After nearly half a century, the Supreme Court’s landmark 1973 decision in Roe v. Wade is poised to be overturned. On May 2, the Supreme Court’s initial draft decision on the critical abortion rights case, Dobbs v. Jackson Women’s Health Organization, was leaked and published online, and it contains a five-to-four majority opinion to overturn Roe. Chief Justice John Roberts confirmed the draft as authentic, although he noted that it was not a final version. A formal opinion is expected in late June or early July.
The leak has people all over the country preparing for a complete rewind on abortion rights, particularly in states likely to ban or seriously restrict abortion once Roe falls. Here’s what to know about accessing abortion if Roe is overturned, particularly for people living in hostile states.
First, check your state’s laws.
In the absence of Roe v. Wade, abortion laws would return to a state-by-state patchwork, in which some states would restrict or even ban abortion, while others would protect it. That means the first step to accessing abortion is figuring out what’s even legal in your area. According to 2022 data from the Guttmacher Institute, 35 states currently require that abortions be performed by a licensed physician, and 19 states require abortions to be performed at a hospital during certain stages of pregnancy. In 43 states, gestational limits are in place, which means abortions are prohibited at certain stages of pregnancy — with some exceptions, usually in cases of “life or health endangerment.” States like Texas currently ban abortion as early as six weeks, while on May 25 Oklahoma passed a law banning abortion from the point of conception. On the other hand, states like New York protect the right to access abortion.
But the list of hostile states is likely to grow longer in Roe’s absence. As of June 6, 26 states are preparing anti-choice legislation that would ban abortion outright, according to the Guttmacher Institute. Out of those 26 states, 13 carry “trigger” laws that would immediately outlaw abortion if Roe is overturned. These laws will undoubtedly make abortion care more difficult to access, on top of barriers like taking time off work, finding child care, covering interstate travel costs, paying for overnight accommodations, and more.
Figure out if you can access care in-state or not.
If you’re still allowed to have an abortion within your state’s borders, there are several ways to access abortion care. To figure out the best options under your state’s laws, you can use several resources, such as the National Abortion Federation (NAF) hotline, INeedAnA.com, the Abortion Care Network, and more. If you’re a minor in an anti-choice state and need a parent or guardian’s consent to access abortion care, you can visit ReproLegalHelpline.org for information on legal options, like how to obtain a judicial bypass.
If you can’t get an abortion in your state, you may have to travel. As of 2022, 16 states, plus Washington, D.C., have laws or policies on the books affirming the right to abortion care, including California, Colorado, Connecticut, Delaware, and more. Although some states have legislation in the works that would ban people from traveling to access abortion care, as of June 6, it’s still perfectly legal to do so. But if the Supreme Court overturns Roe, the influx of people coming from anti-abortion areas will place a heavy strain on health care infrastructure in states where abortion is still legal.
“In states with clear protection around abortion, we're anticipating an influx of patients from other locations,” says Dr. Stephanie Rand, M.D., a New York-based gynecologist and obstetrician, and fellow with Physicians for Reproductive Health (PRH). “That will decrease the availability [of] resources for people who live in our state currently, and access our care here. We’re all brainstorming ways to expand services in order to meet the needs of our own residents of our state, and then people who will be coming from outside of the state.”
How to help, or get help yourself.
“To be able to afford the abortions that [people are] needing and wanting, they often have to stretch the means and [make] decisions between rent, food, [and] child care,” says Destini Spaeth, president at The North Dakota Women in Need Fund — an abortion fund dedicated to providing people with the resources needed to access reproductive health care.
For people who can’t afford the logistics or funds needed to access abortion care, there are plenty of locally-based abortion funds and mutual aid projects like Spaeth’s that are dedicated to helping, such as the Texas Equal Access (TEA) Fund, the Roe Fund in Oklahoma, and the Florida Access Network. These organizations provide people with the resources needed to access reproductive health care, such as transportation and lodging costs, child care expenses, and more. To find an abortion fund in your state, you can visit the National Network of Abortion Funds.
“These organizations have been doing this work for so long, under so many different circumstances,” says Desireé Luckey, the director of policy at Unite for Reproductive and Gender Equality (URGE). “The folks who have been on the ground in this way are some of the folks who are best equipped and knowledgeable to help us navigate and maneuver these new times.”
She points out that this work will become even more necessary should Roe officially fall. “Folks are not gonna stop seeking out the abortions that they need,” Luckey says. She adds that it’s more important now than ever “to commit to working together in very intentional ways around [abortion] criminalization, since we already know who will be most affected.” Even if you don’t need help yourself, abortion funds are a great place to donate to help others.
