For these Black activists, abortion isn't just a woman's issue. It's about race, too

Buried in the data about the nation's abortion debate is an uncomfortable truth: A disproportionate number of women seeking to end their pregnancies are Black.

According to the Centers for Disease Control and Prevention, Black women as a population have the highest rate of abortions -- nearly 24 abortions per 1,000 Black women, compared to about seven abortions per 1,000 white women.

That means that if the Supreme Court overturns Roe v. Wade, the biggest impact would be felt by Black women in the South, where conservative legislators are set to enact restrictions.

To Monica Simpson, a leading Black activist in Georgia and executive director of SisterSong, none of this should be surprising.

"If it's obliterated," Simpson said of the right to abortion, "then we're not only dealing with an access issue. In a bigger way, we're also dealing with criminalization possibilities. And that's a very scary thing in particular for Black folks in this country who are already over-criminalized in so many ways."

The Supreme Court was expected to rule on the abortion case, Dobbs v. Jackson Women's Health, in the next few weeks. According to a leaked draft opinion, the court's decision would leave the issue up to states. If that happens, more than two dozen states, mostly in the South and Midwest, plan to move ahead to severely curtail access to abortion.

Simpson's organization SisterSong, a lead plaintiff in a Georgia abortion case, and several other Black advocacy groups say the decision is tightly coupled with race. Slavery, painful gynecological experiments and forced sterilizations are part of the nation's history when it comes to Black women.

"We all need to be able to determine how many children we're going to have, if we're going to have children. We all have a human right to make decisions about our bodies," said Toni Bond, an ethics and religious scholar who in the 1990s helped to coined the term "reproductive justice" to distinguish concerns among Black women from those of wealthier white feminists.

Among those concerns: Black women are considerably more likely to die from childbirth than white women, even when accounting for education. According to one federal study, college-educated Black women are five times more likely to die from pregnancy than college-educated white women.

Health care access is limited, too, and expensive, with many of the same states voting to restrict abortion also blocking efforts to expand Medicaid, the government's insurance for low-income families.

Police brutality is another factor, advocates say.

"When you look at all of that in its totality, then yes, it's going to feed into the decisions that black women make," said Simpson.

"And if that decision is that they choose not to bring a child into this world right now, that is a decision that is a human right to make, and they should not be shamed for that decision," she added.

During arguments on the abortion case, conservative Supreme Court Justice Amy Coney Barrett suggested safe-haven laws that allow a woman to relinquish her child to a fire station or police station have relieved women of the burdens of parenthood.

Also, anti-abortion groups say their church-based crisis pregnancy centers can assist every women, regardless of her race or ethnicity, on their journey through motherhood.

Simpson and others said that kind of thinking ignores the unique challenges that minority communities face, including the higher medical risk of pregnancy for Black women.

"I think they are not about pro-life at all. They are absolutely about pro-birth," Simpson said of pregnancy crisis centers. "They want us to bring babies into this world, but they have not proven to us or shown us in any way where they have walked with our folks in our community through their lives."

In the end, several advocates told ABC News they were prepared to work outside the legal system if necessary, as Black people have done historically.

"We should see this as something deeply, deeply troubling. This is not just about what is legal. This is about what is moral and just," said Paris Hatcher, executive director of Black Feminist Future.

Because of that, Hatcher said, "I will make sure that anyone who needs an abortion will get (one) by any means."