not choose abortion after all.
Not being able to have an abortion was only the initial violation of Tyler’s reproductive autonomy. When Tyler couldn’t choose abortion, she could not choose the timing, her partner, her financial stability, or the community in which she was having another baby either. When we think about “reproductive choice,” too often we use it as shorthand for abortion. But not being able to choose abortion also means not being able to make choices about the circumstances of parenting.
Tyler’s story highlights two important points about abortion in this country. First, even with Roe and subsequent judicial decisions still on the books, abortion is not a real choice for pregnant people like Tyler. Policies restricting abortion delayed Tyler’s ability to seek care and then eliminated her choices altogether.
Second, the impact of these policies is not random. For people like Tyler, abortion restrictions matter because they cannot risk losing a job or paycheck to take care of themselves. Compare this with others who have paid sick days, reliable child care, above-minimum-wage jobs, and friends or family who have enough to lend them the funds.
Racism is part of this story. Fifty of the 58 women I interviewed for my book identified as Black. I didn’t set out to study a particular racial or class group. I was interested in how abortion restrictions affect (or do not affect) people’s pregnancy decision making, so I sought to interview pregnant women who considered but did not obtain an abortion. That most of those who met these criteria identified as Black and were financially struggling is itself an important insight into understanding for whom abortion is currently unavailable.
Poverty and class more generally are not independent of the long history of racism in the United States. Racist policies like redlining, Jim Crow laws, and the failure of government to fulfill its promises to provide basic resources to formerly enslaved people and their descendants have resulted in Black families’ facing both a persistent wage gap and a persistent wealth gap, compared to their white counterparts.
These financial inequities matter for access to abortion. Despite the mythical story of pulling oneself up by one’s bootstraps, persistent income and wealth racial inequalities mean Black Americans have fewer resources to share across generations to support out-of-pocket costs for a health care service like abortion. Structural practices like eviction and mass incarceration, which disproportionately target Black Americans, stretch even further the resources of those who are financially struggling.
To return to Tyler: She was prevented from obtaining an abortion when she wanted one because of abortion restrictions. But factors that contributed to her financial vulnerability mattered, too. In the lives of low-income and poor Black women, abortion restrictions do not operate alone. They work in concert with policies and practices that produce and entrench racialized poverty. Ultimately, this means that even with Roe the apparent law of the land, many people have had and continue to have no real choice regarding abortion and the circumstances under which they want to have a baby.
Navigating abortion restrictions takes time and money—and those resources are not equitably distributed. Protecting Roe doesn’t make abortion more affordable for those already priced out. Systematically eliminating the financial barriers that they face can. Legislation such as the EACH Act, which would eliminate the restrictions on abortion insurance coverage for people enrolled in government plans like Medicaid, and the Women’s Health Protection Act, which would protect the right to abortion, is an important start. To fully ensure reproductive choice, however, we also need anti-poverty legislation that ensures families’ financial stability, such as reinstating the expanded Child Tax Credit, which lifted millions of children and families out of poverty, and worker protections like protected sick leave. In order to support all people who need an abortion, we need to dedicate our attention to eradicating the systemic race and class obstacles that limit true reproductive choice.
