Collage of newspaper headlines, the Supreme Court justices, and Norma Corvey, the plaintiff in Roe v. Wade

If Roe Falls

Medication abortion or traveling to other states will be options for some. Others will endure unsafe procedures or other costs.

By Julie Scharper • Photo Illustration by Patrick Kirchner

If the Supreme Court upholds a Mississippi law that bars abortions after the 15th week of pregnancy, it will overturn nearly a half century of abortion rights in the U.S.

Then what?

Twenty-six states are poised to ban abortion, according to the Guttmacher Institute, causing more than 40% of women in the U.S. to lose access to abortion care in their home state. The result: Broad and devastating public health impacts. 

“It’s hard to find the right words to express how profoundly troubling this is. To say it is disappointing or disturbing, none of those words are strong enough. It’s a gut punch,” said Carolyn Sufrin, MD, PhD, an associate professor of Obstetrics and Gynecology at the Johns Hopkins School of Medicine and in Health, Behavior and Society at the Bloomberg School. “It’s hard to overstate how detrimental this will be for people with the capacity to be pregnant and for their families and children,” she says, noting that the bans would likely lead to an increase in unsafe attempts to end pregnancies, more high-risk pregnancies being carried to term, more babies born in states with limited access to prenatal care, more maternal health complications, and severe emotional and economic stress for families.

Some will travel to states where abortion remains legal. Others may make use of FDA-approved drugs for medication abortions at home.

"To say it is disappointing or disturbing, none of those words are strong enough. It’s a gut punch."

After Texas passed a law banning abortion after six weeks of pregnancy, researchers at the University of Texas at Austin found that most people who wanted but were barred from the procedure either traveled out of state or used medications to terminate the pregnancy at home. However, traveling for an abortion can be extremely costly, explains Joanne Rosen, JD, MA, a senior lecturer in Health Policy and Management. A person would need to pay for transportation, lodging, and potentially childcare to have the procedure—which costs between $500 and $3,000, depending on location and the length of the pregnancy. The challenge would be even greater if numerous states in a region curtail access to abortion, as states clustered in the South, West, and Midwest are likely to do. This would make it very hard for a low-income person to travel for an abortion—further exacerbating existing health inequities, Rosen says. 

Moreover, providers in states where abortion remains legal may be overwhelmed by out-of-state people seeking care. This happened in Louisiana and Oklahoma after Texas passed its new law, according to The New York Times. This means longer wait times for an abortion, and as a result, clinics are providing abortion services to people later in pregnancy. One clinic reported now providing most abortions to patients at the end of the first trimester or beginning of the second trimester, while previously terminating pregnancies in the middle of the first trimester. Oklahoma lawmakers in April approved a near-total ban on abortions; if this bill is signed into law, it will further burden abortion providers in nearby states.

Abortion medications, which are FDA-approved to terminate a pregnancy through the 10th week (but can safely be used through the 11th week), are a promising alternative for those unable to travel, Sufrin says. Although some states have tried to prevent access to these drugs by mail, such laws are hard to enforce. The challenge with these drugs is that many pregnant people don’t know that they exist or how to obtain them. Several nonprofit organizations, including Plan C, an initiative of the National Women’s Health Network, and Femhealth USA, are working to bolster access to the medications.

Others will likely turn to unsafe measures to terminate their pregnancies, says Suzanne Bell, PhD ’18, MPH, an assistant professor in Population, Family and Reproductive Health. “Abortion rates are similar in countries where abortion is widely available and those where it is legally restricted,” Bell says. “The main difference is the safety of those abortions.” While abortions performed by a trained medical provider are extremely safe—with lower rates of complication than tonsillectomies or wisdom tooth extractions—procedures performed by unlicensed providers carry a higher risk of hemorrhage, infection, or death. 

Still many people will wind up carrying unwanted pregnancies to term, experts said. The Turnaway Study, a longitudinal project conducted by researchers at the University of California San Francisco, followed 1,000 people divided into two cohorts: those who successfully terminated a pregnancy and those who were unable to obtain an abortion. They found that in the following decade, those who carried unwanted pregnancies to term were more likely to experience household poverty, evictions, intimate partner violence, and serious health problems. The risks of medical complications of birth are far higher than the risks of complications from an abortion, Sufrin says, noting that birth complications are particularly high among Black and Latina mothers. 

Having to carry unwanted pregnancies to term would be particularly devastating for pregnant people who are poor or have little access to health care, says Rosen. “Sixty percent of people who want an abortion already have a child. Seventy-five percent of the people who seek abortions either live at the poverty line or are very low income,” says Rosen. “Approximately 40% of women say they had an abortion for financial or socioeconomic reasons. They did not have the economic stability to support a child.”

Rosen points out that none of the states that have imposed strict abortion laws have passed measures to support parents, such as expanding access to childcare, parental leave, or health care. “One of the adages that is often applied to states that wish to ban or severely restrict abortion is that for them, life begins at conception and ends at birth,” she says.

  • 18th century

    Abortion, mainly via herbs and medications, is a common practice.

  • 1821

    Connecticut passes the first law criminalizing abortion after “quickening” (~4 months of pregnancy).

  • 1880

    All states have laws restricting abortion.

  • 1910

    Abortion at any point in pregnancy is illegal in every state.

  • Late 1960s–early 1970s

    Alaska, Hawaii, New York, and Washington repeal their abortion bans; 13 other states allow abortions in some circumstances.

  • 1973

    Roe v. Wade ruling declares that the 14th Amendment protects a woman’s right to abortion prior to fetal viability, legalizing it in all 50 states.

  • December 2021

    The Supreme Court hears arguments in Dobbs v. Jackson Women’s Health Organization, which challenges a Mississippi law banning abortion after 15 weeks.