Even before Alauni took an at-home pregnancy test just four weeks after a single instance of unplanned sexual activity, she knew it would be positive.
The 24-year-old Texas college student – a single, working mother of three children under the age of 6, one of whom is autistic – immediately felt the familiar signs of her pregnancies. She had intended to buy the Plan B “morning after” pill, but was in the process of moving to another city and hadn’t yet secured new housing.
Amid all her pressing concerns last December, Alauni – who is Black and whose name has been changed in this story to protect her identity – forgot to go to the pharmacy. By the time she remembered, it was too late. When she took an at-home test at four weeks – two weeks before the detectable fetal “flutter” – her fear was confirmed.
“My first thought was, I need to be able to self-manage an abortion,” Alauni said. “I stressed if I would be able to get the medication. I worried that I would be having another child at a time in my life that wasn’t right. … I didn’t want my family to know. I didn’t go to a doctor. I was scared because nowadays if you go to a doctor and you later aren’t pregnant, it’s suspicious. They can report you. I was most scared of the people in my city.”
So began Alauni’s frantic scramble to obtain an abortion after the U.S. Supreme Court on June 24, 2022, ruled in Dobbs v. Jackson Women’s Health Organization that a woman has no constitutional right to abortion. The ruling overturned the court’s landmark Roe v. Wade decision of 1973 and overnight brought sheer panic and a sense of desperation to economically vulnerable Southerners needing an abortion.
Texas, where Alauni lives, is one of 15 states, mostly in the South, with laws that ban or highly restrict abortion in most or all cases unless the patient’s life is at risk from or related to the pregnancy. Some of the states have no exceptions for rape or incest, and anyone obtaining an in-state abortion after six weeks of pregnancy can be criminally charged.
While legislators in some conservative states – including South Carolina and Nebraska – have rejected bills prohibiting the procedure, Dobbs gives states the power to decide whether a woman can or cannot legally have an abortion.
“The Dobbs decision has had a crippling effect on women in Mississippi,” said Waikinya Clanton, the Mississippi state office director for the Southern Poverty Law Center.
The plaintiff in the Dobbs case was the last abortion clinic in Mississippi. It closed because of the decision.
“The decision relegates women to a second-class citizenry and undermines our ability to make the appropriate decisions when it comes to our health and our wealth,” Clanton said.
The burden falls most heavily on economically vulnerable, non-Latinx Black people, who nationwide have a maternal mortality rate three times that of white people. In 2019, Black patients accounted for over 38% of U.S. abortions, even though Black people represent only about 12% of the U.S. population. In a Guttmacher Institute survey of more than 6,600 individuals who obtained an abortion at a health care facility in the U.S. from June 2021 to June 2022, three-quarters of respondents had incomes below 200% of the federal poverty line.
Texas, like Mississippi, Alabama, Georgia, South Carolina and Florida, has rejected the expansion of Medicaid, which provides health insurance for people with low incomes. Louisiana is the only state in the Deep South that has accepted the expansion of Medicaid.
In Central Texas, 33% of the state’s 7 million people of reproductive age – including transgender people – live below 200% of the federal poverty line. (Most abortion-related statistics consider only cisgender women, but trans men can also become pregnant.) Statewide, over 21% of Black, reproductive-age residents lacked health insurance in 2017.
“If you’re Black, you were already in crisis mode of survival, but Dobbs made it worse for people than they already were,” said Jenice Fountain, interim executive director of the Yellowhammer Fund, an abortion advocacy and reproductive organization in Tuscaloosa, Alabama, with a focus on Alabama and Mississippi.
Before the Dobbs decision, Yellowhammer funded abortions for 350 clients monthly, both in and out of the states in which the clients lived. Immediately after the ruling, the nonprofit halted abortion funding and pivoted to providing more contraception, including Plan B emergency contraception and baby supplies, and holding rallies to inform people what to do if they become pregnant.
“Alabama was already in a bad spot,” Fountain said. “Even before Dobbs, clients were telling us, ‘I’m sleeping in my car, and I already have a kid,’ so sometimes we put a client in a hotel after they had an abortion because we didn’t want her to go back to her car. … Other clients are in abusive situations and don’t want to raise a child in a violent home. ... People are still trying to figure out how to get an abortion, and some are resigned to having the baby because they aren’t used to having reproductive agency.”
Fountain predicts that forcing economically vulnerable people to bear children will lead to more Black children ending up in the foster system.
“People are going to need things like food and baby supplies due to economic pressure. Already, almost 40% of kids in foster care in Alabama are Black. More children will be removed by the state for what they term ‘neglect.’ They [child welfare agencies] put the child in another household and pay for the child instead of giving more money to the parent.”
In the late 1990s, when conservative states began enacting “death by a thousand cuts” restrictions on abortion, the total number of facilities providing abortions began to drop – from 2,042 in 1996 to 1,603 in 2020. During that same period, half of the country’s 452 abortion clinics closed, requiring pregnant people to travel longer distances and spend more money to obtain an abortion.
