What My Ancestors Might Think of This Moment in U.S. History

Abortion rights activists during a Bans Off Our Bodies rally and march to the Supreme Court on May 14, 2022 in Washington, DC. (Kent Nishimura / Los Angeles Times via Getty Images)

As a teen, I developed an interest in genealogy. I interviewed any relative who could help me understand the people whose lives had made mine possible. Three decades and hundreds of ancestors later, I have a clear picture of the people who make up my family tree.

I am the descendant of African slaves and their captors in America. As such, I read the draft decision by the Supreme Court in the Dobbs v. Jackson Women’s Health Organization and wondered what my ancestors would think of us—the U.S.—at this moment.

I knew immediately what one might think. Her name is Lillie and her story motivates my work as an obstetrician-gynecologist and as an advocate for sexual and reproductive rights globally. She would say that history is repeating itself after learning little from its past.


This is the year Lillie delivered her first child. She was 17 and her child did not live to see his 20th birthday. Lillie experienced at least 18 pregnancies during her lifetime.


The numbers separating the paragraphs in this essay mark each year Lillie gave birth. Undoubtedly some pregnancies are lost to history. But the 18 recorded births speak volumes about her life and the options available to her.


Lillie was one of my paternal grandfather’s sisters. Like him, she was born shortly after slavery ended. Yet, their family suffered indignities more commonly associated with slave life. Rape.

Like Lillie, I did not always have a choice about which men touched my body. As a poor Black girl in America, those assaults were a daily reality.


Several of Lillie’s siblings were conceived through rape—the result of white men repeatedly taking sexual advantage of a Black woman’s body. That Black woman had chosen another man as her life partner. Yet, she had to raise the children of both her chosen partner and those of her rapist.

Like Lillie, I did not always have a choice about which men touched my body. From the man at a shoe store who groped me when I was out of my mother’s sight, to men on crowded public transportation who touched me with anonymity, to the hotel employee who tried to force himself on me in my hotel room. As a poor Black girl in America, those assaults were a daily reality.


I do not know if Lillie was conceived through rape. The 1880 census records suggest this is the case as she is recorded as a “mulatto”; her pictures suggest the same. She and my grandfather’s skin colors are as different as night and day. She is fair; he is jet Black, like the coal he mined for decades in the West Virginia coalfields.


I often wonder how the social dynamics around conception played out in my grandfather’s childhood home. He died shortly after I was born, so I never got to ask him. From family conversations 100 years later, it is clear the effects of reproduction without consent linger on my family’s psyche across generations. Slavery has long arms, no matter the form it takes.


Lillie married at 15 and had her first child two years later. She had little choice in either decision. Early marriage and childbearing were socially sanctioned.

One hundred years after her marriage, I graduated from high school at age 17 and headed to a prestigious women’s college. Although Lillie and I were similar in that we grew up in poverty, without health insurance, and in redlined communities, I was destined for a very different life. Unlike her, I had access to reproductive health services, like sex education, birth control and abortion.

From family conversations 100 years later, it is clear the effects of reproduction without consent linger on my family’s psyche across generations.


Although Lillie’s life opportunities were limited, access to family planning options might have afforded her some important benefits. Birth spacing may have prevented the deaths of several of her infants born in close proximity between 1900 and 1914.


Lillie lived before the era of modern birth control options. She had little choice in how many children she would conceive and birth.

Sometimes I like to imagine how she might have benefited from what birth control offers many women today: flexibility to pursue an education, wider employment opportunities, and more time in the labor market to accumulate wealth. Those imaginations are brief because the reality is that Lillie would not have reaped those benefits due to her race and gender. It is a stark reminder that reproductive autonomy is contingent. Its potential is intricately tied to other forms of autonomy. When decoupled from access to other life opportunities, reproductive choice is not real autonomy. It is the appearance of choice but functionally is like removing a shackle from one limb while leaving the other three bound.


Lillie was lucky. Maternal mortality rates at the turn of the century were very high. Given that the risk of death due to pregnancy and childbirth is cumulative, the fact that Lillie survived 18 pregnancies is remarkable.


Her children were not so lucky—especially those born in the years when she had more than one child in less than one year. One lived for four months, another a few weeks, and one lived for only a day.

A paper published in 2019 estimated that disparities in infant mortality rates between Black and White infants in the U.S. in the first 12 months of life have increased since 1850. This raises critical questions about the healthcare system and the larger environment Black families must navigate to nurture and sustain their children. Respecting their right to choose their family size and timing preserves dignity for Black people living in an America where daily indignities are the norm, not the exception.

Given that the risk of death due to pregnancy and childbirth is cumulative, the fact that Lillie survived 18 pregnancies is remarkable.


