Shanayl Bennett is intimately familiar with the disparities that deprive low-income Black women of the resources they need to thrive as mothers.
Bennett, a professional labor assistant who provides support throughout pregnancy and postpartum, said women of color in Detroit often don’t have access to the family planning resources and reproductive health options they need. She’s worried that a repeal of Roe v. Wade will create more risk for more Black women, who face higher chances of pregnancy-related death and health complications.
“There are some women at the hospital that don’t even know their body parts,” Bennett, a Detroit doula, told BridgeDetroit. “There are some women that didn’t even know how they became pregnant. Maybe so many people wouldn’t be young mothers if they had access to contraception or adequate sex education.”
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Detroit’s maternal death rate is triple the national average. Nurses and advocates in the city say Black women in particular will face dire consequences if the U.S. Supreme Court criminalizes abortion.
A leaked draft opinion suggests the high court this month is poised to strike down the landmark Roe v. Wade decision nearly 50 years after it enshrined a Constitutional right to an abortion without excessive government restriction. The ruling would trigger a 1931 state law banning most abortions, effectively outlawing the practice in Michigan and requiring more women to take on birth-related health risks.
At a time when Black women are the fastest growing demographic of entrepreneurs in the country, Bennett also views banning abortion as an attempt to control them.
“There are so many reasons why Black women decide to get abortions; It’s not just that they don’t want to have a child,” she said. “There are plenty of Black women that want to have children and they choose not to because they don’t think this world is safe. They don’t have insurance that covers adequate paid leave and paid time off. They don’t work a job that covers affordable childcare. They don’t have access to basic needs.”
Researchers who track maternal mortality expect to see a corresponding increase in pregnancy-related deaths if abortion is outlawed, particularly among women of color. Black women in Michigan are three times more likely to die from pregnancy than white women.
“I just see flashing neon lights; We are going to see a huge uptake and even more disparities of care,” said Nutrena Tate, a pediatric nurse and associate dean at the College of Health Professions at the University of Detroit Mercy. “I think (criminalizing abortion) is going to turn into a public health crisis. We’re going to see more mortality, we’re going to see more morbidity. More women are going to have to face pivotal decisions with their lives.”
An abortion is statistically much safer for women than childbirth. The most recent CDC figures show there are 0.41 deaths per 100,000 legal abortions, compared with 24 deaths per 100,000 live births in the United States. State data shows 80 women die each year during pregnancy or within one year after pregnancy.
There were 6,933 abortions performed in Detroit that year. State data shows 52 per 1,000 Detroit women received an abortion in 2020, compared to 16 per 1,000 women at the state level.
More than three-quarters of Detroit’s population is African American and more than a third of its residents live in poverty. Those two factors mean Detroiters experience higher rates of maternal mortality and infant mortality, said Carol Goss, board chair for Planned Parenthood Michigan.
“When you think about the kind of structural racism that exists in that maternal health care system, Black people in Detroit are affected by that in larger numbers than anyone else,” Goss said. “They have difficulty accessing care early enough in a pregnancy and maintaining the consistency over the life of a pregnancy, which would ensure a healthy outcome of the baby. If they’re faced with unplanned pregnancy, not having choices and resources to support them, I’m really worried about that. The families that are going to suffer the consequences the most are poor families and families of color.”
Gwendolyn Norman, a lifelong Detroiter, nurse, faculty member at Wayne State University and coordinator at the Alliance for Innovation in Maternal Health, said a large body of research has shown implicit biases and racial discrimination in the healthcare system affect Black women’s health.
“The higher up the socioeconomic level, the greater the disparity you see in birth outcomes for African American women,” Norman said. “They’re exposed to factors that are outside of their own personal control.”
Norman said she’s interviewed Black women who have been ignored by healthcare providers when they bring up pain, irregular bleeding or other signs of trouble in their pregnancies. Black mothers also are less likely than white mothers to receive prenatal care, which makes them five times more likely to have a pregnancy-related death.
