Barbara Harris’ mother was 35 when she was sterilized by the state of Virginia in the 1960s.
“She could have a desire to get married, and have a family with her new husband. But she was not able to do that,” said Harris, a longtime nurse who now is executive treasurer for Virginia Organizing, an advocacy group. “ That choice was taken away from her.”
Her mother, a single parent, was threatened with loss of state aid for her four children if she didn’t get sterilized.
Between 7,200 and 8,300 people — 22% of whom were black — were sterilized in Virginia from 1927-1979 on grounds of homelessness, insanity or “unworthiness to procreate”.
Decades after the program ended, statistics show that women of color still have disproportionately negative outcomes relating to maternal health. Some advocates, including Harris, worry that the Supreme Court’s decision to overrule Roe v. Wade may make that situation even worse if abortion becomes illegal in Virginia.
“This country doesn’t show up for us,” said Cierra Lewis, an abortion-rights advocate from Norfolk. “We fight. That’s the thing — Black women, we fight for ourselves, we fight for our community, we will advocate for our neighborhoods.
“I won’t say we know something is happening before it happens, but I feel like some things will hit us first, and then we see the trickle-down effect when feminists become outraged because it hits them. This has hit us before. “
In 2012, the most recent year for which Virginia data are available, Black women were 2.7 times more likely to terminate a pregnancy than their white counterparts. While 17.8 pregnancy-related deaths occurred for every 100,000 live births among white women in Virginia, among Black women, that rate was 45.8 deaths.
These continually disproportionate figures in Black and white maternal mortality are actually an improvement from pre-Roe numbers, according to a paper signed by 154 economists and submitted to the US Supreme Court as an Amicus Brief in support of abortion rights in Dobbs vs Jackson Women’s Health Center.
The brief notes that Black women experienced a 28% to 40% decline in maternal mortality due to the legalization of abortion.
Dr. David Peters, an abortion provider at Tidewater Women’s and LGBT Health Center in Norfolk, said high maternal death rates are among the reasons pregnant people may choose to have an abortion.
“The simple fact is women and children die during labor,” Peters said. “The amazing thing is that with everything we have in America, we have one of the worst maternal mortality rates in the world. And now they’re going to start forcing women to have children. There’s no sense to this whatsoever.”
In a study published in early 2022 by the Commonwealth Fund, women in the US were found to have a higher maternal mortality rate than women in ten other wealthy nations surveyed at a rate of 23.8 deaths per 100,000 births. In Black women, that rate was 55.3 deaths per 100,000 live births.
“The women who could least afford to have another baby are the ones most affected by by these abortion bans,” Peters said. “Your average upper middle class person with health insurance, their doctor is going to find a way to get them an abortion . It’s always been that way through history, and I’m sure it will continue that way. It is the lower socio-economic individuals that can least afford a pregnancy that are the most impacted.”
Dr. Anila Ricks-Cord, an OBGYN who works in El Paso, Texas, said she already has seen the consequences of that state’s abortion restrictions, especially on poor women. Her post-Dobbs reality is treating women who can’t afford out- of-state abortions and find extra-legal ways to terminate a pregnancy, yet fear prosecution should they visit an emergency room if they experience complications. She said she worries some women will die rather than risking medical care..
“Poor people utilize the emergency room as their doctor’s office. And a lot of people don’t come unless they are hearing their ancestors, Jesus and angels call their name,” Ricks-Cord said. “As an emergency room OBGYN, I have seen the gamut of people practically on death’s door for various and sundry reasons related to being female, and bleeding and having complications with pregnancy or complications with surgery as a consequence. I see that this is just gonna get worse.”
Dr. Patricia King, a member of the Board of Trustees at East Virginia Medical School, said medical conditions that factor into reproductive health — like obesity, diabetes, hypertension and heart disease — disproportionately affect Black people. Social and economic factors that contribute to developing Those diseases — like limited access to healthy foods, stress, single parenthood and financial insecurity — may also contribute to maternal mortality.
“There’s so many pieces of the puzzle, there’s no one thing,” King said. “In our communities, you have to look at the lack of knowledge about the importance of having a healthy diet, exercising on a regular basis, getting regular doctor visits and follow up visits. A lot of us don’t have access to good quality medical care. A lot of pregnant women don’t receive any prenatal care, and sometimes when they do, it is towards the end of the pregnancy.”
In underweight infants, too, there is a disparity between Black and white births. According to 2020 statistics from the Virginia Department of Health, 6.6% of white infants in 2020 were born at “low” birth weights of under 2000 grams compared to 13.5% of Black infants, and 1.0% of white infants compared to 2.9% of Black infants were born at “very low” birth weights of under 1,500 grams.
Dr. Donna Hamilton, a pediatrician, worked on The New Jersey infant mortality task force in the 1990s. Her team found that, even when controlled for socio-economic and environmental factors, Black women and their babies were far more likely to die.
“If a homeless Black woman and a white woman — they live next to each other, they were poor, they had dropped out of high school, they use drugs, if everything was the same — both got pregnant, the Black woman’s infant was still about two to three times more likely to die than that white one,” Hamilton said. “On the other end of the spectrum, if you had two women who were living next door to each other in an affluent neighborhood and they got pregnant, that Black woman’s baby was still two to three times more likely to die.”
Teenage pregnancies and abortions too, are higher in Virginia for Black women, which Virginia Organizing activist and Virginia Beach resident Patrice Smallwood attributes in part to the lack of resources.
“Our young women are economically disadvantaged, you know, as women of color, and they don’t have the same resources available,” Smallwood said. “If this situation were to occur, and they needed to have an abortion, they don’t t have the resources available – not for the abortion, but they don’t have the resource available to take on the child.”
And the consequences of women carrying unwanted pregnancies to term reaches even beyond them.
“When a woman is forced to have a child that she does not want, it affects her mental health, and over time, it erodes her mentally, physically, emotionally and spiritually. And the person that suffers the most is the child that came into the world,” Harris said. “They are the children in classrooms that have no attention span. They are the children that don’t want to go home to the hell that they have to live with. It is a harsh thing to live as an unwanted or unloved child.”
Access to abortion may worsen for Virginians following influxes from surrounding states where has been banned or limited. Most of the state’s 22 abortion-providing hospitals and clinics are in cities, limiting access to rural women. Advocates say boundaries to abortion care have especially negative effects on low-income individuals.
The Dobbs decision did not change abortion law in Virginia, but Gov. Glenn Youngkin has signaled support for a ban on the procedure after 15 weeks of pregnancy.
Many women, Peters said, may not even know they are pregnant until eight or nine weeks along. And Peters said she isn’t certain a 15-week ban is the real goal.
“The people that he wants to help write this law have said they want to do away with abortion. So make no mistake, it’s a slippery slope that will just continue,” Peters said.
Reflecting on the progress between her mother’s forced sterilization and the Dobbs decision, Harris has hope for a more equitable future. But that future will not come without consequences–especially for the Black women and poor women for whom reproductive healthcare has always been less equitable.
“It’s gonna be just as hard to get back to where we’ve just been tossed from, as it was to get there in the beginning with Roe versus Wade,” Harris said. “It’s gonna be a nightmare for a lot of women. “
Suzannah Perry, firstname.lastname@example.org
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