MONTCLAIR, NJ—While New Jersey has strong legal protections for the right to reproductive autonomy and abortion care, reproductive justice advocates say that doesn’t mean everyone has equal access to abortion—especially those in disenfranchised, low wealth and under-resourced communities and women of color regardless of income level.

The Freedom of Reproductive Choice Act (S49/A6260), which was passed in January, reinforced the constitutional right to reproductive choice in New Jersey. But advocates say it fell short of expanding abortion access regardless of someone’s race, gender identity, sexual orientation, immigration status, income level, or lack of insurance coverage. 

"When we talk about reproductive justice, it's intersectional," said Alejandra Sorto, Campaign Strategist for the American Civil Liberties Union (ACLU) of New Jersey on the issues of immigration, reproductive rights, democracy and economic justice. "And it has to be rooted in the real-life experiences of people, and how our identity and how our systems of oppression prevent people from access. So let's think about it like: the right is there but take a step back if you are an immigrant; take a step back if you're of low income; take a step back if you live in a rural area.” Each classification lessens the chance of “actually achieving the right,” Sorto added. 

New Jersey is one of 21 states where abortion is still legal after the United States Supreme Court overturned Roe v. Wade, giving individual states the power to regulate abortion. In an effort to expand reproductive justice to all women in the state, advocates are demanding the New Jersey State Legislature approve the Reproductive Equity Act (S2918/A4350). The 36-page bill would lift the barriers preventing communities of color, immigrants, LGBTQ+ communities and low-income people from accessing reproductive care. 

While the bill codifies regulations authorizing health care professionals to provide abortion care and protects providers and patients seeking an abortion, it expands the number of private insurance providers to cover abortion care with no out-of-pocket costs. The cost of an abortion in New Jersey can range between $380 to $2,100—a steep price for people who are low-income, undocumented and uninsured.

On Nov. 1, advocates and supporters of the Reproductive Equity Act gathered at the Unitarian Universalist Congregation in Montclair for a panel discussion on reproductive health care and abortion rights and how the pending bill, stalled in the legislature since June, would help ensure access to reproductive rights for all.

“New Jersey, yes, we have the protections, but one in three counties don't have a provider,” said Sorto, who was on the panel. “So, we have Pro-life abortion access deserts in New Jersey.”

For anyone uninsured or underinsured, including undocumented community members, the bill would establish a program to support the costs of abortion care. Currently, most undocumented women seeking abortion care don't have access to health insurance, which forces them to pay out of pocket or get charity care, which is limited. 

"When we talk about the folks that are mostly low income, if you add that they are undocumented, if you add a language barrier, that's where it becomes nearly impossible for them to access care," said Sorto.

The bill will also create a $20 million Reproductive Health Access Fund to support abortion care clinical training programs, preserve and expand facilities across the state, and offer grants to reproductive health care facilities for security and operational needs to protect against the growing hostility over abortion.

“Folks don't realize that women who have had abortions are all around us—nearly one in four women will have had an abortion—but we don't talk about it, and we don't know who they are,” said Susan Mack, who had an abortion decades ago, when she was in her early 20s, but only recently decided to share her story.

“These conversations must take place,” Mack said. “Our daughters, our nieces, our granddaughter's lives hang in the balance. We've got to come out of the closet and tell others about our story.”

Expanding the number of providers and clinics is especially important since New Jersey is now a safe haven for women coming from states where abortion is illegal. Additional training programs would ensure that enough practitioners are available to meet the need, as well as provide opportunities for out-of-state trainees since abortion care can no longer be taught in states that have outlawed abortion, said Linda Sloan Locke, a clinician, therapist and midwife for over 40 years. 

The lack of abortion care training could put schools and healthcare facilities in danger of losing their teaching accreditation because they won't be able to teach the full breadth of women's health care.

"Somebody comes in with an ectopic pregnancy, you know, you need to be able to take care of that," said Locke. “If somebody has horrendous cardiovascular disease and pregnancy would be dangerous to her health. You need to be able to do that.” 

According to the Guttmacher Institute, 58 percent of women between 13 to 44 live in states that are hostile to abortion rights. The Economic Policy Institute (EPI) found that these states typically have higher poverty rates, low wages, barely functional public services and no paid leave or parental support. The denial of abortion care is just one piece of a broader problem—a problem of economic subjugation and disempowerment, the EPI report said. 

“It's disappointing and discouraging and disheartening to see, but it goes along with so many other oppressive things that are going on in the country,” Locke said. “It's not happening in a vacuum. When you look at the rampant racism that's going on, it's just intersectional.”

Intersectionality looks at how social, economic and political systems work together to oppress people of color, and the reproductive justice movement is an attempt to take on all these systems. The purpose of the movement is to advocate for the right to choose and live free from fear and violence, which can only be achieved when all women have the full economic, social and political power and resources to be able to make healthy decisions about their bodies, families and communities.

