Even under normal circumstances, Black motherhood in the United States can be heavy, moving between feelings of hope and pride and feelings of fear. As Black Lives Matter cofounder Patrice Khan-Cullors put it, being a Black mother means being someone “who has to carry the weight of having to protect her children in a world that is conspiring to kill them.” Consignment to this sorrow is part of what it means to be Black in America.

Now that Covid-19 has swept the nation, these contradictions can be even harder to sustain. The pandemic has laid bare the dark reality of our health inequalities, in particular in terms of access to testing and treatment, and revealed the inadequate measures adopted to protect essential workers. But the inequities don’t stop there. Americans across racial categories are warier of growing their families during the coronavirus pandemic, but Black people in particular are facing financial burdens that make the decision a hard one to make. A recent study found that 44 percent of Black people are shifting their fertility preferences toward delaying or abandoning the idea of a pregnancy, compared to 34 percent of the general population. That’s not surprising, given that financial insecurity and unemployment overwhelmingly impacts Black Americans. Meanwhile, those who are pregnant are more vulnerable: In July, the American College of Obstetricians and Gynecologists published a report that Black and Latinx pregnant patients are more likely to test positive for Covid-19 than their white counterparts.

But this hesitation to grow our families likely doesn’t come only from the recent economic instability and health insecurity. It is well known that maternal morbidity as well as mortality are particularly high among Black people in the United States. In the US, Black women are three to four times as likely than white women to experience pregnancy-related deaths, and in the UK, they are five times as likely. Even when one accounts for class, middle-class Black women are more likely to die than working-class white women in America. Fame does not protect one from these adverse events, as we learned when affluent Black women Serena Williams and Beyoncé both went through harrowing experiences in pregnancy and delivery. We know that childbirth is more dangerous for a Black American woman with a PhD than a white woman with a high school diploma. As a Black American woman with a PhD, the prospect of my birthing a child seems unappealing. Add to that that the US ranks 33rd out of 36 among OECD countries for infant mortality, and it is not surprising that many Black people would prefer to abstain from childbirth.

Another disparity is in newborn survival, which, according to a new study, is correlated with interpersonal dynamics between medical staff and patients. Black babies in the United States are more than twice as likely to die before the age of 1, irrespective of their mother’s income or education level. A longitudinal study which documented newborn and physician relationships from 1992 to 2015 showed that Black babies were three times more likely to die under the medical guidance of a white doctor than when treated by a Black doctor. This same study saw no difference in white newborn survival rate when they had doctors of the same or a different racial background.

At the same time, Black Americans disproportionately lack access to contraception and abortion. Anti-choice zealots want to make abortion illegal in the United States, and their efforts have been unflagging since the ascent of the 45th US president. Trump’s nomination of conservative Christian judge Amy Coney Barrett to the Supreme Court raises the stakes even further. The anti-abortion movement, aligned with Christian conservative groups and the Republican Party, has relied on scare tactics and racialized fear, and an arsenal of unsound claims, to make it difficult for people to access safe and affordable abortions in the United States. This strategy is not new but part of an ongoing culture war that is tied to racially motivated campaigns which, as Michele Goodwin has argued in Policing the Womb, criminalizes the wombs of poor people and people of color.

When I lived in New York City in 2011, I was appalled by an anti-abortion billboard in Lower Manhattan that featured a Black girl in a pink dress looking bewildered with a message above her reading, “The most dangerous place for an African American is in the womb.” The ad was created by the “That’s Abortion,” a right-wing campaign that targeted abortion providers. Behind their brand of racially motivated anti-abortion provocation was a pernicious lack of awareness about the actual harms of Black life. These arguments evade the ways that Republicans and Christian conservatives have interfered with Black people’s health and wealth by cutting funding for education, Medicaid, and housing.

In 2019, there were 18 federal and state proposals to restrict or ban abortions, many tied to race and sex selection, but all ultimately restricting access to pregnancy termination. In June 2020, Tennessee lawmakers, with the approval of Republican Governor Bill Lee, passed a law that would have prohibited abortions when a heartbeat was detected in a fetus. The law was ruled unconstitutional by the US district judge. Earlier this year, in June Medical Services v. Russo, the Supreme Court ruled that a Louisiana law that would have required doctors performing abortions to hold active admitting privileges in a hospital, was ruled to cause an undue burden for patients to obtain an abortion. At present, African Americans make up 18 percent of Tennessee’s population and 34 percent of Louisiana’s, which is well above the national average of 12.5 percent. When Southern states pass these laws, one cannot ignore that anti-abortion legislation in the American South will have a particularly deleterious impact on Black people.

The wave of anti-abortion measures, passed by Republican legislators, is part of an effort to overturn Roe v. Wade. It’s also part the Christian right’s attempt to erroneously conflate abortion with eugenics, as a way to draw in conservatives of color such as Ted Cruz and Ben Carson. The theoretical falsehood is moving the goal posts from actual, harmful genocidal programs such as the force sterilization of Black women in the civil rights period and the known eugenics programs that disproportionately targeted Black Americans in Southern states such as North Carolina, which carried out state-led sterilizations until 1977. Civil rights activist Fannie Lou Hamer was galvanized in part by her forced sterilization in Mississippi in 1961. Anti-choicers claim to be fighting for racial justice, yet, their propaganda fails to acknowledge that a significant share of Black Americans support access to abortion.

These disparities in healthcare access have deep roots. Black women have faced a long history of medical abuse and experimentation. Enslavement, as Professor Deirdre Cooper Owens has noted in Medical Bondage, meant that a Black woman’s pregnancy and her fetus were considered valuable commodities for their enslavers. This was predicated on Black women being valued for their reproductive and productive labor, which Professor Angela Y. Davis also highlighted in her book Women, Race, and Class. Some Black women resisted their enslavers’ limitations on their reproductive agency, using abortifacients or committing infanticide to prevent their offspring from living a life under enslavement. They were willing to use whatever means they had to have greater control over their bodies and potential suffering from a brutal system of chattel slavery.

We must address all these structural inequalities around reproductive health head on, rather than wishing them away. We can learn from the example set by the People’s Free Medical Clinics that were organized by the Black Panther party, as Professor Alondra Nelson has documented in her monograph Body and Soul. At the heart of these programs was providing free healthcare, free preventive screening for sickle cell disease, and free gynecological exams, through autonomous community networks, an anti-racist model that could be useful for Medicare for All. Tackling health inequalities means listening to Black people and their concerns about healthcare access and empowering people to receive the care they want, without judgment.