How Missouri’s abortion ban affects Black women’s health

When the Supreme Court struck down Roe v. Wade in June, Missouri became the first state to outlaw abortion. Since then, logistics centers and clinics in neighboring states where abortions are legal are feeling the brunt of the decision. Demands for services are increasing, and people from Missouri are flocking to Illinois or Kansas get an abortion.

About 20 minutes east of downtown St. Louis sits Fairview Heights, Illinois. Kawanna Shannon has to sift through a stack of patient files daily to see who she needs to follow up with and what type of assistance they are seeking. Shannon, patient access director for Planned Parenthood of the St. Louis Region and Southwest Missouri, also runs the Fairview Heights regional logistics center, which opened in January.

“We’re just trying to be here for all the patients, really trying to be able to make their process a little bit easier and less stressful, because … their lives still go on,” she said.

In 2020, a year after state legislators passed a strict ban on abortion after eight weeks of pregnancy, 3,391 Missourians received an abortion. Of that number, 1,837 white women and 1,160 Black women underwent the procedure. That same year, according to the Illinois Department of Public Health, doctors in Illinois performed 6,578 abortions on Missouri residents. Meanwhile, the 2021 Kansas Department of Health and Environment’s preliminary data found that 3,458 Missouri residents received an abortion in Kansas.

Shannon’s team helps people with the logistical side of getting an abortion — booking out-of-state transportation, making hotel arrangements, and connecting women to abortion fund organizations. Her workload has tripled since abortions became illegal in Missouri. Women are traveling to the Fairview Heights clinic from Missouri, Texas, Oklahoma, Tennessee, Indiana, Alabama, Mississippi and other states that have strict abortion laws. Missourians who need abortions near Kansas City, Missouri, can travel across to Planned Parenthood Great Plains’ new clinic in Kansas City, Kansas. However, the staff is swamped, just like the clinic in Illinois.

Shannon works around the clock at times to help patients obtain abortions because unexpected events happen often. People might experience flight or bus delays while trying to get to appointments in another, that if missed, could determine whether they will be able to receive an abortion in a timely fashion.

Shannon, a longtime women’s health worker, recalled a time when a 24-year-old Black mother from Memphis, Tennessee, called the logistics center to receive an abortion, but she could not afford to get to Illinois because she lost her job due to pregnancy-related illnesses. The patient also expressed that she was grieving the death of her son. Shannon said the patient felt relieved once all the services she needed for the abortion were booked.

“She was grateful for that, but it broke my heart,” she said.

A long time coming

On a hot June morning in St. Louis, LaQuetta Cooper listened with hope to Health and Human Services Secretary Xavier Becerra, U.S. Rep. Cori Bush (D-Missouri), Planned Parenthood of the St. Louis Region and Southwest Missouri officials, local health officials and reproductive rights advocates as they spoke about abortion access in the state at the last abortion clinic in the state.

The atmosphere was charged and determined, as some advocates told abortion stories to panelists and guests. Over the course of the roundtable discussion, Cooper, Planned Parenthood of the St. Louis Region and Southwest Missouri’s director of health operations, watched the mood change from attentive to devastated.

Disbelief spread around the room when the message was delivered that the Supreme Court had overturned Roe v. Wade. With that news, Missouri had just become the first state to ban abortions due to its “trigger law,” which was written to go into effect when the decision was overturned, and the building Cooper and others were in had to immediately cease abortion services.

“We already had that leaked report, saying that it was going to get overturned, but in my head, I was thinking, ‘It’s really not going to happen,’ ” Cooper recalled. “But to see all those people in the room hugging each other and the sadness that came across the room, this was truly happening.”

Though the news rattled the health director, she let go of her feelings and immediately began texting her clinic managers at the St. Louis location and in Fairview Heights. Cooper wanted to make them aware of the news and to provide guidance on how they should move forward.

“We’ve been fighting this abortion fight for a long time,” she said.

In 2019, the Missouri Department of Health and Human Services did not renew Planned Parenthood of St. Louis’s abortion license. The department claimed that state inspectors found several violations and that Planned Parenthood officials failed to correct them. That year, Missouri legislators passed a law that banned abortions after eight weeks of pregnancy, with no exceptions for rape or incest. Because of the state’s trigger law, once the Supreme Court’s decision came down in June, only abortions in cases of a medical emergencies are permitted now.

While women across Missouri have been affected by the statewide abortion ban, reproductive rights advocates and health care workers in the state say Black women will suffer the most because they are faced with maternal health care disparities that are deeply rooted in systemic racism.

A recent report from Missouri’s health department found that Black women are three times more likely to die while pregnant or within a year of pregnancy than white women. And over the past 10 years, Missouri’s maternal mortality rates have increased. Some factors for Black women residents include late entry for prenatal care, pregnancy-related homicides, and that Black mothers in rural areas of the state experience low birth weight and preterm births at a greater rate than white mothers in rural or urban areas or Black women in urban parts of the state.

This data exposes the inequities in health care access and maternal health outcomes for African American women, which points to why advocates say more Black women in Missouri will die because of lack of access to abortions.

As an African American woman, Cooper is not oblivious to the facts; it is her reality as well. She works consistently at trying to find resources to help people who need abortions in Missouri, now that they have to travel to Illinois or other states where abortions are legal. She said women are scared to travel across the Mississippi River to Illinois to get an abortion because they do not know the ramifications of doing so. Many women also lack reliable transportation, do not have child care, or cannot afford to pay for the procedure.

