A pro-life demonstrator kneels before a line of volunteer clinic escorts.
A pro-life demonstrator kneels before a line of volunteer clinic escorts in front of the EMW Women's Surgical Center, an abortion clinic, on May 8, 2021, in Louisville, Kentucky. (Jon Cherry/Getty Images)
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For six days last month, Kentucky was the only state in the nation without access to abortion services. A sweeping law that banned abortions after 15 weeks also included new requirements for providers, which the state’s two clinics said they couldn’t meet. 

Reproductive health organizations worked to overcome new barriers to abortion in one of the nation’s poorest states. Hotline operators at nonprofit Kentucky Health Justice Network scheduled out-of-state services for clients, arranged child care and secured hotel rooms for overnight stays. Volunteers drove people without access to transportation 113 miles north to appointments in neighboring Indiana. The state’s abortion funds helped shoulder the cost of services for those who couldn’t afford them.  

A federal judge has temporarily blocked enforcement of the state law until May 19, allowing Kentucky’s EMW Women’s Surgical Center and Planned Parenthood to resume abortion services. But their fight is not over. 

In a U.S. Supreme Court draft opinion obtained by Politico this week, Justice Samuel A. Alito Jr. argues for the majority that the right to abortion is not held in the Constitution. He pushes decisions to regulate or ban abortion to the states. 

If Roe v. Wade is overturned, Kentucky is one of 26 states expected to ban the procedure. Five hold spots among the top 10 states with the highest number of reported legal abortions: Florida, Texas, Georgia, Michigan and Ohio. Washington, D.C., and 16 mostly coastal states have laws that protect abortion rights.

People of color and low-income people will be disproportionately harmed by state restrictions and bans of abortion services, and are most likely to be criminalized for seeking care, say researchers. 

According to the Pew Research Center, 59% of U.S. adults say that abortion should be legal in all or most cases. 

The most impacted

Childbirth can be difficult, even dangerous, for some women, said Candace Bond-Theriault as her 11-month-old son whimpered in the background. Black women, in particular, face a high and rising maternal mortality rate. They die at three times the rate from pregnancy-related causes than white women. 

“It’s dangerous and no one should be forced to go through that experience if they don’t want to,” said Bond-Theriault, director of racial justice policy and strategy at the Center for Gender and Sexuality Law at Columbia Law School. 

State restrictions may also force people to delay abortions, and safety risks increase the further along in a pregnancy, said Guttmacher Institute’s Senior Research Scientist Liza Fuentes. Two-thirds of people accessing abortion care live in poverty, she added, which makes arrangements such as taking time off from work a heavy burden. 

In jurisdictions that require parental permission prior to receiving abortion services, adolescents who can’t safely  disclose their pregnancies to caretakers could be in danger, she added. About 57% of pregnant people who obtain abortions are ages 20-29, followed by 31% in the 30-39 age group and 9% up to the ages of 19, according to data from the Kaiser Family Foundation

Restrictions that ban Medicaid coverage of abortions particularly affect Black and Latino people.  

Since rates of unintended pregnancies are highest among low-income people and people of color, those populations will be most vulnerable to arrest and prosecution for violating state restrictions to obtain abortions, Fuentes added. 

“When we think about what it means for abortion restrictions to harm people, we have to understand that it is taking place in the same health care system and criminal justice system that has perpetuated inequities that harm Black and brown people,” Fuentes said.   

In Kentucky, low-income and rural Kentuckians will be affected the most, said ACLU Kentucky spokesperson Samuel Crankshaw. The land-locked state is bordered by other states that would likely ban abortion in the future, including West Virginia, Ohio, Indiana, Missouri and Tennessee. 

“People are always going to need abortions whether it’s legal or not, and people with the most resources are always going to be able to leave and go somewhere where it is safe to do that,” Crankshaw said. 

In November, Kentucky voters will weigh in on the future of reproductive health care through a proposed state constitutional amendment: “To protect human life, nothing in this Constitution shall be construed to secure or protect a right to abortion or require the funding of abortion.” 

“A lack of sexual and reproductive health care access has already had dire consequences for Kentuckians,” Planned Parenthood of Kentucky spokesperson Nicole Erwin said in an email. Kentucky has one of the highest teen birth rates in the country, which Erwin said would likely increase if Roe v. Wade is overturned. 