Just before Dobbs, only 79 clinics remained open across 15 states in the South and Midwest, and in the 100 days after the ruling, 66 clinics in those states stopped performing abortions. The remaining 13 clinics were in Georgia, according to the Guttmacher Institute. One month later, Georgia reinstated its six-week ban on abortion.
The Atlanta-based organization supports reproductive justice in Alabama, Florida, Georgia, Mississippi, South Carolina and Tennessee. Eighty-one percent of callers seeking abortion information from ARC are Black, and 77% are already parents, higher than the nationwide average of 59%.
“They were already coming from other states – Mississippi, Alabama, Texas. We had to call people and redirect them to other states. It was very hard on people with economic insecurity. They had to travel farther, take more time off from work, and some people can’t afford to do that.
“The patients would say things like: ‘I have two kids. If I’m forced to have this child, I won’t be able to care for my family – feed, clothe them and give them the necessary love and attention,’” Jackson said.
“Then the state determines you are an unfit parent. Instead of putting funding into life-sustaining services and institutions, they criminalize the parent. … They [legislators] speak of the importance of life. It’s important for people to understand the contradiction. Half the people in Georgia don’t have an OB-GYN. There are 150 counties, and 79 of them don’t have one.”
‘Property of the state’
At the time of the Dobbs ruling, only one abortion clinic remained in Mississippi. The state consistently ranks as the poorest in the U.S., and Black patients made up 77% of all abortions there in 2020.
The remaining clinic in Mississippi was operated by the Jackson Women’s Health Organization (JWHO), the plaintiff in the Dobbs case. After the Dobbs ruling, the owner shuttered and then sold the clinic building and relocated to New Mexico, where abortion at all stages of pregnancy is legal.
Rob McDuff, a longtime Mississippi reproductive rights attorney, was one of the lawyers representing JWHO.
“Pregnancy involves carrying a fetus for nine months,” McDuff said. “No one should be forced to do that against their will by the vote of a politician. Just because someone becomes pregnant doesn’t mean they automatically become the property of the state. But that’s the upshot of these laws that ban abortion.”
Expanding Medicaid would help provide health care for children and parents living in poverty. The federal government provides the funding for Medicaid, but states are responsible for administering the funds.
“Republicans keep saying that expanding Medicaid would cost the state money, but state economists put out a report before the 2022 session that it wouldn’t cost the state anything,” said Cassandra Welchin, executive director of the Mississippi Black Women’s Roundtable. “Though we were successful in the 2023 legislative session with passage of Medicaid extension from 60 days to 12 months post-partum, our work is not done. We need to expand Medicaid for the rest of Mississippians who don’t have health care.”
Alauni finds a way
The Dobbs decision and the immediate enactment of “trigger bans” in many states turned Florida into a refuge for Southerners seeking abortions.
“At our Tallahassee and Jacksonville clinics, we had lines of people waiting in the parking lot in the morning, who had driven all night from Texas, Louisiana and Georgia,” said Annie Filkowski, policy director with the Florida Alliance of Planned Parenthood Affiliates.
“We had to provide care on Saturdays for working folks and parents. We had one patient in her early 20s who had a 1-year-old at home that she had to pick up from child care before she drove down and back from Georgia to be on the parent pickup line in the morning. And for every one of her, there are 20 who couldn’t make it.”
But soon Florida, too, may close its doors to many in need of an abortion, despite the right to abortion enshrined in the Florida Constitution.
In line with other Southern states, on April 13 Florida Gov. Ron DeSantis signed a six-week ban that criminalizes abortion but allows exceptions for rape or incest up to 15 weeks. The ban is on hold until a legal challenge to the current 15-week ban is decided by the Florida Supreme Court.
Meanwhile, on April 7 a federal judge in Texas outlawed the self-managed abortion drug mifepristone nationwide. The Biden administration immediately appealed the decision and on April 21 the U.S. Supreme Court issued an emergency ruling to keep mifepristone available in the states where abortion is legal as the ban moves through the courts. The high court is expected to ultimately decide the issue. Last year, medication abortions accounted for 53% of all U.S. abortions. If the ban were to take effect, abortion would virtually end across more than half the country. In 2020, over 620,000 abortions nationwide were performed.
Despite all her challenges, Alauni was luckier than many pregnant Black people living in the post-Dobbs South: Through word-of-mouth last January, she was able to find the medication she needed to have a self-managed abortion at home.
“I was at home with my kids and took the first pill around lunchtime. Twenty-four hours later, I took four pills, let them dissolve between my gums for 30 minutes and then swallowed what was left over with water,” Alauni said.
“My kids and I watched Cocomelon cartoons from the couch, and in the afternoon, we cuddled together and fell asleep. It was a sunny, perfect day outside, and I remember looking out the window from the couch thinking that it was a blessing that I was able to access the medication. And it was a blessing that I was able to have the option to terminate an unwanted pregnancy in the privacy, convenience and comfort of my own home.”
Photo at top: Protesters gather outside the U.S. Supreme Court Building in Washington on June 24, 2022, following the court’s decision in Dobbs v. Jackson Women's Health Organization. The decision, which reversed Roe v. Wade, has proven particularly burdensome for economically vulnerable Southerners who need abortions. (Credit: Brandon Bell/Getty Images)