Midwives and doulas to the rescue

Love Holt, a reproductive freedom organizer with Pro-Choice Missouri and a doula, found her voice in reproductive advocacy work after dealing with years of trauma and pain. Throughout her motherhood journey, Holt had three abortions. Her first one was at age 17. She had two more as an adult. She also suffered from cervical cancer at 25.

Holt, a mother of five, found out she was pregnant with her last child, who is 2, a few days after Missouri’s 2019 bill to ban abortions after eight weeks of pregnancy became law.

“When the ban came in effect, I was very upset,” Holt, 36, said. “I was hoping my period came because I knew I wouldn’t be able to get an abortion.”

Not only did Missouri’s 2019 eight-week abortion ban anger Holt, but it reminded her that she lived in a state where she had no bodily autonomy. She is happy to have her son, but the pregnancy was mentally and physically stressful.

Women in Missouri have been dealing with strict abortions laws for years, even before the fallout of Roe v. Wade. Missouri Democrats pressed Republicans about the 2019 measure, asking why there was not a greater focus on Black maternal mortality rates in a state that has one of the highest rates in the country.

According to Missouri’s Pregnancy-Associated Mortality Review, Black women in Missouri experience higher rates of severe maternal morbidity. The report found a rate of 220 deaths per 10,000 live births for Black women and white women in Missouri at a much lower rate – 89 deaths per 10,000 live births.

Disparities in maternal outcomes are higher for Black women in Missouri. And why Holt continues to fight for abortion rights, especially for Black women.

Last year, to get ahead of the uncertainty of Roe v. Wade, Holt began hosting focus groups to gather data and information from the community about access to health care, birthing plans, medical abuse, mental health, miscarriages, abortions and medications. Pro-Choice Missouri’s policy team adapted the data and created a bill for St. Louisans to receive greater access to reproductive health care.

A city alderwoman brought the proposal to the St. Louis Board of Aldermen, and in July, Mayor Tishaura Jones signed the Reproductive Equity Fund bill into law. It appropriated $1 million of the city’s American Rescue Plan funds toward abortion logistical support; $500,000 to assist organizations that provide doula, reproductive care and lactation support; and $250,000 to oversee the process.

“I am very proud of Board Bill 61,” Holt said of St. Louis’ Reproductive Equity Fund.

Black doulas like Holt nurture Black women emotionally and physically with abortion care, during pregnancies, and postpartum to help lower Black maternal morbidity rates. Holt encourages them to practice herbal remedies and mindfulness techniques throughout their pregnancy, besides offering midwifery or medical care.

Across the nation, more Black women are taking their maternal care into their own hands by working with midwives and doulas to improve their maternal and infant health care outcomes. In Missouri, the Uzazi Village in Kansas City and the Jamaa Birth Village in Ferguson have birthing centers that provide culturally sensitive care for women who may have experienced trauma during previous pregnancies or want more maternal assistance than what hospital medical staff can provide.

Okunsola Amadou, founder and CEO of Jamaa Birth Village, understands what it’s like to have a difficult birth experience. “I was forced into an induction, there was no medical indication, it was a choice made by a provider,” she said, recalling the birth of her first child when she was a teen. “I wasn’t asked what did I want to do, how did I want to do it. … I had no bodily autonomy.”

After another traumatic birthing experience and years of hearing so many mothers at day care talk about their bouts with postpartum depression or being victims of medical abuse, Amadou decided that a birthing center for Black women in the St. Louis area was critical to their health.

In 2015, she founded Jamaa Birth Village, a midwifery clinic and pregnancy care center. The village offers prenatal and postpartum doula and midwifery care, childbirth classes, herbal apothecary, support groups, counseling and chiropractic care for mothers and their families.

Amadou, Missouri’s first Black certified professional midwife, said the center could help eliminate socioeconomic barriers that Black women are often faced with during childbirth and postpartum care.

“Nobody’s ever turned away from Jamaa Birth Village for inability to pay,” she said.

The birthing village operates on a sliding scale, and so far, it’s served more than 1,000 families. More than 200 Black doulas in the St. Louis area have received training through the village. Before the Roe v. Wade leak and the official decision came down, Amadou decided to launch the St. Louis Doulas of Color Collective, which helps people connect to doulas to help them throughout nearly every phase of the reproductive process. Patients can search by specialization, which includes reproductive health, pregnancy loss, infant feeding, emotional support at hospitals and abortion support.

Benetta Ward is a full spectrum doula, which means she also offers emotional support to people needing medical or chosen abortions. Before the Supreme Court ruling, Ward helped some of her clients with postpartum abortion support. She said many of her clients who need an abortion doula do not understand the transition the body goes through to pass an embryo or fetus. After the ruling, however, no one has signed up with her for abortion doula services.

“It’s always a hard decision,” Ward said of the choice to terminate a pregnancy. “Being able to have that [abortion doula services]as an option is most important.”

Fighting for abortion access

In September 2021, U.S. Rep. Cori Bush testified at a House Oversight Committee hearing held on reproductive access about being sexually assaulted as a teenager, which left her pregnant and in need of an abortion.

Recently, Bush hosted a reproductive rights tour across Missouri to rally her constituents and others to vote for candidates who want to expand abortion access in Missouri during this year’s midterm elections.

Speaking at a rally in St. Louis, the former nurse and activist said the Black women she spoke to in cities across the state believe that no one is listening to them, and that their disparities in maternal health care are not being heard, especially if they live in Republican-leaning areas.

“This is about human beings, and there are Republicans who have abortions,” Bush said. “This affects any and all people, so any and all people should have a voice in this.”