“African Americans in general do not get the same treatment and care when they walk into a healthcare institution,” Norman said. “They are regarded differently and treated differently. In critical situations where life and death decisions are being made, that disproportionately impacts people of color.”
Some biases that cause improper care of Black patients have direct ties to historic racism. For example, a false myth that Black people are less sensitive to pain is linked to a 19th Century doctor who performed medical experiments on Black slaves. Studies show the false belief is still held by medical students, making Black patients less likely to receive pain treatment.
Top causes of death include severe bleeding, infection or sepsis and cardiomyopathy, which can lead to heart failure. Identifying these conditions early can make the difference between life and death.
America’s mothers are more likely to die from pregnancy compared to any other developed nation. More than half of these deaths are considered preventable, but pregnancy and childbirth are becoming more dangerous.
The national maternal mortality rate more than doubled since 1990, according to the CDC. The rate has increased even faster for Black women in recent years.
The CDC recorded a 48% jump in the maternal death rate for Black women between 2017 and 2020. For white women, the rate increased 29% over the same time period.
The Alliance for Innovation on Maternal Health is a national organization that works to decrease maternal mortality and morbidity in partnership with the Michigan Department of Health and Human Services. It has found success by coordinating with hospitals to implement best practices for patient safety. These include recommendations to reduce racial and ethnic disparities in care, including implicit bias training and data collection tools.
Gov. Gretchen Whitmer introduced a “Healthy Moms, Healthy Babies” initiative in 2020 to improve care for women and combat medical bias. The effort seeks to increase access to birth control and evidence-based home visiting programs while training future doctors and nurses about anti-Black bias in the healthcare industry. Whitmer also announced in May that the state is expanding Medicaid coverage for a full year after delivery.
However, the disparity among women of color persists.
Dr. Jody Jones, Michigan AIM operations co-chair, said there’s a strong emphasis on addressing the differences in care women receive in southeast Michigan.
“We’re focusing on the hospitals where there’s the highest number of severe maternal morbidity events,” Jones said. “A lot of those hospitals are where our patient population is mostly Black women. We also are looking at education pieces and trying to think out of the box about how we approach this differently, not just through the lens of looking at data and (best practices). It’s all about patient-centered, trauma-informed, personalized care for every woman, every time and getting that to be the standard here in Michigan.”
With the prospect of a statewide ban on abortions looming, Tate said she’s concerned that repealing a woman’s right to choose would undo headway made toward improving outcomes for Black mothers.
Factors outside the hospital’s control can have a major impact. Chronic diseases associated with increased risk for pregnancy-related mortality, like hypertension and diabetes, are more prevalent in Black women. Securing transportation to attend medical visits and inadequate housing conditions have also been identified as contributors to pregnancy-related deaths by the CDC.
These problems are also rooted in racial discrimination, as advocates like Tate are quick to point out.
“Poverty and power is at the precipice of these disparities,” she said.
‘Abortion is not going away’
Whitmer filed a lawsuit in April asking the Michigan Supreme Court to nullify the state’s 1931 ban on abortion. The law is a sleeping giant made dormant by Roe v. Wade but it was never pulled off the books. The law makes performing an abortion a felony offense, unless the woman’s life is threatened.
Abortion rights activists see the governor’s lawsuit as the best chance of ensuring abortion rights remain in Michigan. The state Legislature is controlled by Republicans who have no interest in removing the law – many of them supported bills that sought to ban certain abortion procedures just a few years ago.
The Legislature is attempting to intervene in a separate Planned Parenthood lawsuit against the state, arguing no one is adequately defending the 1931 law. Michigan Attorney General Dana Nessel, a Democrat, has said she will not prosecute abortion cases if the 1931 law is triggered.
The Supreme Court appears ready to declare the legality of abortion is for individual states to decide. Goss said such a ruling would create an uneven landscape across the country. What it wouldn’t do, she said, is stop abortions from happening outright.
