How abortion restrictions have disproportionately impacted Black women

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• Amna Nawaz:

  It's been more than two years since the Supreme Court ended the constitutional right to abortion. Since then, nearly two dozen states have banned or restricted access to the procedure and to abortion pills.

  Special correspondent Sarah Varney Sarah Varney traveled to one of those states, Tennessee, to report on the disproportionate impact abortion bans are having on Black women.

  It's part of our ongoing coverage of Race Matters.

  Nicole Blackmon, Mother of Shooting Victim: He's actually 14 in that photo. This was the year where he was graduating from the eighth grade.

• Sarah Varney:

  Nicole Blackmon's son Daniel was shot and killed in Mobile, Alabama two years ago, an innocent bystander. Overcome with grief, Nicole and her husband moved to a Nashville suburb.

• Nicole Blackmon:

  After so many tries, I did finally get pregnant.

• Sarah Varney:

  Blackmon long had difficulty conceiving after having Daniel, so she was elated when she became pregnant after arriving in Tennessee. But four months into her pregnancy, doctors discovered that the fetus' organs were growing outside its body, and Nicole had became so dangerously ill, she was hospitalized.

  It was only when she decided to end her pregnancy that the couple found out Tennessee lawmakers had outlawed abortion.

  When you learned that you were unable to make the choice to end your pregnancy here in Tennessee, what was your husband's reaction?

• Nicole Blackmon:

  He was devastated: "You're putting your life on the line. You know, we just lost Daniel, and I don't want to lose you."

• Sarah Varney:

  The couple considered driving out of state. But Nicole was already too sick to work, with no paid sick leave, and her husband, a house painter, would lose a week of wages. At 31 weeks, she vaginally delivered a stillborn baby.

• Nicole Blackmon:

  Me knowing the condition of the baby, I did ask that the doctors to put a sheet in between me and the doctor, because, mentally, I did not want to be prepared to see the baby like that after just losing my son, and I wanted to just have a memory in my head on how I wanted the baby to be in my head.

• Sarah Varney:

  And Blackmon isn't facing these restrictions alone; 57 percent of Black women between the ages of 15 and 49, or about seven million women, live in states where abortion is banned or limited. Tennessee has one of the highest maternal mortality rates in the country, and Black women here are about 2.5 times more likely to die from pregnancy-related causes as white women, regardless of their income or level of education.

  The Republican-controlled legislature here in Tennessee made a few limited changes to its total abortion ban last year. Abortions are now legal if a pregnant woman is facing death or is at risk of irreversible damage to a major bodily function. But doctors here say pregnant women are still in danger.

  How long have you been practicing in Tennessee?

• Dr. Rolanda Lister, Vanderbilt University Medical Center:

  Since 2016.

• Sarah Varney:

  Dr. Rolanda Lister is a maternal fetal medicine specialist at Vanderbilt University Medical Center in Nashville.

• Dr. Rolanda Lister:

  One of the unfortunate challenges with not having choice for a mother, especially when there is a lethal fetal anomaly, is the complications that can potentially happen from continuing a pregnancy.

• Sarah Varney:

  Complications like postpartum hemorrhage and preeclampsia, a high blood pressure disorder that can lead to organ failure.

• Dr. Rolanda Lister:

  So it's hard to justify continuing some pregnancies that have very little to no likelihood of survival.

• Sarah Varney:

  Lister says it's not uncommon for her office to recommend patients leave Tennessee for abortion care.

• Dr. Rolanda Lister:

  We provide them with phone numbers, foundations that help with travel. So we do our best to assist patients if that's what they have decided to do after hearing about the unfortunate news about their unborn baby.

• Sarah Varney:

  Last year, more than 171,000 patients traveled across state lines to end a pregnancy. That's more than double the number who did so in 2019.

• Usha Ranji, KFF:

  Some people have been able to travel out of state to get abortion care, but, for a lot of people, that's not really practical.

• Sarah Varney:

  Usha Ranji is the associate director of women's health policy at KFF, a nonprofit health research organization.

• Usha Ranji:

  Most Black women say they actually don't have enough savings to be able to afford a $500-or-more unexpected expense. So there's both the financial cost of getting the care, the abortion itself, but also the logistical issues of traveling, potentially long distances.

• Sarah Varney:

  She says Black women who are pregnant enter the health care system already at a disadvantage.

• Usha Ranji:

  Black women, we know, have experienced discrimination and racism in all sectors of society, including the health care system, and that has affected their access to care, their relationships with providers, and their treatment by providers for a very long time.

• Tia Freeman, Reproductive Health Organizer:

  There are safe ways that you can obtain abortions right now. They might not be safe in a legal aspect all the time, but there are safe ways where we don't have to find people using coat hangers or caustic substances.

• Sarah Varney:

  28-year-old reproductive health organizer Tia Freeman educates Tennesseans about their options outside of medical settings. She leads trainings on how to safely take medication abortion pills in a state where Republican lawmakers have made doing so illegal.

• Tia Freeman:

  We're getting more and more people who are scrambling to find people they're in community with who know someone who might know someone that can help them. And were also seeing a lot of people continue unintended pregnancies because they don't have access to a clinic that's nearby.

• Sarah Varney:

  Access to reproductive health care has long been limited for women in Southern states, especially Black women.

• Tia Freeman:

  A lot of people say like, Roe was the floor, not the ceiling. And the reason that is, is because a lot of people were barred from care anyway.

• Sarah Varney:

  And Black women between ages 18 to 59 have higher uninsured rates than their white counterparts. That's in part because far more Black women live in Southern states that have not expanded Medicaid under Obamacare.

  Without insurance, women's access to health services is limited and costly, including prescription birth control pills and IUDs and routine gynecological care.

• Usha Ranji:

  Having health insurance and access to care is really important before, during, and after pregnancy. But we know that, in states that have not expanded Medicaid, a lot of people only gain health insurance once they become pregnant. And that's particularly for lower-income people.

• Sarah Varney:

  Freeman has had two abortions. She wants to focus on supporting her son financially and emotionally, and she's deeply committed to his future and her own.

  A landmark study that tracked 1,000 pregnant women for a decade found that 72 percent of those who were denied an abortion ended up in poverty, nearly 20 percent higher than women like Freeman, who were able to obtain abortion care.

• Tia Freeman:

  I think that, for Black people, abortion is a liberatory point of access because of the blockages for upward mobility when people experience unintended pregnancies, the lack of access to career options, college and education, because of the high rates of maternal mortality.

• Sarah Varney:

  For now, Nicole Blackmon is waiting for her day in court. She's the lead plaintiff in a Center for Reproductive Rights lawsuit against the state of Tennessee over it's abortion ban. But she's already taken a painful step to protect herself.

• Nicole Blackmon:

  I did decide to have my tubes removed, because I was scared of going through all of that all over again, knowing that I'm going in a battle with no support from the doctors, because the doctors' hands are tied, and that's — not much that they can do.

• Sarah Varney:

  Had you been able to have an abortion when you wanted it, would you have wanted to try again, try and get pregnant again?

• Nicole Blackmon:

  Yes. I would have gave myself another chance at having another baby.

• Sarah Varney:

  Who do you blame for what happened to you?

• Nicole Blackmon:

  I blame the law. I blame the law for being made, not thinking about the different reasons women go through what they go through, not making it where women are able to make their own decisions when it comes to their body.

• Sarah Varney:

  Decisions, she says, that can be life or death.

  For the PBS "NewsHour," I'm Sarah Varney in Nashville.