Earlier this month, Politico published a draft opinion in Dobbs v. Jackson Women’s Health Organization, authored by Justice Samuel Alito, that promises to eviscerate constitutional protections for abortion care. Among the most jarring aspects of this anti-choice screed was its suggestion that proponents of abortion access “have been motivated by a desire to suppress the size of the African American population.” 

The draft cites to an amicus brief filed on behalf of Black and Latinx “religious and civil rights organizations and leaders,” which argues that contemporary abortion advocacy grew out of the emerging racist pseudo-science of eugenics. The sliver of a kernel of truth behind this claim is that a handful of historical abortion advocates, including Planned Parenthood founder Margaret Sanger, were eugenics supporters. But as Adam Cohen, author of Imbeciles: The Supreme Court, American Eugenics, and the Sterilization of Carrie Buck, recently explained for Balls & Strikes, the blanket claim that abortion supporters are thus eugenicists is patently wrong. The conspiracy theory’s appearance in this case is part of a larger trend of right-wing organizations pushing extreme arguments before this ultraconservative Supreme Court, more confident than ever that they’ll find a friendly audience.

Alito’s myopic focus on abortion obscures the larger truth: Harms like the persistent lack of access to prenatal care and the social deaths of incarceration and deportation present actual life-threatening dangers to communities of color. It isn’t abortion that is killing Black people; it is childbirth. 

Missing from the leaked draft, for example, was any discussion of the maternal mortality rate in Mississippi, the home of the anti-choice law at issue in Dobbs, where Black women are three times more likely to die in childbirth than their white counterparts. A de facto abortion ban that forces people to carry unwanted pregnancies to term puts Black women in more danger than white women. Yet Alito’s opinion waves aside the notion that abortion restrictions discriminate based on sex, and ignores their devastating impact on communities of color altogether.

This isn’t just a problem in Mississippi. The U.S has the highest maternal mortality rate among developed countries, a number that increased by 14 percent during the first year of the COVID-19 pandemic; per The New York Times, of these deaths, one-third were Black women. In developed countries like France and Canada, the maternal mortality rate is less than half that of the U.S.; in New Zealand and Norway, the rate is about one-eighth.

Unsurprisingly, the likelihood of a mother dying in childbirth increases if she is living in a high-poverty county or state. A U.S. Department of Health and Human Services study of maternal mortality rates found that women living in “middle-poverty” counties are nearly 60 percent more likely to die from complications related to pregnancy, a figure that increases to over 102 percent for women living in “high-poverty” counties. 

Adding to the bleakness of the lives of lower-income pregnant people is the fact that Congress and the Supreme Court have blocked them from receiving government assistance if they wish to terminate their pregnancies. Most poor Americans are recipients of Medicaid, which provides health insurance for people with lower incomes. Nationally, 40 percent of mothers who need postpartum care receive Medicaid assistance, and the number is higher in high-poverty states. But in 1976, Congress passed the Hyde Amendment, which has since been approved every year, that prohibits funding from being used for abortion care except when the life of the pregnant person is in danger—a law the Supreme Court sanctioned four years later Harris v. McRae. For people who are poor, facing the dangers of childbirth is hardly a real choice.

The dangers of childbirth don’t end when the baby is born. Nearly half of pregnancy-related deaths occur in the year after delivery, but Medicaid funding expires a mere 60 days after birth, leaving people with no recourse for care after that. The American Rescue Act Plan Act, which Congress passed in 2021, extended the availability of postpartum care for Medicaid recipients, but states must choose to implement it first; about half have yet to do so. These states are effectively denying critical, potentially life-saving care to their poorest mothers.

In states that do fund postpartum care for Medicaid recipients, many mothers are still blocked out of the system.  Immigrants who are poor are twice as likely to be uninsured as their U.S. citizen counterparts. And even after immigrants obtain permanent legal status—a green card, for example—the vast majority must wait five more years before they can even apply for Medicaid.

Undocumented mothers are also susceptible to substandard healthcare in Immigration and Customs Enforcement detention, where Black migrants are particularly vulnerable to abuse. In 2020, whistleblowers alleged that doctors in a detention facility in Georgia had forcibly sterilized women by performing hysterectomies without their consent. A year later, the Biden administration prohibited ICE from detaining pregnant and nursing mothers, but did nothing to restrict Customs and Border Protection agents from doing so, even though both agencies have been criticized for their mistreatment of pregnant people.

In the dystopia that is the United States’s crumbling social safety net, jail or prison is often the only place where uninsured pregnant people receive any kind of prenatal care. Each year, some 58,000 pregnant people pass through carceral institutions in which they may be forced to give birth while shackled or otherwise restrained—a dehumanizing and potentially life-threatening experience. 

If the Supreme Court really cared about the well-being of Black mothers, it would not have blessed restrictions on the use of Medicaid funds for abortion care. It would not be wondering why Border Patrol agents don’t detain every immigrant arriving at the border. Perhaps it would have declared the shackling of incarcerated pregnant people unconstitutional. If anyone is engaging in an attack on mothers of color, it is a legal system that criminalizes and deports them. The Supreme Court just isn’t in the business of holding those entities accountable.