Pregnancy has long been riskier than abortion in America. About 650-750 US women die during pregnancy each year, the highest maternal death rate in the industrialized world.
Comparatively, very few women die from abortion or suffer complications: two women died from abortion complications in 2018. So, when Roe v Wade was overturned last summer, there were fears that deaths and complications from pregnancy would shoot up – particularly among women of color.
Black women were 2.6 times more likely to die during pregnancy and childbirth than their white counterparts in 2021 according to CDC analysis. Structural racism, Medicaid coverage and a failure to properly invest in maternal healthcare all contribute to this. Black women report being dismissed, overlooked and ignored during childbirth and by the medical institution generally when it comes to maternal care.
After Roe v Wade was overturned, it was mostly states in the south and the midwest that banned abortion immediately. These states have the largest shares of women of color living in them. Women of color are also more likely to have abortions – Black women were almost four times as likely as white women to get an abortion in 2020; Latina women were almost twice as likely. This could be for a whole host of reasons: women of color generally earn a fraction of what their white counterparts earn; they are more likely to live in states where contraception is hard to access; and Black women, specifically, are more prone to miscarriage.
Here are two stories of women of color who had to navigate their pregnancies after being denied an abortion in post-Roe America.
Anya Cook
It was the first week that Anya Cook, 36, felt comfortable going out as a fully fledged pregnant person. She was well into her second trimester – 16 weeks – but having suffered 17 miscarriages in two years, she had learned not to get hopeful too early. In December 2022, her city of Coral Springs, Florida, was having its annual parade. Cook felt cute in her two-piece biker-short set as she watched children stuff their faces with ice creams, while parents cheered on the marching band from the sidelines.
Leaving a restaurant later that evening, Cook felt a wet rush down her legs, like someone had thrown a glass of water on her. On the way to the hospital with her husband, Derick, she hoped that even if her water had broken, she could get a small stitch and continue with a healthy pregnancy.
When Cook got to the ER, as far as she could see, no one had been shot, or was in need of urgent care. But over the next hour, she would learn how it felt to be invisible. The receptionist told Cook no beds were available, although Cook believes she saw many sitting empty. People turned their heads away as Cook squirmed uncomfortably in a wheelchair, amniotic fluid gushing between her legs. “Mommy, what happened to her?” she heard a small boy visiting the ER ask. The boy’s mother shushed him.
Soon, Cook would find out. Her water had indeed broken early, and there was no stitch that could reverse it. In the next 48 hours, she would deliver and her fetus would not survive.
Cook would be sent home, to deliver on her own. Because the doctors could still see a fetal heartbeat on the ultrasound, she couldn’t have an abortion, even though they knew 16 weeks was too early for it to survive. And because Cook was not yet in a life-threatening situation, the doctors couldn’t intervene to save her.
“I said, ‘Let me guess. Is it because of Roe v Wade’?” says Cook by phone interview.
The doctor confirmed it was.
Cook left the hospital certain of her fate that evening. After scouring the internet to learn about PPROM – preterm premature rupture of the membranes – she was sure she was going to die: complications from PPROM can include serious infection and hemorrhage.
Cook booked an appointment at the salon the next morning to have her hair done, ready for her casket. She and Derick argued all the way there. He couldn’t believe she was giving up.
Cook delivered her daughter, who she named Bunny, a few hours later, in the salon toilet. In the small, sterile-smelling room, she sat on the toilet with Derick between her legs, and tried to direct him, telling him to remove the cord and help her deliver her placenta, based on things she had seen on TV.
One of the clients in the salon that day was a nurse. When she saw Cook, she spoke with urgency: Cook was hemorrhaging and needed to get to the hospital, stat.
Cook remembers feeling dismissed and questioned when she arrived at the hospital. “The paramedics told them I was bleeding out,” says Cook. Still, she says she was asked by nurses and doctors several times if she was OK before being rushed for treatment.
In the end, to be taken seriously, Cook says she opened her legs. “I literally just released my body and blood. Like a pipe that burst in your kitchen, blood – gushing, shooting out,” explains Cook. “I said, now do you believe me?”
She woke up the next day, having lost almost half of the blood in her body. Lasting damage to the blood vessels around her uterus may make it even harder for her to get pregnant again.
Asked if she believes race was a factor in her care, Cook says yes.
