In abortion debate, echoes of another battle
Legacy of racism, slavery mars reproductive rights for Black women
MONTGOMERY, Ala. — Nailah Nicolas stood in the lateafternoon Southern sun at a park dedicated to three enslaved Black women who suffered torturous experiments to advance the field of gynecology.
That day, hanging heavy in the air surrounding the soaring steel monuments to Anarcha, Lucy and Betsey was the Supreme Court’s forthcoming decision in an abortion case that could overturn Roe v. Wade.
Because of mistreatment and neglect of Black women by the medical profession, and society more broadly, the court’s imminent decision adds a layer of complexity to the continued struggle for equity in gynecologic and obstetric services — and to the divergent views on abortion.
Abortion care is opposed by some for religious reasons or regarded as a form of “genocide,” while others say overturning Roe would mark the latest effort to take away what generations of Black women have seldom had: control of their own bodies.
Nicolas fought for Black liberation as a college student in the late 1960s. As the years progressed, she recognized how the malignant forces of racism, sexism and classism intertwine in Black women’s battle for agency over their bodies.
She shudders to think of reverting to the secretive, shamefilled world she lived in before birth control pills were available to unmarried women and abortion was legalized nationwide in 1973, the year after she graduated from the University of California at Los Angeles. It was a time when sex, pregnancy, abortion — reproductive health in general — were in the shadows, even as hospitals dedicated entire wards to women suffering from complications of abortion because they did not have access to safe procedures.
“They never talked to us younger folks about it,” Nicolas, 71, said. “You almost had to be sneaky and listen to grown folk talk to grown folks.”
Nicolas became an activist, and alongside others, fought for more than the right to choose; they fought for the right to control what happens to their bodies, including having children on their terms and raising them in a safe and secure world that provides for the basic needs of parent and child.
She became a public school teacher as part of her mission and began to feel a broader cultural shift in the late 1970s when the curriculum expanded to fact-based lessons on reproduction, shifting away from moral deliberations.
“No storks. Medical books,” Nicolas said.
That Sunday at the Mothers of Gynecology Monument Park was a day of reflection on the progress achieved in overcoming the burdens and barriers Black women face in accessing not just abortions but also prenatal care and safe births — and the work still to be done.
The United States faces an ev
er-growing maternal health crisis that is especially deadly for Black women, who, along with Native American women, live shorter lives than many other Americans. Pregnancy and childbirth are among the leading causes of death of all teenage girls and women 15 to 44 years old, and Black women are three times as likely to die as a result of pregnancy as white women.
Nearly 2 out of 3 maternal deaths are preventable, research shows.
For the women like Alexis King who gathered at the park, medical racism and the disparities in gynecological care remain all too present. King struggled for eight years to find the cause of excruciating pelvic pain, mood swings, irregular menstrual cycle and excessive facial hair.
Her symptoms started immediately after giving birth to her second daughter in 2008. The 39year-old had a tubal ligation and wondered if she was experiencing complications. One day, she doubled over with what felt like labor pains and was rushed to the emergency room, where she learned there was blood in her pelvic floor from a ruptured ovarian cyst.
Her doctor was blasé about the whole situation, she said, prescribing birth control pills to regulate her period.
“She never took what I was saying serious,” said King, a medical billing specialist from Birmingham. “It was traumatic.”
It wasn’t until she switched doctors that King was diagnosed with polycystic ovary syndrome, a hormonal disorder that causes the ovaries to develop fluid-filled sacs.
The new doctor performed two procedures that remove tissue from the uterus to help alleviate heavy bleeding, including a dilation and curettage — the same procedure used during surgical abortions — and endometrial ablation.
The specter of the court’s decision “worries me for my girls,” King said. “Them being limited in what they can do and what resources they might need is worrisome. We never know what life will bring.”
‘It’s a healing’
The Mothers of Gynecology Monument Park, a place of proud defiance and serene restoration, sits on the More Up campus, the future site of a conference center and resource museum.
