Maybe it was the fact that the car he bought his wife, Anya, sat so low to the ground that she could feel every bump on the road. Or the fact that where they used to live, she had to climb up and down too many stairs. 

Maybe, he thought, they were just doing too much of everything, keeping too busy. Could that explain the long string of miscarriages?

When South Florida resident Derick Cook learned the health insurance from his job would cover in vitro fertilization, the couple started seeing doctors and going through with the procedures. There were a few surgeries and an ectopic pregnancy when the fertilized egg grew outside the uterus, threatening her life. 

The complications piled on.

They are one of many Black families across the nation struggling with infertility and reaching toward in vitro fertilization as a glimmer of hope. But in recent weeks, the battle over reproductive freedom has expanded beyond abortion access — now, IVF has become a point of controversy in some Republican-led states.

In Alabama, a couple of IVF clinics are beginning to restart services after halting their work last month when the state Supreme Court declared frozen embryos as “children,” posing legal liability concerns for facilities. Since the decision, Gov. Kay Ivey has signed an immunity bill protecting providers and people receiving the treatments. And last week, President Joe Biden introduced Latorya Beasley during the State of the Union address. The social worker from Birmingham, Alabama, welcomed a baby with the help of IVF, and her journey gained national attention because her embryo transfer in the hopes of having her second child were in limbo.

What happened in Alabama sparked a nationwide debate. And, a bill was introduced in Congress to protect IVF nationwide but has since been blocked by Republican lawmakers. 

Yet, what flew under the radar was how vulnerable the politics made Black families. It sheds light on how much Black people face both life-threatening and emotionally taxing limits when it comes to reproductive health care. Black women struggle with infertility at higher rates than other racial groups, which is due to a host of factors — from heightened exposure to environmental injustices like Louisiana’s “Cancer Alley,” where industrial plants have leaked cancer-causing chemicals into predominantly poor and Black communities, to disproportionately high rates of health conditions like PCOS. 

Their miscarriages have been criminalized, and they often face challenges accessing IVF, whether caused by finances or difficulty finding a compassionate provider close by. When they are able to gain access, it’s not uncommon to face discrimination throughout treatment. Often, doctors say Black women have to go through multiple rounds of IVF for successful pregnancies. 

And once successfully completed, Black families face grim disparities in maternal and infant mortality, placing their lives at risk.

Read More: Haunted By Trauma: The Black Parents Who Nearly Died In Childbirth

“It’s like Pandora’s box for Black women,” said Regina Davis Moss, the president and CEO of In Our Own Voice, a national reproductive justice organization. 

“What we’re seeing again is extreme and cruel policies that are trying to put limits on the access to reproductive care.”

The ripple effects of restrictive abortion laws

It was the first miscarriage that hinted to Cook that it might be time to tap more into his emotions. He had never learned how. As an athlete, he’d pack up his big feelings in order to perform. That translated to life. He wasn’t devastated by the first miscarriage in the same way his wife was. Cook believed they could keep trying. 

So, they did. 

The catastrophes multiplied, escalating to life and death.

Anya was in the bathroom of a hair salon, nearly 16 weeks pregnant, when she called him in. By then, the fetus had left her body. In his hands, he held the daughter they planned to name Bunny.

He kept his wife from looking down into the toilet, protecting her from the image now seared into his mind like a burn from a branding. He was holding his daughter up to keep her from falling into the water.

“That sent me to the edge,” he said, “actually seeing the baby die.”

The day before, Anya had been rushed to the emergency room. There, she was told that, because of Florida’s abortion law, labor couldn’t be induced. She was offered antibiotics and told to leave. One nurse said she’d pray for her. 

The next day, on a Thursday in December, the couple found themselves grieving in that public bathroom. And in the hours that followed, she lost about half the blood in her body. 

It was IVF that gave them their daughter. They plan to keep trying. 

The process of IVF is an emotionally, spiritually, and physically demanding one — indeed, for Anya, their journey currently feels too difficult to discuss. During the retrieval phase, patients are given hormones to increase the number of eggs accessible, which means a lot of appointments, blood work and ultrasounds, said Dr. Sanithia Williams, an Alabama-based OB-GYN and fellow with Physicians for Reproductive Health. Then the eggs are combined with sperm, grown out, and placed back in the womb. 

Black patients are often lost in conversations around infertility and treatment, Williams said. They’re not held up as the typical IVF patient due to access barriers, but they are at increased risk for complex infertility and less success with treatment, she said.

Williams, who used to be an abortion provider, sees women’s health and reproductive justice as interconnected. The same patients who may need an abortion early in life may need access to fertility treatment later, she said. It’s a continuation of care. 

“These are not different patients,” Williams said.

She believes the state is taking away the autonomy of Black families to choose when and how to build. She thinks of how this country started, rooted in white supremacy and the inability of Black families to stay together, mothers and fathers ripped from their children to be sold to slave owners. 

For some, it all feels like it mirrors the history of oppression that bled into the forced sterilization of Black women. 

“That legacy continues today.”

“We don’t need to go backwards” 

Cook’s grandparents were born and raised in Alabama. In some grim way, the state’s recent attacks on IVF remind him of the stories they’d tell of battles with the police, fights against segregation, and being chased by the Ku Klux Klan. They’d run for their lives. 

It’s another way of saying no to Black people, he said, by striping their rights away.

“We don’t need to go backwards,” Cook said. “It seems like time just keeps repeating itself.” 

Advocates say the Alabama Supreme Court decision adds an extra layer of impact and hurt to the reversal of abortion protections after the 2022 Dobbs decision. 

“If Alabama’s going to do it, what other states are going to do it?” Cook says. 

Sometimes when he reads Florida news, Gov. Ron DeSantis’ comments feel personal. “I just want a word with him.” Cook wonders if he sat across from DeSantis and told his story, would it make a difference? Could I change his mind? He thinks about how a lot of the latest legislation feels inhumane. 

His heart still hurts from the very first miscarriage, although he’s a little bit better now that he is in therapy. He’s not fully healed, he said. 

“We still don’t have our daughter.” But he speaks up to offer other families hope. He sees a shift in people when he shares. 

He’s heard from women whose uncles, brothers, and fathers have gotten them pregnant. They’re afraid to speak up. 

Cooks always tell them he’s out fighting for them. He knows his story can move people to tears. He is committed to delivering his message.

He hopes no other men have to carry the weight of what he’s faced, kneeling next to the wife he almost lost in the hospital, praying for her soul to come back. It’s harder on Anya, he said, whose body is going through it all.

“I tip my hat off to women,” he said. “It’s a different type of strength.”