(We have updated the map and this article since their original publication in December to reflect news Monday night of a possible reversal of Roe v. Wade, and to reflect more recent analysis of state abortion laws and their predicted effects.)
The leaked draft Monday of a Supreme Court opinion in a Mississippi abortion case has raised the prospect of a return to a time half a century ago — when the procedure was illegal across most of the United States and women, perilously, tried to end pregnancies on their own or sought back-alley abortions.
If the court decides to reverse the landmark Roe v. Wade ruling when it releases its final decision in the coming weeks, it will usher in a somewhat different era. Abortion would remain legal in more than half of states, but not in a wide swath of the Midwest and the South.
Legislatures in 25 states would almost certainly move to ban or substantially restrict access to abortion. Some women would be able to travel out of state for the procedure. Others would have access to pills, in some cases illicit, which now offer a relatively safe and difficult-to-police home alternative to clinics.
Where Legal Abortions Would Decline if Roe v. Wade Were Overturned
States with trigger laws and others deemed likely to ban abortion are outlined.
States likely to ban abortion
Abortion clinic
Abortion clinic
likely to close
Areas farthest away from open abortion clinics will see the sharpest declines in access.
Estimated decline in legal abortions (Updated May 3)
-20%
-15%
-10%
-5%
No change
States likely to ban abortion
Abortion clinic
Abortion clinic
likely to close
Estimated decline in legal abortions (Updated May 3)
-20%
-15%
-10%
-5%
No change
Source: Caitlin Myers, Middlebury College
Many women, disproportionately those who are poor, would unwillingly carry their babies to term and rely on a social safety net that is thinner than in most other rich nations, and thinner in some states than in others.
In effect, the United States without Roe would look very different for different people. For women in Democratic states and women elsewhere who have the means to travel to a clinic, abortion would still be accessible. For poor women in many Republican states, traveling to other states for in-clinic abortions could be prohibitively challenging.
Understand the Challenge to Roe v. Wade
The Supreme Court’s decision could be the most consequential to women’s access to abortion since 1973.
An Extraordinary Breach: The leak of a draft opinion suggesting that the justices will end the constitutional right to abortion will be investigated by the Supreme Court marshal, but it’s unlikely the Justice Department will be involved.The Court’s Transformation: As it appears to be close to issuing its ruling in the case of the Mississippi law that could overturn Roe v. Wade, the Supreme Court looks increasingly politics-drivenDestroyed Trust: Justice Clarence Thomas addressed the leak, saying that it had done irreparable damage to the Supreme Court.Protests: Following the leak, supporters of abortion rights have staged demonstrations across the country, including outside the homes of several justices.A 17th Century Judge Cited: Lord Matthew Hale, who wrote that women were contractually obligated to husbands, was cited eight times in Justice Samuel Alito’s draft opinion.
Without Roe, the number of legal abortions in the country would fall by at least 13 percent, according to research by a team from Middlebury College; the University of California, San Francisco; and the Guttmacher Institute, based on the effects of clinic closures around the country between 2013 and 2020.
For women in places that would ban abortion, the average travel distance to the nearest clinic would increase to 282 miles from 33 miles now, according to analysis by Caitlin Myers, an economist at Middlebury and a leader of the research. For about one quarter of them, that distance would be insurmountable and they would not be able to reach a provider, she said, based on her analysis of what has happened after previous restrictions.
That result would be the culmination of a decades-long effort by the anti-abortion movement. “That would create a culture where we would be able to enact policies and legislation to support the women and children in our state,” said Laura Knight, president of Pro-Life Mississippi.
The majority of women who are unable to access a legal abortion in their state would likely get one another way, in another state or by ordering pills, data from Texas suggests. Some would bear children.
In some ways, a post-Roe America would mirror the pre-Roe one. Then, abortion was generally legal in four states, and 13 more allowed abortion for health reasons. Women who could afford it would travel out of state to seek the procedure. But many women turned to coat-hangers, chemicals, unskilled abortion providers and other dangerous methods. In the early 1960s, Cook County Hospital in Chicago was treating more than 4,000 women a year for life-threatening effects of botched illegal abortions.
Now, there are safer options. In contrast with the 1960s, the internet has made it easier for women to learn where they can find a legal abortion or order black-market pills that can safely and effectively end pregnancy up to 10 weeks. Already, many American women order such pills online or cross the border to Mexico, where they are sold over the counter as ulcer medicine. Aid Access, a group that connects women with European doctors and pills from India, will work with women in all 50 states.
It is technically illegal to sell prescription medicine to American patients from another country without a prescription from a doctor licensed in the United States, but enforcement is difficult. Some states are already adding restrictions: In December, a law went into effect in Texas banning medication abortion after seven weeks; it makes it illegal to provide the pills, not to take them.
“We are going to see some women will still do dangerous things like having the boyfriend hit them in the belly or throwing themselves down stairs or taking dangerous herbs,” said Carole Joffe, a professor at the U.C.S.F. Bixby Center for Global Reproductive Health, who has studied the history of abortion in the United States. “But there is now a very safe extralegal option.”
