“Adulting” was not going great for Tia Freeman of Nashville. She had already lost her scholarship at the University of Tennessee and joined the Air Force. As she finished training to be an analyst, she got pregnant despite being on birth control.

Both her parents worked so were limited in the help they could provide as grandparents. Daycare would have eaten most of her paycheck. And even at 20, Freeman knew that as a Black woman, a history of racism was going to make her climb up the economic ladder more difficult than most. 

So, she had her first abortion. 

“I’m at the bottom of the military rank system. I barely have enough to support me,” Freeman, now 26, recalled thinking at the time. “I knew this wasn’t going to be the kind of lifestyle that I would want to provide for a family.”

Black women have disproportionately used abortion services across much of the South — where access is largely set to vanish if Roe v. Wade is overturned. And the consequences may be as much a risk to their economic opportunity as their health.

In Tennessee, Black women accounted for roughly half of the nearly 8,727 abortions in 2019, with an abortion rate four times higher than white women in the state, according to Tennessee records. Data analyzed by the Kaiser Family Foundation shows Black women underwent two-thirds of the abortions in Alabama and Georgia, and three-quarters of them in Mississippi. 

But the disparity has more to do with socioeconomics than race, said Getty Israel, founder and CEO of Sisters in Birth. Located in Jackson, Mississippi, the women’s clinic primarily serves Black women and steers its patients away from abortions — though Israel, who is Black, said she understands why many Black women in her state see termination as their only option. Many are in low-wage jobs with no health insurance, no college degree and no partner with a steady career.

“Poverty is a disease. It affects every aspect of your life,” she said. “We see abortion as another birth disparity.”

If a woman doesn’t have insurance during her reproductive years, she’s less likely to be using birth control or actively planning for children. Mississippi has among the nation’s lowest use of long-acting reversible contraception among those who visit low-income clinics for family planning. The state also has among the country’s lowest rates of college degrees.

Israel said the women she works with are not getting the support they need from the government or their communities to raise a child.

“If you don’t have the college degree and you don’t have the career, you don’t have the funds to live and you don’t have a husband, you’re in trouble. And man, I’ve been there,” Israel said. “The only thing that saved me was my master’s degree — my education.”

For those in states set to ban abortion if Roe v. Wade is overruled, travel to other states that still permit abortion is the top contingency plan. Abortion providers are throwing together programs to help women get to states, such as Illinois, where abortion would remain accessible. But for those who already have children, the lack of support in raising kids may keep many women with low incomes from being able to get to another state for the procedure.

“We do not have the money to get on a plane and go to Chicago or New York to have an abortion,” Rev. Venita Lewis said at a rally in Nashville the day after the Supreme Court’s draft opinion was leaked in May.

The result for those who can’t afford to travel may be more self-induced abortions or giving birth. But that comes with risks, especially for Black women who are nearly three times more likely than white women to die from complications related to childbirth, according to the Centers for Disease Control and Prevention — and their rates of maternal mortality are even higher across much of the South. 

“Either the means of getting an abortion is not going to be safe, so you put your life at risk. Or you carry the baby to term,” said Dr. Digna Forbes, interim dean for school of medicine at Meharry Medical College, a historically Black institution. “Now, you have the economic burden of raising a child that you cannot afford.”

The experience of unplanned motherhood also hit Tia Freeman. She’s bisexual and never saw herself as a mother. But a few years after her first abortion, she became pregnant again and didn’t realize it for several months. 

“I found out so late in my pregnancy that that was my reality,” she said.

Freeman found a way to raise a child. Her grandmother, who was recently widowed, moved in to take care of her son, who is now four. The child’s father also helps.

But since becoming a mother, Freeman has had a second abortion after another contraception failure. 

“Having a child, I know what it costs to have a child,” she said. “I love hanging out with my kid and doing things for my kid and providing for my child. And I had an abortion after my child because I understood that I had the emotional capacity for one. I had the financial capacity for one.”

With one child, she said, she still has enough resources to use her military benefits to go back to college to finish her degree next year.