Two Years On, the Harm of the Dobbs Ruling Is Particularly Felt By Marginalized People

It has been two years since the Supreme Court struck down the Constitutional right to abortion in the Dobbs decision, handing over decision-making on reproductive rights to individual states. I’ve been reflecting on the ruling’s impact, especially to marginalized populations such as persons from communities of color, people who are poor, disabled, LGBTQ, etc., whose identities intersect and overlap. As a Black disabled woman working in disability rights and reproductive justice advocacy, my perspective is informed by my own reproductive health care journey and my advocacy work.

For as far back as I can remember, I’ve been proactive about my reproductive health. I remember having conversations with my mother at around age 10 in the early 1980s about “the birds and the bees” and where babies came from. Two years later, two days after my 12th birthday, my menstrual cycle arrived with a welcome party of nausea. At 14 years old, in the full swing of puberty and hormones, I started getting regular checkups through the gynecology department at a local public health center where I grew up in Boston.

The care provider was a Black woman named Nyna who appeared to be somewhere in her mid-30s or early 40s. She was a sensitive, culturally competent nurse practitioner/sex health educator who listened carefully to my concerns. I remember getting my first vaginal exam and pap smear from her. I remember asking awkward questions and receiving responses that never made me feel ashamed for asking. I also recall getting reproductive health education through a class centered on sex health education for teen girls; I sat at an oblong table with other young Black girls from my community who were also being proactive with their repro health care. As I recall, attending the class was a prerequisite before getting free contraceptives.

Nyna led discussions and imparted lessons while we leafed through pamphlets of information and gazed at plastic models of vaginas and uteri placed atop the table. She educated us about our bodies and encouraged us to ask questions, exercise caution, and be responsible with sexual activity and exploration. We had access to contraceptives such as birth control pills and condoms from federal funding through Title X program grants made available to community health centers.

So when talk from pundits across the media landscape turns disparaging regarding family planning in poor/low-income communities of color, such as Black, brown, and Indigenous people, I know it’s ill-informed. A study from Color of Change conducted by Dr. Travis L. Dixon examined the representation of Black families in local and national news and opinion media over a two-year period. The key findings were that Black families were routinely inaccurately depicted in many areas, including Black fatherhood and criminality, and disproportionately represented as using social safety nets and state support due to laziness and dysfunction. “Overall, the findings show that news and opinion media outlets routinely and inaccurately portray Black families as sources of social instability in society and portray white families as sources of social stability in society, irrespective of facts to the contrary.”

These kinds of portrayals, reeking of ignorance, rife with stereotypes and misinformation, can be absorbed by individuals and society as truth, and can fuel harmful policies that destroy our quality of life. “In a media environment that continues to inaccurately depict Black fathers as absent, Black mothers as bad decision makers and Black families as destabilizing forces,” said Rashad Robinson, president of Color of Change, “and that fails to present evenhanded, accurate and multidimensional portrayals of what it means to be a family in this country, we’re left floundering under an onslaught of bad federal and state economic policies and legislation that will doom families for generations to come.”

As we have watched in horror the curtailing of reproductive rights over the last several years, it’s clear that these restrictions have a deep and widespread impact, particularly harming groups that are marginalized on the basis of race, gender, gender identity, disability, socioeconomic status, immigration status, living in rural communities, and other factors. Since the Dobbs ruling in June of 2022, abortion has been banned or restricted in nearly two dozen states.

I’ve experienced three pregnancies and only one full-term pregnancy. For my first, in my early 20s, I was cared for in the “high-risk” section of the OB/GYN clinic due to having a congenital form of muscular dystrophy, a neuromuscular disability that impacts mobility. Providers there knew very little about my disability or about disability in general. What they did know was often filtered through the limitations lens of the medical model. This lens sees disability as a problem to be cured or fixed and often equates disability with negativity. Their framework was to try to lessen the chance of my giving birth to a disabled child. I was offered genetic testing and the option of terminating the pregnancy if the results were less than “desirable.”

I had multiple ultrasounds to ensure a smooth pregnancy but still had to be induced at 39 weeks due to preeclampsia, a dangerous condition putting stress on the heart and kidneys from elevated blood pressure. I labored for 26 hours before giving birth to my child aided by forceps. It was exhausting, and I needed additional recovery time in the hospital and at home due to my disability.