“We overcome by the words of our what? Testimony,” Michelle Browder, the artist and creator of the park, told the crowd gathered at the monument.
Betsey stands 12 feet tall and wears speculums in her crown. Her pregnant form is made of discarded metal objects, much like Lucy (9 feet) and Anarcha, who has a gaping hole through the midsection of her 15-foot metal figure.
Less than a mile away, J. Marion Sims, the physician known as the “father of modern gynecology,” conducted surgeries without anesthesia on the three women and about seven other enslaved Black women in the 1840s. He was credited with curing what’s known as a “vesicovaginal fistula” — a hole that forms between the bladder and vagina after childbirth, cancer or surgery, causing incontinence — though his legacy in recent years has been scrutinized by scholars and debunked.
Browder urged the crowd to step into a small guard shack, a cathartic space decorated to rival the relaxation room at any spa, and record stories of the care received from the medical system.
“This is not just a piece of art,” she said. “It’s a healing. It’s history.”
Maternal health is informed by an accumulation of life events that start long before pregnancy begins, said Kanika Harris, director of maternal and child health at the Black Women’s Health Imperative, which works to improve the health and wellness of Black women and girls.
“This is about how you show up to pregnancy,” she said.
The shorter life spans of Black women — years taken by higher rates of maternal mortality — reflect hurdles piled one on top of another in a society where poverty and pollution often are concentrated in redlined neighborhoods but not affordable housing, grocery stores or reliable internet.
Black women confront racist stereotypes — lascivious, aggressive, “welfare queen” — that reduce them to caricatures, which affects their physical well-being and the medical care they receive. Health care providers are more likely to dismiss Black pain and to negatively describe Black patients in electronic health records, studies have reported. And researchers have found that the unrelenting stress caused by racism wears the body down, aging it prematurely.
Ending legal access to abortion nationwide would “absolutely exacerbate this crisis,” said Rachel Villanueva, an obstetrician-gynecologist in New York and president of the National Medical Association, the nation’s largest and oldest national organization representing African American physicians.
“We already have a situation where women lack access,” Villanueva said. “States that did not have Medicaid expansion have some of the worst maternal outcomes.”
Legacy of racism
But there also can be financial barriers in states where Medicaid covers abortions. That’s especially true if a woman earns too much to qualify for the public health insurance program but not enough to afford the cost of an abortion, as one woman explained to University of California at San Francisco researchers who published a study last month examining how the enduring legacy of racism affects Black women’s access to and experiences with abortion care.
Researchers interviewed 23 Black women between the ages of 21 and 46 who had abortions. The report described a “complex web of painful injustices” that affected the women’s experiences with pregnancy, abortion and parenting.
About 18 percent of U.S. pregnancies end with an induced abortion, the Centers for Disease Control and Prevention reports. In 2019, more than one-third of abortion patients were Black women, whose rate of abortions was more than three times that of white women, according to federal figures, which did not include California, Maryland and New Hampshire.
Asking patients if they’ve ever been pregnant and the outcome of that pregnancy is part of understanding someone’s medical history, Villanueva said.
“It’s the same as asking when your last Pap smear was … not a matter of judgment,” said Villanueva, who like other reproductive health experts, worries that what they regard as a routine part of the doctor-patient conversation — abortion — could become increasingly fraught, deepening mistrust of the medical system amid the churning landscape of state reproductive politics, which, in some cases, would lead to punishing providers and delaying care.
“The narrative that a lot of groups like to dictate is: ‘People are careless. They’re just having sex. They have an abortion because they’re indiscriminate in what they do,’ ” she said. “We know that’s not the case.”
That’s the same argument King’s 16-year-old daughter, Amarie King, introduced in history class recently.
“Like I was telling them: ‘You don’t know why she ended up pregnant and why she doesn’t want to keep the baby. People get raped all the time. Incest. It could be financial reasons,’ ” she said. “It’s not always what you think it is.”