The Impact of Systemic Racism and Socioeconomic Inequalities on Abortion Access and
Reproductive Health Outcomes in the United States
Literature Review
Genesis Perez
Writing for the Social Science
April 30, 2025
Abstract
Access to abortion and reproductive healthcare in the United States is deeply affected by racism,
poverty, and public health problems. This literature review looks at research that shows how
these issues often hurt marginalized communities the most. By analyzing five scholarly sources,
this review points out the gaps in abortion access for people of color and low-income groups,
criticizes the way abortion is treated as a crime, and explains why better public health tracking is
needed. The findings show clear patterns of unfairness, the strong influence of racism in
healthcare policies, and the need for new policies and more research to fix these problems.
Introduction
Reproductive rights have long been a battleground for social, political, and cultural debates in the
United States. While abortion has been legally protected for decades, access to abortion services
remains profoundly unequal, largely shaped by systemic racism, poverty, and discriminatory
public health policies. These disparities are further compounded by geographic inequalities, with
rural and underserved communities facing additional barriers. Recent legal developments, such
as the overturning of Roe v. Wade, and public health emergencies like the COVID-19 pandemic,
have only deepened these disparities. Understanding the intersectional factors affecting abortion
access is crucial to addressing the broader issues of reproductive justice and health equity. This
knowledge is vital because it highlights how structural inequalities are embedded within legal
and healthcare systems, perpetuating cycles of marginalization and health disparities among
vulnerable populations.
Research consistently identifies systemic racism as a major barrier to equitable reproductive
healthcare. Riley et al. (2022) argue that the criminalization of abortion reflects a legacy of white
supremacy within the American public health system. Restrictive abortion laws
disproportionately harm women of color, exposing them to greater health risks and legal
vulnerabilities. Rooney, Krieger, and Rich-Edwards (2000) similarly highlight that systemic
racism, coupled with poverty, leads to higher rates of unintended pregnancies and abortions
among marginalized communities. These findings underscore the critical need to address the
racialized structures embedded within healthcare and legal systems.
Socioeconomic Inequality and Reproductive Outcomes
Socioeconomic status plays a crucial role in determining reproductive health outcomes.
According to Coleman-Minahan (2022), economic instability exacerbates barriers to abortion
access, especially during public health crises. Communities facing poverty are less likely to have
nearby clinics, face higher transportation costs, and encounter legal hurdles such as waiting
periods or parental consent laws. Dennis et al. (2017) find that financial insecurity significantly
delays abortion care, resulting in higher medical risks and emotional distress for low-income
women. These studies collectively reveal how poverty restricts reproductive choices and health.
Public Health Crises and Policy Failures
Public health emergencies intensify existing inequalities in abortion access. Coleman-Minahan
(2022) highlights how the COVID-19 pandemic led to heightened barriers, particularly for
marginalized communities. State-imposed restrictions during the pandemic, such as deeming
abortion “non-essential,” widened the gap between privileged and disadvantaged groups.
Moreover, research by Guttmacher Institute (2022) reports that natural disasters, health crises,
and political upheavals often shift healthcare priorities away from reproductive services, leaving
vulnerable populations without essential care. Both sources emphasize the urgent need for
resilient healthcare infrastructures that safeguard reproductive rights, even during crises.
The Need for Standardized Public Health Surveillance
A common theme among the literature is the call for better data collection and monitoring.
Coleman-Minahan (2022) advocates for mandated public health surveillance systems to track
abortion access disparities systematically. Reliable data, policymakers craft effective
interventions to close the gaps in access. Riley et al. (2022) also stress the importance of
measuring the racial impacts of health policies to dismantle systemic barriers effectively. These
calls highlight a significant deficiency in current public health research: the lack of standardized,
race-conscious surveillance mechanisms. Accurate and disaggregated data are essential for
identifying specific community needs, evaluating policy impacts, and designing targeted
interventions that promote reproductive equity.
Discussion and Evaluation
The existing scholarship provides a comprehensive view of the multiple and interconnected
barriers to abortion access in the United States. A consistent finding across the sources is that
systemic racism and economic inequality are not peripheral factors but central determinants of
reproductive health outcomes. However, while these studies identify clear patterns of inequity,
several important gaps remain, which warrant further discussion and evaluation.
First, there is limited research that captures the lived experiences of affected individuals beyond
quantitative data. Much of the literature relies on statistical analyses without incorporating
qualitative studies that document how women of color and low-income individuals navigate the
healthcare system. For example, personal narratives reveal the emotional and psychological toll
of navigating complex legal and logistical barriers, which quantitative data often overlook.
Future research could provide a richer understanding of these experiences by integrating
community-based studies, ethnographies, and interviews, thus humanizing the statistics and
informing more empathetic policies.