A religious history of abortion restrictions

About 77% of white evangelical Protestants say abortion should be illegal in all or most cases, according to the Pew Research Center

But when Roe was initially handed down in 1973, most evangelicals deemed it a “Catholic issue,” said Randall Balmer, a historian and religion professor at Dartmouth College. Evangelicals weren’t too concerned about it. 

Some leaders spoke out — in favor. W.A. Criswell, then-pastor of First Baptist Dallas and a former president of the Southern Baptist Convention, issued a statement supporting reproductive choice. Two years prior to Roe, and twice afterwards, the Southern Baptist Convention publicly expressed its support for abortion rights. 

But as the ’70s drew to a close, conservative leaders like Paul Weyrich, considered the architect of the religious right, sought to galvanize a political movement in defense of exempting taxes from institutions like Bob Jones University and other religious schools with racially discriminatory policies, Balmer said.

First, Weyrich argued that these places should maintain their policies supporting racial segregation because they were exercising religious freedom. When that didn’t work, he made his next move: Shift attention to abortion, Balmer said.

“I’ve described it as a godsend for the religious right because it allows them to divert attention from the real origins of the movement,” said Balmer, author of Bad Faith: Race and the Rise of the Religious Right.  

In Kentucky, where nearly 80% of the population are Christians, some in the religious left who support access to abortion services are speaking up. The Kentucky Religious Coalition for Reproductive Choice — an interfaith group that advocates for reproductive rights and provides education — plans to distribute stickers to inform people about the availability of medical abortions and to spread the word that abortions are still legal.

Members of the Kentucky Religious Coalition for Reproductive Choice sit on a sofa and on chairs during a meeting.
Members of the Kentucky Religious Coalition for Reproductive Choice meet at the Louisville Presbyterian Theological Seminary to discuss reproductive justice in June 2017. (Melissa Hellmann for YES! Magazine)

The coalition’s national chapter grew out of the Clergy Consultation Service formed in 1967, a group of faith leaders who referred people to trusted abortion providers prior to Roe v. Wade.

“You can be a person of faith and choose to have an abortion, and this is a decision that is not against God,” said Carol Savkovich, vice chair of Kentucky Religious Coalition for Reproductive Choice.

Kentucky has been hit hard by abortion restrictions in recent years. The state had one abortion provider in 2017, down from 17 in the 1970s. After the election of a Democratic governor in 2019, providers increased to two, both located in Louisville.

If Roe is overturned, civil rights organizations worry that other landmark Supreme Court decisions that rely on similar language, such as Obergefell v. Hodges, which ensured marriage equality, will also be at risk. In the draft decision, Alito writes that abortion is not a constitutional right, nor is it implicitly protected. Rights the Constitution does not mention should be “deeply rooted” in history. 

The rights to have an abortion, to marry and to have access to contraception are rooted in the rights to “liberty, privacy, and individual autonomy,” Omar Gonzalez-Pagan, counsel and health care strategist at Lambda Legal, said in an email. The leaked draft opinion is an “assault” on the “many other rights that are premised on the liberty and autonomy protected by the Fourteenth Amendment, including the right to marriage equality,” he added.

A way forward

Post-Roe, there may be opportunities to push for stronger state laws to improve health care access, said Aimee Castenell, southeast region communications director for the Working Families Party. 

“As important as Roe is, in terms of actual access to health care, it has not been the most useful thing,” Castenell said. “So I think moving outside of this idea of what Roe can and cannot do will create a space to have stronger laws that are beneficial to the people who need health care.”

With the focus on states, this year’s midterm elections carry even greater weight. Voters will elect candidates for 35 U.S. Senate seats and all 435 U.S. House seats. At the state level, 36 governorships and hundreds of state legislative positions are open.

“We will be able to take control of this narrative if we don’t slip into some fascist nightmare,” Castenell said. “But in order to do that, we have to be engaged.”

Correction: May. 9, 10:20 a.m.: An earlier version of this story incorrectly spelled Randall Balmer’s last name.

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Melissa Hellmann is an award-winning reporter who covers racial, gender and economic inequality. Prior...

April Simpson joined the Center for Public Integrity in October 2020 as a senior reporter covering racial...