Last December, in a pivotal moment in the nation’s ongoing fight for reproductive rights, the U.S. Supreme Court heard oral arguments in Dobbs v. Jackson Women’s Health Organization. The case centers on Mississippi’s 15-week abortion ban and could overturn Roe v. Wade, the 1973 Supreme Court case that legalized abortion. The case is pending until the Court makes its decisions in June.

There’s much at stake in Georgia, where health care quality is low and anti-abortion Republicans are the majority in state government. “In the event that Roe overturns, it’s a very high likelihood that either [Georgia] will completely make abortion illegal or they will restrict any abortion after six weeks,” says Oriaku Njoku, co-founder and executive director of Access Reproductive Care-Southeast (ARC-Southeast).

A recent study found that states with more abortion restrictions also have more maternal deaths. In Georgia, the Maternal Mortality Review Committee reported that Black women were 3.3 times more likely to die from pregnancy-related complications. 

Since 2018, over 46,000 women have received abortions at one of metro Atlanta’s clinics, and 77% of those treated were Black, according to data from the Georgia Department of Public Health. Abortion advocates say abortion restrictions are harmful to Black communities, especially those in Georgia, where the maternal mortality rate once topped all states and has remained consistently high. Capital B spoke with Black abortion care advocates on the implications for Black women in the city and throughout the Southeast, if the Court overturned Roe. 

What does abortion care access in Atlanta look like for Black women right now?

About 89% of U.S. counties do not have an abortion clinic, and in Georgia, that rate is 95%. The National Abortion Federation provider database shows 13 in-person abortion care clinics (and two telehealth providers) in Georgia: 10 in-person clinics are in the Atlanta metro area, and the other three are in Lawrenceville, Columbus, and Augusta. In addition to abortion services, most clinics provide sexual health services, including testing and treatment for sexually transmitted infections, HIV testing and counseling, birth control, and pregnancy testing. 

In Atlanta, abortion access reflects the city’s general pattern of racially segregated access to health care resources: facilities and services cluster in northside neighborhoods. But these clinics serve Atlanta, as well as the Southeast region – virtually all clinics are no more than a mile away from an interstate highway, a small convenience for those who may have to travel hundreds of miles to get needed care.   

“Atlanta, specifically, is essentially one of the hubs for abortion in the South,” Njoku said. Atlanta has become a hub because of the city’s international airport and highways that crisscross the city to connect people just all over the region.

However, most clinics are in Atlanta’s northside neighborhoods. Still, East Atlanta, Forest Park, College Park, and Decatur each have a clinic near I-20. 

Ten percent of people who received abortions in Georgia from 1994 to 2016 were from neighboring states, like North Carolina and Alabama.

Most clinics offer surgical and mediction abortions, depending on pregnancy age and staffing availability. All clinics abide by Georgia’s current laws, which prohibit abortion beyond 21 weeks and six days, require parental notification for minors, and mandate a 24-hour waiting period after the initial appointment. 

Most health insurance plans cover abortion services, but many adults in Georgia are uninsured. For people with few resources to seek safe care, abortion funds like Access Reproductive Care-Southeast provide financial and logistical support.

Njoku was part of a recent study that found that 81% of people seeking help from ARC-Southeast were Black, 87% had Medicaid or no insurance, and 77% were already mothers. 

“The same folks who have issues getting health care, any sort of health care…are the same folks who are impacted [by abortion restrictions],” Njoku said, adding that restrictions further exacerbate existing legislative, logistical, and financial barriers to safe abortion care.  

What about medication abortion in Georgia?

Medication abortions make up over half of those that occur before nine weeks and have a 0.4% risk of significant complications. Last December, the Food and Drug Administration approved abortion pills by mail. 

Medication abortion is promising for women affected by logistical barriers like getting to a clinic. “You could be sitting at home in College Park and talking to your abortion provider at Feminist Women’s Health Center, and go pick up your prescription near your local pharmacy,” says Elizabeth Mosley, a doula and professor at Georgia State University. 

On Feb.9, the Georgia Senate approved a bill to ban medication abortion by mail, including on public or private college or university campuses in the state.

The bill co-sponsor Sen. Bruce Thompson said, “It puts great risk on those females who make that choice. What we’re asking is that these females have a physician involved.”

Medication abortion has been around since 2000 when the FDA first approved mifepristone to terminate pregnancies before 10 weeks and the accompanying hormone blocker, misoprostol. 

Abortion advocates say that requiring a physician examination for medication abortion is another barrier that disproportionately affects Black people who have fewer resources to get and pay for health care. 

Nearly one in five Black women in Georgia are uninsured, and one in six Black women in Georgia say they do not have a personal doctor or health care provider.

What’s Georgia’s track record with previous abortion legislation?

Georgia lawmakers are no stranger to introducing abortion restrictions, and they are not alone. The state is one of 26 that aims to ban abortion if Roe is overturned. 