Women face higher poverty rates than men across races and ethnicity. Although Black women make up only 12.8 percent of all women in the U.S. population, they have one of the highest poverty rates, at 22.3 percent, according to the U.S. Census—an outcome of chattel slavery and Jim Crow racialized political and economic policies.

Historically, Black communities have experienced generations of political segregation and social and economic disparities across income, education, housing, health care and the law, to name a few.

The Guttmacher Institute found that 49 percent of abortion patients live below the federal poverty level, and affordability or the inability to meet current responsibilities was a frequent reason for an abortion—forced to decide between caring for their family or continuing their pregnancy. 

Wendy McNeil, a member of the Unitarian Universalist Congregation and chair of the Undoing Racism Education Team, said the country doesn’t have the infrastructure to support single-parent households or married women with children—and 59 percent of women obtaining abortions are mothers. 

“We don't like to help people in this country,” said McNeil. “And we're cutting back and cutting back, and all of those states, all of those states that have banned abortions are also the states with the highest poverty rates, the highest divorce rates.” That makes for a “dysfunctional society,” she said.

In 2019, the Center on Budget and Policy Priorities found that 29 percent of Black women and 33 percent of Latina women of reproductive age with incomes below the poverty line were uninsured with no pathway to affordable health coverage. Research shows that Black women face barriers to reproductive health care because of their income and historical mistrust of the system. As a result, Black Women have higher rates of unintended pregnancy and lack of contraception access.

“You can't make a choice in a vacuum,” Locke said. “So your choice is going to be influenced by everything that's going on around you, it might be fear. And people that are in communities that have been historically oppressed, I mean, this whole concept of weathering—we've been subjected to these stressors our entire life—so just having that kind of stress impacts your ability to be able to make choices, and your health, and the outcome.”

Racism and oppression can take a toll on the human body, elevating stress to toxic levels and causing weathering—the consistent strain and deterioration of health from being discriminated against and marginalized—which can contribute to adverse outcomes in birth and pregnancy. “There is no income level that protects Black women in the state [of New Jersey] from having a healthy pregnancy,” said Dr. Nastassia Harris, the Executive Director of Perinatal Health Equity Initiative. 

Harris said Black women are seven to eight times more likely to die from a pregnancy-related complication regardless of income or educational status—and New Jersey is one of the worst states to give birth in for any woman.

“We have actually found that Black women who are educated and have wealth are actually more at risk for these complications than Black women who were not,” said Harris, noting that research often only focuses on women who are low income. “Black women who are affluent are more likely to navigate white spaces, where they are more likely to be exposed to racism and have to manage that on their day-to-day life.”

Not only are there inequities in health care access and health outcomes, but Pregnancy Crisis Centers push actual health care further out of reach for immigrant and communities of color that are already facing multiple barriers to health care. These centers live across the state, especially in Black and brown communities, and aren't healthcare facilities but part of an organization that seeks to intercept women considering abortion care. So, they're not even entitled to comply with Health Insurance Portability and Accountability Act (HIPAA)—meaning they aren't required to protect the privacy of protected health information.

“This is a real and pervasive issue in New Jersey,” said Sorto. “I Googled in my neighborhood and the first thing that comes up is a Crisis Pregnancy Center and that's extremely concerning. They target immigrant communities of color, and they offer it as like free care.”

Locke, who has worked in qualified community health centers and became the clinic director of Planned Parenthood in 1970, said she would see women late in their pregnancy because they had previously been going to a crisis center for health care without realizing what it actually was. “Not only do they prevent people from obtaining a termination of pregnancy or an abortion, they prevent people from really getting good prenatal care in a timely fashion,” Locke said. “So, they really are very, very, very dangerous.”

While Sorto says the state needs to invest in countering the misinformation propagated by Pregnancy Crisis Centers and consider passing laws to protect communities—municipalities in other states have passed ordinances to regulate these centers—the Reproductive Equity Act will further protect the right to abortion and expand access to abortion care.

Advocates say the right to bodily autonomy that goes beyond the protection of privacy and pregnancy but allows people to fully realize themselves and exist in the world was impeded the moment Roe v. Wade was overturned and clinics that provide a whole host of health care services shut down. At least 66 clinics across 15 states have stopped offering abortion care, and while 40 are still offering other services, 26 have shut down entirely, according to the Guttmacher Institute.

Passage of the Reproductive Equity Act would be a crucial first step toward ensuring reproductive equity for every woman, Sorto said. “I think quick action, sending a postcard, an email, making a call, I think that's really important,” she said. “When legislators begin to get called from their constituencies, it's sort of like they perk up and it's like ‘oh whoa. Like this is an issue that they care about,’ and I think we really need to push them to take action on this bill.”