Ni’aisha Banks’ sixth pregnancy came after she already had four children. Her very first pregnancy resulted in a stillborn baby, so she was excited about bringing a fifth child into the world.

Then, Banks started to feel concerned about her health.

“I was severely ill, and had to find other people to help watch my children because I was in and out of the hospital so much,” she said. “I was severely dehydrated. I could not eat, I couldn’t drink.”

The symptoms carried on for much of Banks’ first trimester. She couldn’t even take care of her kids full time and eventually had an in-home nurse to help keep her hydrated. But Banks, who formerly had an anti-abortion stance, said she had no choice but to terminate her pregnancy when her oldest son spoke up. 

“My 6-year-old was frustrated because he has to help take care of his younger siblings,” Banks said. “It wasn’t fair to him to be put in that situation with that much responsibility because he wasn’t even old enough to take care of himself. But I was sick all of the time.”

A public benefit specialist at Savannah Technical College, Banks finds herself infuriated that the U.S. Supreme Court could overturn Roe v. Wade – the landmark case that greenlighted a woman’s right to abortion.

“I believe that if Roe is overturned, suicide will be at an all-time high,” Banks said. “Because just think about the women and young girls who experience unintended pregnancy, or who get pregnant because they are raped and are left without options.” 

As the national debate over abortion rights rages on, reproductive rights activists and health experts in metro Atlanta are watching developments closely.

For Black people in Georgia, a potential overturning of Roe v. Wade would be dire. That is because they represent 65% of abortions in the state, according to the most recent data, despite being only a third of the population. There are myriad reasons why, including financial implications tied to systemic racism, that could point to why Black people make up a large percentage of the state’s abortions. 

According to a study from Emory University, abortions for Black people in the state increased 16 percentage points between 1994 and 2016 — from 52.7% to 68.9%. A second study from Emory also found that after Georgia passed a law banning abortions after 22 weeks in 2012, that figure increased among Black women.

That same study shows that Black people often have less access to contraceptives, higher levels of unintended pregnancy, and are more likely to live in poverty that would result in the decision to go through with an abortion.

Researcher Johanna Pringle, the co-director of administration at the RISE Center, noted that contraceptive access in the state isn’t great, and that can have an impact on why people choose abortion. Without contraceptives, or tools used to prevent pregnancy like birth control pills and condoms, someone is likely to be put in a position to terminate a pregnancy. 

“Even if you did have access … you may have copays that reach up to $100 depending on what kind of contraception you’re seeking,” Pringle said. “Or you may be within a public system that requires a sliding scale that still may be unaffordable. Or you just don’t have access altogether.” 

Power to Decide, a campaign to prevent unplanned pregnancy, says that in Georgia, more than 630,000 women live in areas with less access to contraceptives. Of those women, 44,000 live in counties without a single health center that provides a full range of contraception options. 

Other studies show that finances can play a role into why some people might choose abortion. Black Americans, according to the Pew Research Center, are more likely to face economic instability than others. Economic instability makes family planning difficult, and denying abortion can push people into poverty. 

“A lot of people that are getting abortions are parents already,” said Sabia Wade, an author and educator known as the Black Doula whose work is focused on equity in reproductive rights. “Having a child, especially for Black and brown [and] Indigenous people, can put you further into poverty if you’re not already there. We think about just the cost of children from the time that they’re born, like hospital bills. … All that stuff costs money.” 

Kwajelyn Jackson, the executive director of the Feminist Women’s Health Center in Atlanta, shared Wade’s sentiment, but she added that a lot of those challenges stem from systemic racism tied to several issues disproportionately affecting Black communities.

“That might translate into economic insecurity that might make growing your family difficult or untenable,” she said. “That might mean that your housing situation or your employment might not support your ability to have more children.” 

Some researchers fear that any abortion restriction — like the state’s “fetal heartbeat bill” passed in 2019 — would cause an increase in the number of maternal deaths, where rates tend to be higher in  Black women. One researcher from the University of Colorado Boulder predicted a 21% jump in pregnancy-related death in the country if Roe v. Wade is overturned, and a 33% increase for Black women. 

Speaking of maternal deaths, Black mothers in Georgia are nearly three times more likely to die from pregnancy than their white counterparts. “That’s not talked about enough,” Wade said. “Some Black people are not having kids because they’re scared of dying.”

While skeptical of the ability to predict percentage increases in maternal mortality because of Roe’s possible overturn, Pringle noted that part of determining a public health crisis is an agency’s ability to mitigate those spikes. In Georgia, she said, the planning and response to maternal and pregnancy-related problems are lacking. 

The state’s health experts believe a majority of maternal deaths are preventable. “Based on what we’ve seen in Georgia, and its ability to manage and maintain those numbers or even reduce them, it’s a very slow process, if at all,” Pringle said. “And so, we potentially could exacerbate an already existing crisis.”

For Banks, an overturn of Roe v. Wade goes deeper than reproductive justice. 

“This is not a women’s issue. It’s a human rights issue,” she said. “If they take away these rights from us, it’s only a matter of time before they take away other rights. Black people and women, Black women specifically, have already been oppressed.”

Clarification: An earlier version of this story attributed only one source of a study detailing the impact of abortion restrictions and lack of access to services on Black women. The study was also performed by Emory University.

Kenya Hunter is Capital B Atlanta's health reporter. Twitter @KenyaTheHunter