Last month, the Guttmacher Institute released a new study examining characteristics of patients who’ve had more than one abortion. This study is the first of its kind to use data from a sample of U.S. abortion patients to explore if there are particular factors that contribute to people having multiple abortions over the course of their lives.

Even as stigma abounds, the study issues a clear directive: Maintaining access to care is of utmost importance, regardless of how frequently someone may need an abortion.

The researchers found that having multiple abortions is quite common, with about 45 percent of abortion patients nationally reporting having more than one abortion. The study also makes clear that structural inequalities play a detrimental role in health-care access—a point echoed by people sharing their abortion stories as part of We Testify, a program of the National Network of Abortion Funds, in interviews with Rewire.

“The health-care system is designed to fail you, not protect you, especially when we live in a world that makes birth control inaccessible, Plan B inaccessible, and sex education that covers pregnancy options is virtually nonexistent, especially in the South,” Stephanie Loraine, 25, told Rewire. The 25-year-old vice president of the Central Florida Women’s Emergency Fund said she experienced significant barriers to getting the abortions she needed. Her first pregnancy resulted from being sexually assaulted at a party, and after her abortion, she recalled that her father threw her birth control prescription out the window. When she found out she was pregnant again a year later, a local pharmacist refused to sell her partner emergency contraception (EC) because he wasn’t the one who was going to take it. The FDA, however, allows men to purchase EC for their partners.

Knowing that she didn’t want to involve her parents but not sure how to navigate the health-care system as a minor at the time, Stephanie Loraine panicked. “I googled everything I could find about self-abortion,” she told Rewire. She ended up saving money from her waitressing job to better navigate the appointments with both a lawyer and a judge to secure a judicial bypass and be able to have an abortion without parental consent. “My parents would’ve made me stay pregnant as a punishment for not saving myself [for marriage] after the first [abortion],” she said.

According to the new study, experiencing “disruptive life events” in the last year—such as exposure to violence, financial hardship, and unemployment—increased a person’s chances of needing more than one abortion, particularly if they experienced more than one of these events at the same time. These disruptive life events point to structural and institutional barriers to health-care access that are often rooted in racism, sexism, classism, and geographic location.

Kelsea, a 31-year old board member of the Carolina Abortion Fund, shared that after a clinic told her the cost of the abortion, “I hung up really quickly, and the first thing I researched was how to cause your own abortion.” Kelsea ended up using half of her unemployment check to pay for the abortion, and the other half “went to pay for my insurance premium, which wouldn’t cover the cost of the abortion.”

Twenty-five states restrict insurance coverage of abortion in exchange plans, and 21 states restrict abortion coverage for people who get their insurance through the government. The average cost of first-trimester abortion is $480, an often-impossible sum for people living paycheck-to-paycheck.

The study also found that increased age was also strongly associated with having more than one abortion, with people 30 and older having more than two times the odds of having had a prior abortion compared with people in their early 20s. “If we’re sexual beings who are able to get pregnant over the course of our lives, it only makes sense that people have multiple abortions,” Stephanie Loraine told Rewire. Indeed, if people must use contraception consistently and correctly for three decades to prevent pregnancy (and that’s if you want to have two children, the U.S. average), it makes logical sense that most people need access to abortion at different times in their lives.

The researchers discovered that more than half (54 percent) of Black women in the study reported having multiple abortions, a higher percentage than white women or Latinas. This is likely due to the compounding negative effects of racism and sexism on Black women’s health, which is also reflected in unjust policies like the Hyde Amendment. That amendment is attached as a rider to the federal budget every year and has the effect of disproportionately denying health care to women of color.

Community-level abortion stigma also affects how and why Black women access abortion care: “There’s a stigma in the Black community about being a single parent, being a Baby mama,” Kenya, a 42-year old abortion clinic employee in Texas, told Rewire. “For me, I didn’t want to be a statistic. I didn’t want to be a single mother with a lot of children. I [had a baby] once and didn’t want that to be my life.”

Kenya works at the clinic where she had her abortions, and realized that she was keeping her personal experiences from her patients for fear of their reaction. “I started to ask myself why I wouldn’t say that I’ve had multiple abortions aloud. Maybe it can help someone else not feel bad about their choices or not feel judged. There’s nothing to be ashamed about. Multiple abortions are necessary, and a lot of women do it.”

Because the Guttmacher study is quantitative in nature, it didn’t delve into the experience of having multiple abortions, particularly the worries about judgment and shame, an experience that even people in the reproductive health, rights, and justice community have. “I worried my friends would be like, ‘Seriously, another one though? There’s no reason for you to do this again,'” Kelsea told Rewire. “Despite fighting stigma every day, I still felt it and was mad at myself for letting this happen again.”

Megan, a 34-year old operations manager in Illinois, echoed this sentiment: “I don’t think I’ve ever said out loud that I’ve had two abortions, except to my husband and best friends, and I’m an abortion rights activist … I was surprised at how much weight saying that was for me, and then once I said it, it helped the shame dissipate a bit.”

Internalized stigma and fear of what others may think wasn’t the only factor keeping people from sharing their multiple abortion experiences with loved ones. “Online all the time I see memes about people who’ve had multiple abortions as serial killers,” Stephanie Loraine told Rewire. “The [anti-abortion] memes say things like, ‘if you’ve had multiple abortions, then your womb is a tomb.’” Despite the proliferation of these awful messages, there’s no reason to consider multiple abortions a negative health event or even something to be prevented.

As the study authors note, “the ability to access abortion care when needed—even if more than once—should be prioritized.” While some people may expect negative social consequences for sharing your experiences with abortion, having more than one abortion has no documented negative health outcomes, meaning that there is no medical reason to encourage women to have fewer abortions. Discouraging patients from seeking the health care they need, including multiple abortions, may in fact contribute to stigma instead of a patient’s physical and mental well-being.

“We’re good people making the best decisions we can for the circumstances we’re in,” Kelsea said. “We should approach people who’ve had multiple abortions with a genuine desire to appreciate where they’re at instead of a judgment about why they did what they did.”

CORRECTION: A previous version of this piece listed Megan as from North Carolina; she’s from Illinois.