Navigating medication abortion and self-managed abortion.
OK — you can’t access abortion in your own state, and you can’t travel out of state. What now? Let’s talk about medication abortion.
As of June 6, ending a pregnancy through a medication abortion is safe and legal in 49 states, as well as the District of Columbia. (On May 26, Oklahoma passed a law fully banning abortion from the moment of conception, with exceptions for rape, incest, and life of the parent. However, the law, which has a civil enforcement mechanism patterned after Texas’ “bounty” law, exempts pregnant people from being sued for their own abortion.) You can access medication abortion through an in-person doctor’s appointment, or through telehealth services in some states. There are several resources to access abortion care through telehealth, like Planned Parenthood and Plan C Pills. These organizations will connect you with a health care provider who will walk you through the medication abortion process from the comfort of your own home.
However, many states have laws banning telehealth abortions, as well as medication abortion at certain points during pregnancies. This is where many people may choose to self-manage their own medication abortions. “Self-managed” abortion often refers to people who are self-sourcing and self-administering safe, effective medications to end their pregnancies — the very same medications that a physician would prescribe in a clinical setting.
Spaeth says the biggest factor in accessing abortion now versus before Roe was passed is the internet. “Every third post I see is on [self-managed abortion],” she says. “There’s an effort to destigmatize it,” she adds. “[This] is how the people will take this matter into their own hands.”
“Those medications typically are mifepristone and misoprostol,” says Rand. “When taken together, [they’re] able to safely end most pregnancies, require little follow-up, and have very few risks.”
Guidelines from the World Health Organization (WHO) say self-managed medication abortion can be used to end a pregnancy of up to 12 weeks at home, and after 12 weeks in a medical office. (Clinical protocols in the United States usually suggest medication abortions up to 10 or 11 weeks.) “[Mifepristone] works against one of the hormones that supports pregnancy, and prepares the uterus and cervix for the second [dose] of medications,” Rand says. While studies have shown that misoprostol is most effective when taken 24 to 48 hours after the first dose of mifepristone, Rand explains it can be taken sooner if needed. “After taking that second set of pills,” she says, “people will experience cramping, bleeding, passing blood clots, and then eventually passing the pregnancy.”
In December 2021, the U.S. Food and Drug Administration (FDA) lifted restrictions on abortion through teleheath services — making it easier for people all over the country to self-manage their abortions. Now, the FDA permanently allows health care providers to prescribe abortion medications and send them through the mail. One of the simplest ways to source mifepristone and misoprostol is through sites that connect patients with telehealth services, such as Plan C Pills, Aid Access, Hey Jane, and more.
Self-managed abortion: What are the legal risks?
While, according to experts and doctors, self-managed abortion carries very few health risks, it can be a heavy legal risk in some states with anti-choice legislatures. At least six states, including Texas, Arizona, Louisiana, Arkansas, Indiana, and West Virginia, ban the use of telehealth for abortion, while 13 states require a health care provider to prescribe the medication in person. And according to information in Plan C Pills’ FAQ section, “at least 60 people who have self-managed an abortion or have helped someone else are known to have been arrested or prosecuted” since the year 2000.
Many online sources suggest the pills needed for a self-managed medication abortion could be mailed from states where abortion is legal to people in states where it’s banned. Luckey explains there are two sides to the situation: the patient’s, and the provider’s. While patients may be looking for less traceable ways to obtain the medication, abortion care providers have to consider if they’re willing to break the law.
Luckey lists several legal possibilities for those seeking a mail abortion, like having the pills mailed to a state where abortion by mail is legal and then having those pills forwarded to a state where it’s banned. “I know folks who are trying to access care using telehealth resources, and they try to get something from a website, and they're just not gonna send it to their state, so they have to find another way.”
While experts and doctors say self-managed abortion is one of the safest ways to terminate a pregnancy, should something go wrong, Rand notes that medically, there’s no way to tell the difference between a self-induced medication abortion and a spontaneous miscarriage. “The process people experience after taking medication for an abortion is the same they would experience during a miscarriage,” she says. “You cannot detect either medications in blood tests.” In short: patients don’t have to tell health care providers if they’ve taken abortion medication. “We know that people [have been] reported from emergency rooms in the past,” Rand explains. “We don’t know predictors.”
If the Supreme Court does indeed overturn Roe, abortion will almost instantly become illegal in nearly half the country. However, this doesn’t mean reproductive rights advocates like Spaeth are giving up on fighting for abortion access anytime soon. “We’re in for a long fight. We're starting from the ground, but we're not gonna forget about the work that needs to be done today, and tomorrow, and the next day,” Spaeth says. “We’re not going anywhere.”