Roe v. Wade FAQ: What if abortion rights law gets overturned?

In a leaked draft opinion made public Monday (May 2), the U.S. Supreme Court voted to overturn Roe v. Wade, the landmark case that has protected abortion rights in the U.S. for nearly 50 years. Although the leaked draft is not necessarily the final opinion of the Court, it has sparked a wave of reactions from both abortion rights and pro-life advocates. If the final opinion mirrors the draft, it would drastically change abortion rights in America.

Here are answers to questions about what could happen if the landmark ruling is overturned.

 What happens if Roe v. Wade is overturned? 

If Roe v. Wade were overturned, each state would determine its own laws regarding abortion. More than 20 U.S. states have laws that could restrict access to abortion without Roe v. Wade. These include 13 states with "trigger laws" that would immediately make abortion illegal if Roe v. Wade is overturned and nine states that still have abortion bans on the books from before Roe v. Wade was enacted (which are currently not enforced), according to the Guttmacher Institute, a nonprofit organization for sexual and reproductive health research and advocacy.

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Where would abortion be illegal?  

According to the Guttmacher Institute, 26 states are certain or likely to ban abortion in the event that Roe v. Wade is overturned. These include 22 states that already have laws in place that make it near-certain that they will ban abortion, including trigger laws, pre-Roe bans on abortion, laws that ban abortion after six weeks (before many people know they are pregnant) and constitutional amendments that prohibit abortion rights. These states include: Alabama, Arizona, Arkansas, Georgia, Idaho, Iowa, Kentucky, Louisiana, Michigan, Mississippi, Missouri, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia, Wisconsin and Wyoming.

In addition, four states — Florida, Indiana, Montana and Nebraska — appear likely to ban abortion in light of recent actions to limit access to abortion, according to the Guttmacher Institute.

In contrast, the 16 states with laws in place to protect the right to abortion include California, Colorado, Connecticut, Delaware, the District of Columbia, Hawaii, Illinois, Maine, Maryland, Massachusetts, Nevada, New Jersey, New York, Rhode Island, Vermont and Washington.

Can people get abortion out of state? 

Currently, yes, people can cross state lines to access abortion care in a state that allows it, provided they have the time and resources to do so. In the months after Texas passed a near-complete abortion ban in September 2021, disallowing abortions after six weeks of pregnancy, about 1,400 pregnant people each month traveled to Arkansas, Colorado, Kansas, Louisiana, Mississippi, New Mexico and Oklahoma to receive an abortion, The New York Times reported.

However, some states may soon restrict out-of-state abortions, and Missouri has already attempted to.

Missouri lawmakers recently proposed legislation that would allow private citizens to sue anyone who helps a state resident have an abortion, whether or not that individual resides in Missouri, Politico reported. The law was initially blocked in the state’s legislature, but it could gain traction again if Roe falls, experts told The Guardian.

Are there abortion options that don't require going to a doctor's office? 

Yes, "self-managed abortions" describe a situation where someone induces their own abortion outside of a medical setting, according to Whole Woman's Health. Self-managed abortions involve taking abortion pills called mifepristone and misoprostol; these drugs are either taken in combination or misoprostol can be taken by itself, according to the World Health Organization (WHO). In general, taking pills for abortion is known as "medication abortion." 

The combination regimen involves taking mifepristone, orally, waiting 24 to 48 hours, and then taking misoprostol by placing the pill in the vagina, under the tongue or in the cheek, the WHO states. Mifepristone blocks a hormone called progesterone, which is required to maintain pregnancy, and misoprostol induces contractions, which can trigger bleeding, uterine cramping and pain, similar to a miscarriage, according to Whole Woman's Health. 

"Medication abortion is a safe and highly effective method of pregnancy termination," according to the Kaiser Family Foundation. If administered by the ninth week of pregnancy, "the pregnancy is terminated successfully 99.6% of the time, with a 0.4% risk of major complications, and an associated mortality rate of less than 0.001 percent (0.00064%)."

Misoprostol taken alone can also effectively and safely end a pregnancy, although the combination regimen is specifically approved by the U.S. Food and Drug Administration (FDA), the Whole Woman's Health website notes.  

The FDA has approved the use of mifepristone (brand name Mifeprex) and misoprostol within 10 weeks of the person's last menstrual period. As of 2021, the agency has allowed people to receive these medications by mail, rather than needing to get them in person from a health provider at a specialized clinic, The New York Times reported. Providers can prescribe the pills and mail them after a telemedicine appointment with the patient.

However, several states restrict at-home access to abortion pills by forbidding the mailing of pills; requiring pills to be picked up in-person; or setting an earlier limit on when the pills may be taken, meaning earlier than the 10 weeks specified by the FDA. Some states also ban telemedicine appointments for abortion care. Pregnant people in states with such restrictions have, in the past, traveled to a permissive state and received the pills by mail there, instead, according to the Times.

To see a map of which states have restrictions on abortion pills, check the Kaiser Family Foundation website.

How would abortion bans affect the rates of the procedure? 

Exactly how much abortion rates would fall after Roe v. Wade being overturned is hard to predict. That's because pregnant people who live in states where abortion is illegal may still order pills online, or seek potentially dangerous illegal abortions, according to The New York Times. It's also possible that more clinics would open in areas where abortion is legal to treat patients from out of state, the Times reported.

By one estimate, legal abortions in the country would decline by 14%, according to the Times. That's based on research of the effects of abortion clinic closures, which make it more difficult for patients to receive in-clinic abortions. If Roe v. Wade is overturned, the average distance that a person seeking an abortion would need to travel to reach a clinic would increase from about 35 miles to 279 miles (56 to 449  kilometers), the Times reported.

How do abortion bans affect pregnant people? 

Studies have found that preventing people from obtaining wanted abortions can have serious adverse consequences, including mental, physical and financial effects. In one study known as the Turnaway Study, researchers at the University of California, San Francisco, analyzed information from 1,000 U.S. women who sought abortions and either received an abortion or were denied an abortion because they were beyond their states' gestational limit. The study found that women who were denied an abortion and gave birth were more likely to have serious complications, including eclampsia (seizures tied to high blood pressure in pregnancy), postpartum hemorrhage and death, than women who received an abortion.

In addition, being denied an abortion was linked with increases in anxiety, stress and lower self-esteem shortly after the denial, compared with women who received an abortion; these increases went away after six months.

People who were denied an abortion also experienced financial hardship, including an increase in household poverty that lasted at least four years, the researchers said.

Originally published on Live Science.