Centering Black women’s abortion experiences

Black women in the United States have a deeply complex history of having their reproduction controlled and devalued in a society built on racism. They have experienced forced reproduction and sterilization, and coercion into birth control they don’t want. Structural factors like mass incarceration, police violence, and policing of Black motherhood through child protective services continue to limit Black women’s reproductive freedom and the ways they engage with reproductive health care.

Conversations about Black women and abortion often fail to account for these structural factors and are framed by comparing their experiences to white women as the “norm.” New research from Katherine Brown, MD, and team provides an alternative by centering the experiences of Black women and working to understand how they experience abortion care and the impact of structural racism on those experiences.

The researchers interviewed 23 self-identified Black women who’ve had abortions. The overarching theme that arose is that choice is a privilege that Black women do not always have in the context of structural racism and systemic oppression. They described experiences of structural racism that created a network of difficult choices that often led to the decision to have an abortion. That’s not to say that it wasn’t a choice actively made, but to put those decisions in the context of structural racism and reproductive injustice.

The women shared multiple levels of experience that they ultimately carry with them into the decision to have an abortion and the experience of having an abortion:

Community experiences and intergenerational wisdom

The women discussed overlapping elements in their lives directly and through their communities including structures of oppression, experiences of reproductive injustice, experiences with the healthcare system and experiences of pregnancy in Black communities. They shared many ways that structural racism had touched their lives and the lives of their communities and the challenges of navigating a world not meant for Black people.

“They had a billboard in Oakland years ago that was offering $200-and-something right in the heart of the ghetto, like, ‘$200 now, come get this new –' and it was sterilizing people...You know, people are in poverty, don’t have any money, that big billboard right there. ‘Come get sterilized.’ …But I knew it. I said, ‘They’re gonna sterilize community.’”

Personal experiences and beliefs

The women shared their own personal experiences and beliefs that informed decision-making around pregnancy and abortion. They shared beliefs around pregnancy and abortion, oppressors around their pregnancy, experiences parenting, their personal mental health, and sources of support in their lives.

When accessing healthcare in pregnancy, many discussed ways in which they felt ignored, overlooked, and mistreated.

“With my last daughter, at my last months I wasn’t feeling well. And I'm like, ‘Okay, this is my fourth child. I know my body.’ … And they were like, ‘No, we don’t induce until 41 weeks. You're fine. Your tests are showing great. Everything is great.’ And that just wasn't the case. I ended up actually going to Kaiser right over here. My blood pressure was like 178 over 60, really high.”

Pregnancy, reproduction and abortion.

Women discussed deciding to have an abortion, access, abortion care, reflecting on abortion experiences and imagining an ideal for abortion care.

“As a parent, … you work really hard not to create situations where your kid is going to be in pain or to suffer unnecessarily. And that was really big on my mind.”

While some women, like in other health care experiences in their lives, felt that they weren’t listened to while receiving their abortion care, many shared the impact of having abortion providers of color, especially Black women.

“And so, she helped me through this decision. She sat with me. She listened to me. I cried, she held, I mean, she physically held me. She never inserted her opinion. Even though I wouldn’t have minded if she did, she didn’t. She just listened and listened. I think they should clone her.”

Reflecting on abortion experiences

Several people raised the importance of honoring the pregnancy in some way in imagining ideal abortion care:

“I think it would include— it’d be very similar to probably someone giving birth. Not in a hospital, but at a birthing center where it’s like being warm and in a really cozy environment and having some sort of process around the loss itself. Just like there’s a process around having birth and bringing in life. I think there’s something important about honoring what’s not going to happen, for whatever reason it’s not going to happen.”

Future research, policy and clinical care should continue to center the lived experiences of Black women. This means allowing space for trauma, untimely loss, multiple injustices, other pregnancy experiences and the understanding that many healthcare experiences have been marked with disrespect for Black life. We must make space for Black and Indigenous people of color in abortion work. Fostering diversity benefits the field in many ways, including providing a sense of validation, understanding, comfort and support to patients. We must scrutinize and dismantle the ways abortion care perpetuates white supremacy, structural racism and reproductive injustice.