“If abortion became illegal in our state, I assure you abortion is not going away,” Goss said. “What is going to go away is safe, legal, and healthy abortion. It’ll be available to those who have resources, who can get on a plane and go to another state, but it will not be available to the most vulnerable families in our communities.”
Half of all Michigan abortions performed in 2020 were received by Black women. White women received 37% of abortions and 3.4% of women were Hispanic.
Abortion-related deaths took a steep drop after Roe v. Wade, according to National Center for Health Statistics data.
The memory of unequal access to abortion, and the consequencs of such a two-tiered system, is just a generation away.
Norman was in college when Roe v. Wade was decided. She remembers how young women who did not want to carry out their pregnancy had to seek clandestine clinics or perform risky procedures themselves. Stories of women using coat-hangers are very real, she said.
Norman fears that eliminating access to safe abortions will again drive women toward unsafe alternatives.
“My concern is that women are going to start to resort to trying to affect abortions on their own, which is very dangerous,” Norman said. “(Abortion) isn’t going to stop, but it’s going to go underground. There are going to be people who are not licensed, who are not skilled, but are performing abortions.”
The vast majority of Michigan abortions – nine in 10 – take place in licensed freestanding outpatient facilities instead of hopsitals or physicians’ offices.
Most abortions also take place before the first trimester of pregnancy. State data shows 89% of all abortions happen within 12 weeks of gestation and three-quarters of all abortions happen within 9 weeks.
Non-surgical methods have become more common in the last 50 years. Suction curettage, a process of removing pregnancy tissue with a suction device, was once the most-used abortion procedure, but non-invasive medical abortions using prescription drugs were used in a majority of reported 2020 cases.
Today, abortion can be as easy as swallowing a pill. The Food and Drug Administration lifted a restriction on prescription abortion pills last year, allowing people to obtain them through the mail and at pharmacies. Previously, mifepristone and misoprostol were only available at a doctor’s office, hospital or abortion clinic.
Mifepristone can end an early pregnancy if taken up to 70 days from gestation and followed by a dose of misoprostol 24 to 48 hours later. The pills temporarily block a hormone called progesterone, which is needed to grow a pregnancy.
State data shows most abortions aren’t covered by insurance and the overwhelming majority (88%) of women who get an abortion aren’t referred by physicians, social agnecies, health officials or family planning agencies.
Goss, the Planned Parenthood board chair, said women are making choices that are in their best interests. She worries that making vulnerable people carry out an unwanted pregnancy will broaden inequality.
“I grew up in the 50s and 60s, so I remember what it was like when abortion was illegal, and the fight for the right to choose,” Goss said. “Families now are fighting to have better education, for higher paying jobs, for stable housing, for quality childcare. We’re fighting for a whole set of services to keep families whole. To add this on top of it, somehow it just doesn’t seem fair.”
As she’s talked about the possible repeal of Roe v. Wade with friends, Bennett reflected on going through labor after her second pregnancy resulted in a late-term miscarriage.
Bennett said she was fearful going into the procedure, wondered whether she would survive and felt the stress of being a low-income, working mother responsible for another baby that yet hadn’t seen a first birthday. She said she returned to work three days later after delivering a stillborn child.
“My mind and body was in a space like I had just had a baby, but I had to go back to work in order to maintain financially,” Bennett said. “It just makes you not want to have children, that’s a realistic thought. I know other women who have been told by doctors early in pregnancy that their baby has a disorder which could put them in harms way and they opted into terminating. People made them feel bad about choosing their life first because they have other children they had to live for.”
Bennett later learned her grandmother died during childbirth after being told she would likely die if she became pregnant a sixth time. It happened anyway. She and the baby died.
“There is a fast-growing amount of Black women who have decided to just not have children at all. They’re scared they will either die and hemorrhage out or they’re going to develop high blood pressure because of the stress,” Bennett said. “I still have talks with my friends who are like, ‘If I’m going to die, I’m just going to die from being old. I’m not going to die from having a baby.’ They want to have a surrogate instead or adopt.”