Second, while the role of public health emergencies is acknowledged, there is insufficient
examination of how different types of crises such as climate-related disasters versus
pandemics—uniquely affect reproductive health. For example, climate disasters may cause
displacement, damage to healthcare infrastructure, and increased economic hardship, all of which
can further restrict access to abortion services. Guttmacher Institute (2022) begins to explore this
issue, but more detailed, crisis-specific studies are needed to develop tailored policy responses
that are resilient to various emergency scenarios.
Third, although Coleman-Minahan (2022) and Riley et al. (2022) advocate for better surveillance
systems, there is little consensus on what effective surveillance would look like in practice.
Future studies should not only call for improved data collection but also propose standardized
models that are sensitive to racial, economic, and geographic disparities. For instance, integrating
geographic information systems (GIS) to map clinic availability and barriers across regions could
facilitate targeted interventions. Additionally, establishing racialized and socioeconomic data
disaggregation protocols ensures that subtle disparities are not masked by aggregate statistics.
Fourth, while systemic racism is identified as a root cause, few sources offer concrete solutions
for dismantling the racial hierarchies embedded in reproductive healthcare. Moving beyond
critique, research should explore structural reforms such as expanding community-based clinics
in underserved areas, implementing universal healthcare coverage for reproductive services, and
enacting reparative policies that address historical injustices. For example, policies that fund
mobile clinics or community health workers can improve access in marginalized communities.
Addressing these systemic issues requires a comprehensive approach that combines policy
reform, community empowerment, and structural change.
Conclusion
The literature on abortion access in the United States reveals a complex web of systemic racism,
socioeconomic inequality, and policy failures that create profound barriers for marginalized
populations. Scholars agree that structural factors—not individual choices—largely determine
reproductive health outcomes. Moreover, public health crises like the COVID-19 pandemic
exacerbate existing disparities, highlighting the fragility of reproductive rights under current
systems.
Despite these valuable insights, important gaps remain, particularly regarding qualitative
research, differentiated analyses of various crises, and specific strategies for reform. Addressing
these gaps will require a commitment to intersectional approaches, standardized public health
surveillance, and a reimagining of reproductive justice rooted in equity and inclusion. Only
through sustained, systemic change—such as structural reforms to healthcare access, targeted
community interventions, and policy shifts—can true reproductive freedom be achieved for all
individuals, regardless of race, income, or geographic location.
References
Coleman-Minahan, K. (2022). Evaluating the impact of policies, disasters, and racism on
abortion access: A call for mandated and standardized public health abortion surveillance. Health
Affairs, 41(4), 623–631. https://doi.org/10.1377/hlthaff.2021.01791
Dennis, A., Blanchard, K., & Bessenaar, T. (2017). Identifying indicators for quality abortion
care: A systematic literature review. Journal of Family Planning and Reproductive Health Care,
43(1), 7–15. https://doi.org/10.1136/jfprhc-2015-101427
Guttmacher Institute. (2022). The State of Sexual and Reproductive Health and Rights in the
United States. Retrieved from https://www.guttmacher.org
Riley, T., Zia, Y., Samari, G., & Sharif, M. Z. (2022). Abortion criminalization: A public health
crisis rooted in white supremacy. American Journal of Public Health, 112(11), 1662–1667.
https://doi.org/10.2105/AJPH.2022.307624
Rooney, B., Krieger, N., & Rich-Edwards, J. (2000). Racism, poverty, abortion, and other
reproductive outcomes. Epidemiology, 11(6), 740–742.
https://doi.org/10.1097/00001648-200011000-00016
In developing my literature review on abortion access and systemic racism, I began by refining
my research question through careful consideration of the broader social and public health issues
surrounding reproductive rights. I initially wanted to focus solely on abortion laws, but after
reviewing preliminary sources, I realized that systemic racism and economic inequality were
essential factors that needed to be part of the conversation. This shift helped me formulate a
more comprehensive and intersectional research question: How do systemic racism and
socioeconomic disparities impact abortion access and reproductive health outcomes in the United
States?
One of the challenges I faced during the research process was finding scholarly sources that
addressed both abortion access and systemic racism directly. Many studies focused heavily on
legal debates without emphasizing the public health and equity aspects I wanted to explore. To
overcome this, I used advanced search strategies in academic databases, combining terms like
“systemic racism,” “abortion,” and “public health” to find more focused articles.
During my research, I encountered a few sources that I ultimately discarded. Some articles were
outdated or lacked a peer-reviewed, scholarly basis, while others presented highly biased or
purely opinion-based arguments without sufficient evidence. I prioritized peer-reviewed journal
articles and reports from reputable organizations to maintain academic rigor.
Analyzing the sources presented its own difficulties, particularly in synthesizing a wide range of
information into clear themes rather than summarizing each article separately. To solve this, I
created a thematic outline before writing, grouping similar ideas together. This strategy helped
me organize my thoughts and ensure that my literature review was cohesive and analytical rather
than just descriptive.