Points of View

A Black Abortion Provider’s Perspective on Post-Roe America

List of authors.
  • Bria Peacock, M.D.


As a Black woman raised in the South, I have seen how policies affect the ability of marginalized people to make choices about their own bodies and reproduction. Witnessing my older sister become a mother at 16 years of age and learning that my grandmother birthed my mother at 14 years of age, I became all too familiar with unintended pregnancies and how the complex intersectionality of racism, sexism, and classism is used to challenge the morality of abortion. Antiabortion activists often take out of context the fact that in the United States, Black women are 5 times as likely as White women to get an abortion, and they use this fact to push the characterization of abortion as “Black genocide.” This claim contributes to the narrative feeding the impending overturning of Roe v. Wade.

I’ve always known this was a false narrative, and now as a Black gynecologist, I see how deeply it’s harming our community.

Growing up, I witnessed the consequences of limited access to reproductive choice: perpetuation of poverty, intergenerational “curses,” and the resentment experienced by young women who felt forced to have babies and give up their dreams. Watching Black women in my community come to terms with these situations is how I came to my prochoice values. I wondered what life would be like if these women could decide whether, when, and how to grow their families.

Yet it wasn’t until I read up on our nation’s history of Black reproductive exploitation that I grew resolute in my perspective. The policing of Black bodies and reproduction dates back centuries, part and parcel of the commodification of Black bodies. The institution of slavery allowed for intrusion into nearly every realm of Black women’s lives, including the birthing of babies for profit and labor. Once the importation of enslaved people from Africa was abolished, the reproduction of enslaved people in America was vital to the perpetuation of slavery as a profitable system. For capitalistic gains, White men — doctors and slaveowners alike — increased their interference into the reproductive lives of Black women by means of forced breeding and rape.

In those history books, I saw the women in my community, still struggling with the same oppression generations later, and began to center my life’s work around creating community and support for us.

Today, facing the likelihood of a post-Roe America, I think about forced births in this population that bears the highest maternal morbidity and mortality in the country. Black women will be disproportionately affected by the lack of abortion access and overrepresented in pregnancy-related deaths. I think about our ancestors each time I support Black women as they give birth or choose not to. I think about the young women of my community whose lives are forever changed by a lack of choice. As a Black female physician, I aim to ensure that my patients can choose for themselves, knowing that I’m there to support them, not exploit them for anyone’s gain.

A few weeks ago, I sat down with a patient who’d decided to terminate her pregnancy. There were many layers that connected us — from our fresh new braids to our love of Southern food. I saw her, and she saw me — multidimensional Black women, unapologetically free in our choices. As I walked her to the procedure room, she asked me why I performed abortions. Caught off guard, I explained this history. I reminded her of her power. There was no need to explain her “why” to anyone; this procedure was her choice, and I supported her fully. She thanked me softly, knowing she was not alone. As I performed her abortion, I thought of that connection and that versatility, recognizing that the very fact of Black abortion providers unapologetically supporting Black women is revolutionary.

In that moment, I felt that unshakeable feeling of pride and joy intertwined with Blackness and its many trials.

That’s why accusations that abortion access contributes to the “genocide” of my community shake me to my core. It is not possible for genocide to look like the relief on my patients’ faces as I enter the room, putting them at ease because I, too, know what it’s like to walk through the world as a Black woman.

Forced births and reproductive exploitation of Black bodies are historical facts, and history often repeats itself. When it does, marginalized people usually suffer the most. As I read those history books, I felt that truth. As I walked through life as a Black woman in the South, I felt that truth. As I think about a post-Roe America, I feel that truth. But those same history books, South, and future America also contain advocates who understand nonnegotiable reproductive freedoms. We know the plight of Black people who birth babies and have abortions, and we will continue to fight unapologetically for the freedom to safely do both.

Bria Peacock, M.D.
University of California, San Francisco, San Francisco

Funding and Disclosures

Disclosure forms provided by the author are available at NEJM.org.

This article was published on June 8, 2022, at NEJM.org.

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