Recent years brought a tsunami of anti-abortion legislation, including one of the most restrictive to date: Texas’ six-week abortion ban

Dr. Tiffany Hailstorks is an Atlanta-based Ob-Gyn and family planning doctor who provides abortion care services. In a given week, Hailstorks sees about 20 to 50 abortion patients between two clinics: Feminist Women’s Health Center and Atlanta’s Women’s Medical Center. She says “at least half” of those patients are Black women. 

After Texas’ ban went into effect, Hailstorks immediately noticed the fallout: patients traveling from Texas to receive abortions and asking for contraception. Her Georgia patients realized the potential consequences. “If it can happen there, it could happen here,” Hailstorks said. 

Abortion access in Georgia came under threat in 2019 when Gov. Brian Kemp signed House Bill 481, known as the fetal heartbeat bill, that would ban all abortions after six weeks or detection of a heartbeat in the womb. Abortion advocates argue many women don’t even know they are pregnant before six weeks, making the bill a “de facto” ban on abortion. They also say it violates Roe, which says states cannot ban abortion before a fetus is viable or able to survive outside the womb under normal conditions

The same year, abortion advocates, including the Atlanta-based SisterSong Women of Color Reproductive Justice Collective and the American Civil Liberties Union, filed a federal lawsuit to keep HB 481 from going into effect. A federal judge blocked the law in July 2020, as it “constitutes a pre-viability abortion ban.” Under Roe, states can not ban abortion before 24 weeks of pregnancy, which is when the fetus is viable or can live outside the womb under normal conditions. The case went to the U.S. Court of Appeals, which delayed its review, pending a decision by the Supreme Court on Dobbs v. Jackson Women’s Health Organization. Access to abortion in Georgia depends on Roe, which now hinges on Dobbs.

What is Dobbs v. Jackson, and how could it affect abortion access in Georgia?

SCOTUS abortion protest sign
An abortion rights supporter holds one of many signs that was displayed at a reproductive rights rally at Smith Park in Jackson, Miss., Wednesday, Dec. 1, 2021. (AP Photo/Rogelio V. Solis)

The Supreme Court case case is rooted in Mississippi’s 2018 prohibition of abortions after 15 weeks of pregnancy, except in cases of fetal abnormalities or a medical emergency. 

Jackson Women’s Health Organization – the only licensed abortion clinic in Mississippi – filed an emergency order to block the law, which the U.S. District Court granted, stating that it was unconstitutional. 

State Health Officer Thomas Dobbs appealed the case to the U.S. Court of Appeals, then to the U.S. Supreme Court in 2020 where arguments were heard last December. 

The implications of banning abortion in Georgia are dire and overwhelming. For Black women living in Georgia, a state that consistently ranks high for maternal mortality, denying abortion is a direct threat to life. The Turnaway Study followed 1,000 women from 21 clinics who were denied access and found women who gave birth reported more chronic headaches or migraines, gestational hypertension, as well as life-threatening complications compared to those who received wanted abortions.

In addition to the health and medical complications, denying people abortions also has far-reaching social and financial consequences, including lasting poverty, more debt and lower credit scores, inability to cover basic expenses years later, and rearing children without a partner or family members. Denying an abortion can even affect the development and poverty level of a woman’s existing children. 

“When it comes to folks making decisions around whether they want to be a parent or not…those things are what people are considering,” Njoku said. 

There is concern that neighboring states would follow Georgia’s lead if Roe is overturned, and “patients will be traveling a distance to get abortion care,” depending on the gestational limits, Hailstorks said. Likely destinations are Florida and North Carolina for pregnancies under 20 weeks, and Washington, D.C., or Colorado for pregnancies beyond gestational limits.

Now what?

Access in Georgia remains legal but in danger. Atlanta advocates are working to provide care to those who need it and be more proactive against the onslaught of anti-abortion legislation. “There are moments that it feels heavy,” Hailstorks said, referring to the work of ensuring patient’s abortion care is “seamless.” Hailstorks says there is “a ton of work going on in the background” when coordinating an abortion. 

Georgia’s current abortion laws and stigma all make providing abortion uniquely more difficult to provide compared to other preventive services,” said Hailstorks. For example, she has to vet medical staff to ensure they are “OK” with providing abortion care. 

“More restrictive legislation makes it so much harder to be able to do what is already difficult,” she said.

Njoku finds promise in the city’s Reproductive Justice Commission, which works to increase awareness around access to reproductive, maternal and infant health, as well as abortion. The commission was sponsored by Councilman Amir Farokhi in 2019 in response to Georgia’s heartbeat bill.

“It’s a group of folks that are like ‘OK, well, when we’re talking about reproductive freedoms, reproductive justice in this state, what does that look like? Who is impacted?’”

The commission has not been very active since it was formed in 2019, but for Njoku it reiterates that Atlanta is, “a bit more progressive than other cities in the state.”