Texas’s new abortion law, S.B. 8, imposes restrictions on women’s reproductive rights that will intensify the flaws in the state’s health care system and further compound racial disparities in maternal health. It has no place in an equitable health system.
To fully grasp the damage the law will do to Black and brown people of childbearing age and their offspring, it is important to understand that the state’s health care system has been failing them for years. Long before S.B. 8’s passage, Black infants in Texas were twice as likely as white infants to die before their first birthday. While Texas does not report deaths among new mothers by race, we know the national Black maternal mortality rate was 44 deaths per 100,000 live births in 2019 compared to a rate of 17.9 white deaths. There is every reason to expect this pattern holds in Texas, where overall maternal mortality is higher than the national average.
And as an overall indicator of the inequity of the Texas health care system, in 2018 Black people in Texas were almost twice as likely as whites to die of preventable conditions because they did not get the health care they needed. Texas still has not expanded Medicaid eligibility rules, further predisposing low-income women to inequities in health care coverage and access to contraception, and delays in basic preventive care that impact health outcomes.
It is not hard to see how S.B. 8 will exacerbate the system’s existing failures. Afflicted for centuries by poverty and discrimination, lacking access to reproductive health services, Black women in Texas have been more likely to experience unintended pregnancies. The result is that abortion is accessed more commonly among Black women. Unplanned pregnancies are associated with higher rates of maternal mortality, prematurity, and infant mortality. S.B. 8 will therefore compound the long-term damage of racism in the Texas health care system, disproportionately injuring Black mothers and their children.
This is how systemic racism works. Directly or indirectly, explicitly or not, it results in policies or institutional structures that hurt Black and brown people, perpetuating and increasing inequities that began with the importation of Black people to America as slaves in 1619 and persist to this day.
Any discussion of the racial implications of S.B. 8 must also consider its sanctioning and rewarding private citizens to enforce the law. This conjures chilling memories of the Fugitive Slave Act that used vigilantism to preserve slavery and the Jim Crow era, during which gangs of private white citizens routinely beat and murdered Black people for alleged crimes.
Reversing the systemic racism of S.B. 8 will require legal and policy interventions to make constitutionally protected abortion services equitably available. If the courts fail to rein in the law, other similar state laws will likely follow. Should this happen, it will likely fall on the federal government to make certain such services are available and affordable outside these states.
Throughout our history, policies and laws have exacerbated racial inequities and entrenched the impacts of systemic racism in our health care system and beyond. The pending reconciliation legislation is a potentially historic reversal of this pattern. It proposes significant investments in maternal health equity, generous postpartum care, early childhood education, access to health insurance, along with other social services that would help reverse the health effects of more than 400 years of systemic racism that daily victimize Black Americans.