It’s hard to think back to anything besides the presidential election dominating the airwaves these past few weeks, but just a few weeks prior, the confirmation of Justice Amy Coney Barrett into the Supreme Court commanded the national dialogue. Not only was Barrett’s nomination and subsequent confirmation mere days before a presidential election, she is also filling a seat previously occupied by one of  gender equality’s most influential icons. The death of late justice Ruth Bader Ginsburg left room for President Trump to create a Supreme Court with a 6-3 conservative majority that will have the votes needed to overturn the landmark 1973 case that established Americans’ right to terminate a pregnancy. While she dodged questions regarding the topic during her confirmation hearings, Justice Barrett’s ruling and statements in the past have made clear that she is pro-life. So what happens to abortion in America if Roe v. Wade falls? 

The first aspect to make clear is the fact that overturning Roe v. Wade will simply end legal and safe abortion, not all abortion altogether. States will be left to decide for themselves if abortion is legal. This will likely have the largest impact on those who live in conservative states, where the overturning of Roe v. Wade will probably result in the shutdown of any remaining clinics, which are already few and far between. Nonprofit organizations like Planned Parenthood as well as private clinics both face obstacles. Women seeking an abortion will have to acquire the necessary funds to travel to a democratic state to receive the procedure, and in some cases may even face legal consequences upon returning home. To balance this, abortion funds created by activisits for women in need to fund abortions and accompanying costs will need to increase budgeting for women to travel around the country to obtain safe abortions. Providers with the ability to perform the official medical procedure will also continue to operate. There could also be an increase in self-managed abortions, colloquially known as taking the “abortion pill”. Assembling a response for this possible reality will require outstanding efforts from providers and advocates alike, from raising money to help women seeking abortions to campaigning against laws that restrict reproductive freedom. It is easy to forget that illegal abortion was common before the procedure was legalized in 1973 across the nation, and that denying women access to a legal abortion does not prevent them from having abortions, but just increases the likelihood that they will resort to an illegal abortion carried out under unsafe conditions.The number of illegal procedures in the country plummeted from around 130,000 to 17,000 after the passage of Roe v. Wade.

In 1973, the Supreme Court invalidated state abortion bans through Roe v. Wade on the grounds that states could not impose an undue burden on Americans’ right to have an abortion, but state legislatures have found ways to push these limits. In 2010, a number of states throughout generally conservative regions in the South and Midwest passed laws with extremely strict rules and limitations for abortion clinics to follow in order to stay in practice. These included requiring providers to have admitting privileges at a local hospital, which led to the closure of many clinics in those regions, leaving some states with few places, or sometimes just one, where women can legally obtain an abortion. Other laws require ultrasounds and waiting periods prior to an abortion, which drive up costs and make the process time consuming for patients. Low-income Americans experience an even greater financial obstacle because Medicaid is barred from covering the majority of abortions, forcing them to pay out of pocket for these procedures. Even though advocates and providers have been working to counter abortion restrictions, the overturning of Roe would require a new and stronger response.

Women who are unable to receive a legal abortion are likely to turn to self-managed abortions. One recent study found that inquiries for the abortion pill online were higher in states with more restrictions on abortions laws. Self-managed abortions are generally regarded as safe by physicians, with complications occuring in less than 1% of usages. In fact, the largest risk is not posed by the medication itself but by the criminal penalties for swallowing it. Delaware, South Carolina, Arizona, Idaho, and Oklahoma have legislation that specifically bans abortion medication. Many others still have laws against feticide or similar acts that can be counted as self-management and lead to the arrest of those who use abortion pills. Besides the abortion pill, women also turn to more dangerous, medically unsound strategies for self-management. These could not only affect a woman’s reproductive system for the rest of her life, but also have deadly consequences. 

Overturning Roe would likely also lead to a greater dependence on community-based abortion providers, who perform the procedure outside of medical clinics. Their methods vary from the use of the abortion pill to surgical techniques like vacuum aspiration depending on the stage of the pregnancy. Due to the blurred lines regarding the legality of their work, however, it is difficult to find statistics of their success rate. Performing abortions outside of a traditional abortion clinic is legally more risky than seeking one because most anti-abortion legislation  aims to limit providers, not patients.

Twenty-one states already have legislation that would criminalize abortion if Roe was no longer viable. This includes ten states that have so called “trigger bans” that will immediately prohibit abortion if Roe falls. Unless these laws are repealed, abortion in a future without Roe could echo a past in which women were forced to conduct their own abortions at home. However, without the lax legal environment where women could do so without fear a century ago, the accessibility of self-managed abortion and community-based providers returns abortion care to women, but under the looming threat of prosecution. The challenge in a future without Roe will be removing this threat to provide healthcare to women in need.