ATLANTA – A routine pregnancy visit to a doctor ended tragically for Alabama native Chaniece Wallace in October 2020. 

The odds were already against her as a Black woman, who have the highest maternal mortality rate among any race in the U.S.   

Wallace is a health care worker who attended medical school at University of Alabama. Her husband, Anthony Wallace Jr., is an educator who attended Alabama A&M University where he first met Chaniece. 

Prior to her pregnancy they had discussed issues Black women face in pregnancy. 

“We just talked about how the struggle for Black women to receive quality health care and just the trauma around Black maternal health and Black women just not being heard and just Black women struggling and losing their lives,” Anthony said. “And trying to give birth and just not receiving the quality attention they should be receiving and things like that.”

That conversation foreshadowed the tragedy of the birth of their first child, Charlotte, Oct. 20, 2020.

Chaniece had experienced a smooth pregnancy until she went for a checkup that day and doctors noticed protein in her urine and that she had severe hypertension, he said.  

She was admitted into an Indiana hospital and doctors began administering medicines to lower her blood pressure, he recalled. 

According to a lawsuit against the hospital, Chaniece’s labs began worsening and a variation of medicines were administered. 

Doctors said she was developing preeclampsia — a severe form of hypertensive disease in pregnancy that can cause organ damage — and an emergency C-section was performed, at least a month before baby Charlotte’s due date.  

“It just went downhill…and eventually resulted in losing her life,” Anthony said.  

Wallace filed a lawsuit against the hospital alleging negligence in his wife’s Oct. 22, 2020 death. His wife’s death, in part, is why he supports abortion access.  

Health officials say abortion restrictions disproportionately affect Black women and low-income women. According to Guttmacher Institute, a reproductive health research and advocacy group, 22 states have laws that ban or restrict abortion.  

“Black individuals generally have worse pregnancy outcomes so we have a higher rate of pre-term labor and pre-term delivery,” said Dr. Didi Saint-Louis, an Atlanta OB/GYN. “So we generally have a tendency of delivering before term. That could be anywhere from 24 weeks, which is viability, up to 36 weeks. And so in general, Black women tend to deliver prematurely.”

According to the Centers for Disease Control, among the 30 areas that reported abortions by race and ethnicity data for 2019, non-Hispanic white women and non-Hispanic Black women accounted for the largest percentages of all abortions (33.4% and 38.4%, respectively).

In 2019, compared with non-Hispanic white women, abortion rates and ratios were 3.6 and 3.3 times higher among non-Hispanic Black women and 1.8 and 1.5 times higher among Hispanic women. 

The CDC indicates factors leading to higher abortion rates among certain racial/ethnic minority groups are “complex,” adding that ”disparities in rates of unintended pregnancies, unequal access to quality family planning services, economic disadvantage and distrust of the medical system,” might contribute to the differences. 

Approximately 18% of all pregnancies in the U.S. end in induced abortion, according to the CDC.

Black women make up a majority of the percentage as a demographic that has an increased risk of preeclampsia, due to Black people generally having greater rates of chronic hypertension. 

“Depending on how far along in your pregnancy, it could mean anything from having to consider a medically induced termination to having to deliver prematurely if a woman is fortunate enough, if that’s what you want to call it, to develop preeclampsia closer to term then it means that she needs to be delivered,” Saint-Louis said. 

Some women of color develop preeclampsia during the delivery or in the process of postpartum, as Chaniece Wallace did. It is associated with an increased risk of cardiovascular disease including strokes, Saint-Louis said.  

Black women’s higher rates of obesity and diabetes also put them at risk during pregnancy, medical officials said. The lack of Black OB/GYN and medical personnel are said to contribute to higher maternal mortality rates in Black women.  

“If you call your provider and you’re complaining, there’s a greater chance that if the provider is a Black woman, that person is going to listen to you and listen to the signs and symptoms that you’re complaining about a little bit more closely and carefully,” Saint-Louis said. “Does that mean that just having a Black physician is going to make things better? Not necessarily but we do know now that we tend to get better care from providers who look like us.”

Anthony Wallace Jr. agreed, recalling a Black student doctor who came in shortly before Chaniece’s death and expressed concerns about her care from a group of non-Black medical personnel. The lawsuit indicates that that student doctor recognized that Chaniece was at “high risk of rapid deterioration” and recommended transferring her to ICU. That transfer, however, wasn’t made until several more hours.  

Saint-Louis agreed abortion access is important for Black women, who are more likely to experience pregnancy complications. Women with history of pregnancy complications are at risk of having complications again, she said. And of women who have received an abortion, 60% of them already have at least one child, according to 2019 CDC data.