The Supreme Court is poised to eradicate the small but important step the Roe v. Wade decision made in allowing women the right to privacy when making reproductive decisions. If you have never read it, do so. It is hard to get through not because of the legal language, but because it is clearly less about respecting women as able-bodied decision-makers and more about the state’s interest in controlling women’s reproduction.

Lillie would not need to read it. She watched her mother live it.


When I look at the case before the Supreme Court through the lens of Lillie’s life, I see the fight to control Black women’s bodies enshrined. I see white men’s desire to leverage white women’s reproductive potential when it suits their needs. And, I see controls on Black peoples exercise of other freedoms. These intrusions are reinforced through adjacent policies, such as policing policies that result in mass incarcerations among Black people thereby strangling their voting rights and economic options.


I want to be clear—what Roe offered, while important, was a small concession to women. If it falls, it will have stood for less than 50 years. That’s less than twice Lillie’s reproductive life span. She had 18 children in 29 years and had little choice in the matter. That is the very reality the Supreme Court decision and the hundreds of recently proposed abortion bans wants take us back to.

Black women will endure the harms of the proposed SCOTUS decision more than white women. Those with economic means, access to transportation, and robust social networks for navigating legal hoops will still be able to exercise some bodily control. They tend to be white. They may not be able to fend off the creep in the shoe store, but they will have options for managing an unwanted pregnancy should it result.

Poor women and many Black women, women who already feel the sting of chronic disadvantage and marginalization, will feel the effects of this decision even more.


Lillie buried six children before her last child was born. All died before their 25th birthday.

Although I do not know the reasons for most of their deaths, I know their experience parallels today’s reality where Black Americans experience disproportionately higher rates of early death compared to whites, with most of their deaths occurring in the early decades of life.

This too is codified in U.S. policies, where the legislative emphasis has been on promoting the birth of children without a parallel policy fight to advance children’s health and well-being. Unlike peer nations, the U.S. has no nationwide parental leave allowing parents to nurture their infants. It provides little access to subsidized childcare thereby deepening poverty for many families. And, it provides children with limited access to preventive healthcare or equitable access to quality education, despite being one of the most highly resourced nations in the world.

When I wonder what Lillie might think about all this, I suspect she would be unsurprised to find white men in her family’s bed again telling her she must give birth, then cursing her for the lot her child might endure in life.


Amy Coney Barrett proposed adoption as an alternative to abortion. This is an option some women have and will always choose.

My family tree blossomed by welcoming children with no biological ties to the parents who loved them. My tree is also full of holes representing children forcibly taken from mothers to serve the chattel system of economic exploitation upon which this country was built. It is the height of disrespect for to tell Black women that they cannot choose whether to birth, and when a Black woman does give birth, to suggest giving the child away if the mother’s situation does not allow her to parent the way she feels her child deserves. That is not a noble position. It is slavery masquerading as kindness.

Lillie would recognize that hypocrisy, even if it is hiding behind religious values as it so often does today.


I know Lillie would be proud of what I have made of the opportunities I have had. She would be proud of my educational achievements and the fact that I became a doctor. However, I think she would be more proud of the reproductive choices I have been able to exercise. Lest you forget, reproductive opportunities, like educational and economic opportunities, have been weaponized against Black women in this country. My reproductive opportunities made it possible for me to seize those other opportunities. I have had a choice in who I have sex with, who I bore children for, how many children I had, and the conditions in which I raised them.


It is not the number of children a woman has that defines her status as a citizen. Our government’s ability to recognize a person’s ability to decide with whom, how many, and the conditions in which people will give birth defines citizenhood. Regardless of its final decision, the Supreme Court has already made it clear that women are still not considered full citizens in its eyes. Even Lillie could look at where the Supreme Court is headed and see what is at stake—this case is about denying choice and controlling liberty. Women’s liberty.

Men’s reproductive liberty clearly remains protected. You can replace the shoe store creep or the hotel employee who tried to assault me with one of the Supreme Court justices aiming to remove a woman’s right to bodily autonomy. Intent here is irrelevant; harm is imminent.

For Black women, this decision looks and feels like white men and women making reproductive choices for us again, without our consent, and while doing little to ensure that our children’s needs are met beyond ensuring their birth. That is what my grandfather’s sister would think of this moment.

I agree with her.

Sign and share Ms.’s relaunched “We Have Had Abortions” petition—whether you yourself have had an abortion, or simply stand in solidarity with those who have—to let the Supreme Court, Congress and the White House know: We will not give up the right to safe, legal, accessible abortion.

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Dr. Aletha Y. Akers joined the Guttmacher Institute in May 2020 as the Institute’s vice president for research. Dr. Akers leads the Institute’s talented and widely respected team of scientists as they carry out rigorous, innovative and timely research to advance sexual and reproductive health and rights in the U.S. and globally.