“If I was Ron DeSantis’s wife, I would have gotten the care I needed, right there in that very moment,” she said – referring to the night when she first arrived in the ER.
DeSantis recently signed off on a six-week abortion ban in the state, which will make it even harder for people to get abortion care in Florida in the future.
“[Would] the governor’s wife wait for a bed, or go home to deliver when they know her baby won’t survive? Oh, no. That would have not happened. I don’t lose sight on that, ever,” Cook says.
Samantha Casiano
Deep breaths. That’s how Samantha Casiano, 29, got through the 13 weeks between finding out her fetus was going to be born with half a skull and wouldn’t live long after birth; and knowing she couldn’t get an abortion in Texas anyway.
She had gone home after being told the news and searched the internet for what to do. There were abortion clinics in New Mexico and Colorado, but Casiano immediately felt stupid for having looked. Where was she going to get the money to hire a rental car and drive out of state for three days to get an abortion? And who was going to look after her five children while she went? Her paychecks barely made up $1,200 a fortnight.
![Samantha Casiano: ‘I felt like I was in a prison, in my own body. Why did [Halo] have to suffer like that? She didn’t have to suffer like that.’](https://cdn.statically.io/img/i.guim.co.uk/img/media/05d7e930f52ffbec220e7d7780ba6c0e5786803f/0_0_5207_3758/master/5207.jpg?width=445&dpr=1&s=none)
Frightened, she deleted her search history and removed the idea of escape from her mind.
Casiano spent the next few weeks feeling like a prisoner trapped in her own body. With the growing kicks and pains that accompanied her pregnancy, she felt reminded that the life inside her was growing just to die. She watched, uncomfortably, as her husband increasingly convinced himself their daughter might be OK. Casiano knew the numbers. Almost all babies with anencephaly will die shortly after birth.
At 33 weeks, she hopped atop her brother-in-law’s grey truck with her husband, clutching her stomach as they headed down the road from her trailer to the hospital. It was time.
The doctors had been adamant that Casiano had to continue her pregnancy as though her fetus would survive since they diagnosed anencephaly at 20 weeks. But now she was about to deliver, she realized their pro-life stance would only last the duration of her pregnancy. They had no intention of treating her like someone whose baby was going to live during the birth.
Casiano’s fetus was breech – feet first – for which people are usually offered a C-section, to prevent a more painful delivery. Delivering breech can result in the baby’s head getting stuck on the way out; asphyxiation; and the pelvis seizing. Casiano was offered no monitor to see how her fetus was doing during the birth. “They kept telling me, if this was a normal healthy baby things would be different, but yours is going to pass,” says Casiano. “I felt like I’d been invited to a birthday party, where no one turns up, and no gifts are given.”
Her daughter, Halo, died four short hours after birth.
Casiano spent the next two nights sleeping on the ward of the hospital while she recovered, listening to new parents being united with their children. When she left, the doctors sent her walking out the front doors, instead of gently carting her out in a wheelchair as they do for the mothers leaving the hospital with their newborns. “I felt so degraded,” says Casiano. “It’s like they forced me to carry my baby to the end, but when the time came, they were like ‘OK, let’s get this over with.’”
Casiano is suing the state of Texas alongside 14 other plaintiffs for being denied access to life-saving abortion care. The lawyers representing her have noted that a white plaintiff in the case with the same diagnosis as Casiano was told to go out of state to get care, but Casiano’s treatment was very different.
“When she asked what her options were, her doctor said, ‘You don’t have any. You need to carry this pregnancy to term. They wouldn’t even show her the ultrasound,” says Molly Duane, a senior staff attorney at the Center for Reproductive Rights.
“There could be many reasons for that. But these themes of abortion laws and discrimination and institutionalized racism … it is borne out by real people’s experiences,” she says.
The lawyers also note how Casiano has been singled out in the case.
Casiano could not afford to pay for her daughter’s funeral, or a headstone for her grave, until a GoFundMe page she set up went viral. Recently, the state of Texas filed a motion to have the case dismissed, linking to Casiano’s GoFundMe in the motion, and accusing her of going on a $50,000 “media tour”, with her abortion story.
But Casiano is adamant she will continue speaking out.
“I do it because other women might not be as social as me, or as able as me, to say what they have gone through, and how they feel,” says Casiano.
“If I saw somebody else going through what I went through, I would be like: ‘How are you doing this? Nobody should have to do that’,” she says.