Several years later, in my late 20s, when I became pregnant for the second time, I made the heavy decision not to move forward. The decision to have a medical abortion was made after careful consideration of what was best for me and my well-being. It was not a choice made lightly, but I have no regret or shame about it. I’m grateful that the abortion was accessible, legal, and safe.

My third and final pregnancy came about six years later, in my 30s. My partner and I had taken precautions to prevent pregnancy, so it came as a surprise when my at-home test was positive. Even though I hadn’t planned on having another child, we decided to proceed with the pregnancy. The clinic confirmed the pregnancy and performed an ultrasound and then vaginal ultrasound but still couldn’t detect an embryo. The OB/GYN said that more testing would be needed and sent me home that Friday. This proved to be a near-fatal mistake.

I had cramping over the weekend and by Monday evening had to be rushed to the ER by ambulance after briefly passing out. I underwent emergency surgery because of a ruptured fallopian tube caused by an ectopic pregnancy. This led to significant internal blood loss, several blood transfusions, two hospital stays due to an infection after the first release, and aftercare consisting of three months of visiting nurses providing wound care and follow-up clinic visits. There was no recourse other than surgery and removal of the embryo and fallopian tube to save my life. I can only imagine how the trauma of this experience might have been further compounded if my home state, Massachusetts, had banned abortion or imposed early gestational restrictions, forcing me to carry or face the threat of prosecution.

All over the United States, charges have been brought against women who either miscarried or needed emergency care to terminate a pregnancy. Many of these cases were due to the pregnancy not being sustainable and/or posing a risk to the pregnant person. People with resources, means, and mobility can travel to states that have fewer restrictions. Poor, BIPOC, disabled, trans, and nonbinary folks may not have the same level of support and access to health care. Neighboring states that have upheld reproductive rights end up bearing the brunt, with significant upticks in abortion services when other states have decided to curtail access.

Many disabled persons had difficulty accessing reproductive care services well before abortion bans and restrictions. The bans have exacerbated the problem and made it difficult to track, leaving many disabled persons slipping through the cracks. Black women, no matter their socioeconomic level, disproportionately experience adverse outcomes in health care due to mistreatment, abuse, and disparities from systemic racism and sexism.

My personal experiences have given me perspectives that have fueled my advocacy work centered on disability, race, and gender. I know that low-income communities of color have an abundance of capability to advocate for ourselves and each other, to provide informed care, and to make responsible decisions about our own reproductive lives. We are capable and knowledgeable and need informed policy to support choice.

I’m proud of the work I do as a speaker, writer, and consultant, serving on disability-related boards and projects, and as a peer researcher studying the pregnancy experiences and outcomes of Black people and Latinx/Latinas who have physical disabilities. I’m able to bring informed awareness from lived experience. This is an important factor because disabled persons, especially those who are from communities of color, poor, or multiply marginalized, are generally not included in reproductive health conversations and outreach campaigns.

Last month, Rep. Ayanna Pressley, D-Mass., along with Sen. Tammy Duckworth. D-Ill., and Sen. Patty Murray, D-Wash., introduced a resolution in partnership with disability and reproductive justice advocates that“recognizes the barriers disabled people encounter to accessing sexual and reproductive health care due to systemic discrimination, leaving many with unmet and underserved health needs,” and would designate a day in May as “Disability Reproductive Equity Day.” One of the goals is to build coalitions between disability and reproductive justice communities and more informed conversations and campaigns that are inclusive of disabled persons’ reproductive rights. It has yet to become a normalized fact that many disabled persons are sexually active and have reproductive health needs and require sex health education and services. It may even be a shocker that quite a few of us are parents and conceived the old-fashioned way.

I’m in my early 50s now and in the perimenopausal phase of my reproductive health journey. What I know for sure now is that proactive shy teen I once was helped pave the way for my work in advocacy. I didn’t realize back then how that early reproductive health education would be an investment that would extend way beyond self and well into conversations and community with so much range, nuance, and complexity.

Perhaps if we could envision a world where everyone had access to such education, agency, and freedom, we could all be beneficiaries of that investment. Until such time, we must keep the bells ringing and mobilize to secure a future that makes reproductive health care a safe, affordable, accessible, and legal journey — for all.