Currently, there is at least one abortion clinic in every state, and most women live within an hour’s drive of one. But without Roe’s protections, clinics in at least 25 states are expected to shut down as abortion would be banned immediately or in relatively short order, according to analyses of state laws from the Center for Reproductive Rights, which litigates abortion cases, and one from the Guttmacher Institute, which studies the laws.
Leaving abortion law to state legislatures has been a goal of the anti-abortion movement, though some would prefer to go further, establishing a national policy that would end abortion throughout the United States. Such a goal cannot be achieved simply by overturning Roe. It would require federal action — or a different Supreme Court ruling that grants constitutional rights to fetuses.
Mississippi’s attorney general, Lynn Fitch, and solicitor general, Scott Stewart, left, before going into the Supreme Court in December. Mississippi passed a law making most abortions illegal after 15 weeks of pregnancy.Credit…Kenny Holston for The New York Times
The women most affected in states with bans would be those who can’t easily travel. They are disproportionately poor, Black, Latina, teenagers, uninsured, and undocumented immigrants.
The State of Roe v. Wade
Card 1 of 4
What is Roe v. Wade? Roe v. Wade is a landmark Supreme court decision that legalized abortion across the United States. The 7-2 ruling was announced on Jan. 22, 1973. Justice Harry A. Blackmun, a modest Midwestern Republican and a defender of the right to abortion, wrote the majority opinion.
What was the case about? The ruling struck down laws in many states that had barred abortion, declaring that they could not ban the procedure before the point at which a fetus can survive outside the womb. That point, known as fetal viability, was around 28 weeks when Roe was decided. Today, most experts estimate it to be about 23 or 24 weeks.
What else did the case do? Roe v. Wade created a framework to govern abortion regulation based on the trimesters of pregnancy. In the first trimester, it allowed almost no regulations. In the second, it allowed regulations to protect women’s health. In the third, it allowed states to ban abortions so long as exceptions were made to protect the life and health of the mother. In 1992, the court tossed that framework, while affirming Roe’s essential holding.
What would happen if Roe were overturned? Individual states would be able to decide whether and when abortions would be legal. The practice would likely be banned or restricted heavily in about half of them, but many would continue to allow it. Thirteen states have so-called trigger laws, which would immediately make abortion illegal if Roe were overturned.
“Those most vulnerable will be left behind and be forced to carry pregnancies that they were not prepared for,” said Tammi Kromenaker, director of the Red River Women’s Clinic, the only abortion provider in North Dakota, which has a trigger law that would make abortion illegal without Roe.
As some states have tightened abortion restrictions in recent years, more organizations have helped women book and pay for flights or gas, hotels and child care. But their leaders say they do not have the capacity, in money or staff, to help the number of women who would need it in the South and Midwest if Roe fell.
One of these groups, Fund Texas Choice, received about 35 calls a month before Texas banned most abortions in September, and was able to help nearly everyone who called. Since then, it has had up to 300 callers a month, and has had to turn away half, said Anna Rupani, the group’s executive director. Seventy percent of its clients are people of color, and 60 percent are parents.
“It will be absolutely unsustainable if Roe is overturned,” she said.
Many of the states that would ban abortion also have the least social support for women and children, like robust access to family planning services or paid family leave, and have high levels of child poverty. Studies have found that being denied an abortion has economic effects that last years.
Some who oppose abortion say the next step is to create more of a safety net for poor mothers. “There has never been enough alternative help for women,” said Chuck Donovan, who has worked in the anti-abortion movement for decades, now as president of the Charlotte Lozier Institute. “It’s something pro-lifers could agree to, even if it frustrates spending conservatives.”
He mentioned pregnancy centers; assistance for mothers to find employment and afford things like diapers and car seats; an expansion of Medicaid to cover women for a longer period postpartum; and efforts to collect child support from fathers.
Democrats have proposed ways to expand support for mothers and children, including extending child tax credits, expanding Medicaid and establishing federal funding for child care and pre-K, but these policy ideas have stalled in Congress.
Over the last three decades, roughly six in 10 Americans on average have opposed the overturning of Roe, and around eight in 10 have said abortion should be legal in at least some circumstances, according to Gallup. But most Republican voters would support overturning Roe.
In some parts of the country, a post-Roe world is easier to envision because it has, in many ways, already arrived. In four states — Missouri, Mississippi, North Dakota and South Dakota — there is only one clinic.
In Texas, a law that went into effect in September prohibited abortion after fetal cardiac activity was detected, around six weeks of pregnancy. With the aid of groups offering grants and travel assistance, many women were able to seek care in neighboring states. But others could not make the trip. And nearby clinics became overburdened by the surge in patients, pushing some women too far into their pregnancies to seek care there.
Over time, some clinics will adjust, by either locating near state borders or expanding their capacity to accommodate new patients. Already, the Hill Top Women’s Reproductive Clinic, which was the only abortion clinic in El Paso, closed. It reopened just over the border from El Paso, in Santa Teresa, N.M.