“I’ve had patients who had preeclampsia and had strokes and they decide that they no longer want to be pregnant and you know, being on birth control is not a guarantee that they’re not going to get pregnant again,” she said. “And so being able to decide whether or not they want to stay pregnant is a choice that they should have.”

The American College of Obstetricians and Gynecologists suggests contraceptives are not always effective and can occasionally result in unintended pregnancy. For example, ACGG reports the use of condoms result in 18 or more pregnancies per 100 women in a year, and birth control pills or injections can result in six to 12 pregnancies per 100 women in a year.

Black people have the highest poverty rate in the U.S., 19.5%, according to the the 2020 U.S. Census, and low-income people often don’t have health insurance that covers contraceptives. Nearly 14% of Black women are uninsured, compared to 8% of white women, according to Census data.

Abortion restrictions and bans now make it hard for lower-income women to access abortion services, abortion proponents say — from having funds to travel for abortion or some not able to afford time off to travel for a state that provides abortion.

Guttmacher Institute reports that 12 states explicitly permit abortion prior to viability when necessary to protect the life of the pregnant woman.  

Alabama has banned all abortions, except in the case where the mother’s life is at risk. In Georgia, the Georgia LIFE Act seeking to ban abortions once a fetal heartbeat is detected, typically at six weeks, is pending. There are exceptions for rape, incest and if a physician determines “in reasonable medical judgment, that a medical emergency exists.” The Act defines medical emergency as “a condition in which an abortion is necessary in order to prevent the death of the pregnant woman or the substantial and irreversible physical impairment of a major bodily function of the pregnant woman.”

With this provision in state laws, Saint-Louis said abortions granted in the case of medical emergencies could be subjective and could pose greater risk to pregnant women experiencing health complications.  

“From a medical perspective, how sick do you have to be for it to be an exception? How much bleeding do I have to let you have in order for me to say that you qualify for an exemption? Who gets to decide how sick the patient really is in order for her to be able to qualify for the medical exemption?” Saint-Louis said.  

Saint-Louis said the most common medically induced abortion stems from severe preeclampsia developed before viability (typically 24 weeks). There’s no other treatment but to deliver in most cases, she said.

“If I have to deliver you at 18 weeks, that’s a termination of a pregnancy because the fetus is not viable at 18 weeks,” Saint-Louis said.

The leading causes of 250 maternal death cases that were reviewed by the Georgia House Study Committee on Maternal Mortality for 2012-14 were cardiomyopathy, hemorrhage, cardiovascular and coronary conditions, embolism, preeclampsia and eclampsia and amniotic fluid embolism.

Other pregnancy emergencies, Saint-Louis said, can occur if the membrane is ruptured pre-viability. If the membrane surrounding the baby or fetus ruptures, she explained, bacteria could enter the uterus.

“So for a lot of these women who rupture prematurely, they develop infections. And so now the question is, how infected do you have to be in order for me to be able to terminate the pregnancy?” she said.  

The CDC reports in 2018, Georgia’s maternal death rate was 27.7 per 100,000, among the top five highest in the country along with Alabama, which reported 36.4 deaths per 100,000 in 2018 — both states above the national average of 17.4 in 2018.

Overall, in 2020, the maternal mortality rate for Black women in the U.S. was 55.3 deaths per 100,000 live births, 2.9 times the rate for non-Hispanic white women, according to the CDC.

CNHI reached out to Alabama and Georgia governors and attorney generals to see if there are plans to collaborate with medical professionals on which medical emergencies would warrant an abortion.

The Georgia governor’s office responded: “In Georgia, we are focused on ensuring that our existing law, the Georgia LIFE Act, to protect the unborn is fully implemented,” but did not specifically respond to how medical emergencies would be deciphered. Parties in a lawsuit challenging the Act were ordered to file briefs on the effect the Supreme Court’s June 24 decision to overturn Roe v. Wade has on that lawsuit by July 15. 

Attorney General Chris Carr’s office pointed back to the medical emergency definition in the Georgia LIFE Act and a section that allows abortions if a physician determines that the pregnancy is medically futile, “Meaning, the unborn child has a profound and irremediable anomaly that is incompatible with sustaining life after birth.” 

Alabama officials have not responded.   

Anthony Wallace Jr. said he is hesitant in leaving that decision in the hands of a doctor or judge, especially given his claims that his wife’s doctors were negligent during his daughter’s birth.

“I don’t totally want to leave it up to doctors and judges because like I said, it’s been proven that sometimes they don’t know what’s best for the patient,” he said. “The patient knows what’s best for them and their lives.”