We already know what a post-Roe v. Wade nation will look like. Here’s the data.

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Overview (Post-Roe data)

When Maleeha Aziz of Dallas needed an abortion at age 20, she accidentally made an appointment with one of the state’s crisis pregnancy centers, which seek to dissuade people from abortion. In what she calls “the most traumatic experience of my life,” the staff were “almost harassing” her to not undergo an abortion, ticking off harms they alleged were associated with the procedure.

Aziz wanted a medication abortion, which requires taking prescribed pills in a set time frame, often at a cost of hundreds of dollars, and can be done at home. The crisis pregnancy center staff told her that medication abortions were banned in Texas, which was not true at the time. That’s when Aziz, a Pakistani immigrant who didn’t know the law, “completely panicked.” She spent thousands of dollars to fly to Colorado Springs, Colorado, to start a medication abortion, completing the second stage in her bathroom back home in Texas.

That would likely have profound negative effects on the physical and mental health and economic status of millions of people who seek abortions going forward, according to extensive scientific research on the effects of abortion limits. Those from marginalized populations — including people of color, immigrants and people already under financial strain — would sustain the greatest impacts, studies suggest, including insurmountable expenses, increased risk of domestic violence and preterm birth when they can’t access abortion services.

Thesis (Post-Roe data)

Thesis

Health Lens

The risks of domestic violence and preterm birth increase when abortion is denied

Legal risks stemming from immigration status, or from being a person of color, can also dissuade people from seeking abortion, especially when they must travel far to reach a provider. “I am concerned about undocumented people who fear that traveling long distances puts them at risk for deportation, just being out and interacting with healthcare providers in other states,” said Ushma Upadhyay, a public health social scientist at UCSF. Furthermore, “people who are low-income live in fear that accessing abortion services could put their eligibility for other services at risk.”

But not all states allow abortion medications to be mailed, rendering moot the FDA’s changed stance.

Even as self-managed abortion becomes increasingly important “as a form of reproductive autonomy when your state is trying to take it away from you,” she said, “the main risks are not medical ones but legal ones.”

Economics Lens

Access limits come at a high price

The blow of a denied abortion is heavier to people experiencing poverty.

Those who could not obtain a wanted abortion had a 78 percent increase in overdue unpaid debt and an 81 percent increase in rates of tax liens, evictions and bankruptcies. These effects lasted years after the denial of abortion; those denied abortions were less likely to have a prime credit score at two years after giving birth, for instance. Foster and her co-authors concluded that being denied abortion was a financial blow equivalent to being evicted or losing health insurance.

Any furthering in travel requirements beyond the local region presents a difficult obstacle. “Even an increase in distance to 25 miles can prevent a substantial number of people seeking abortions from reaching providers,” Myers said. Although people of all ages and ethnicities are affected, the resulting increase in births is most weighty for women ages 15 to 24 years and for non-Hispanic Black women.

Yet most abortions, especially medication abortions, are not specialized care, notes Upadhyay: “This is primary care. People shouldn’t expect to have to travel an hour or more to reach an abortion provider for primary care.”

Politics Lens

Texas’ restrictive laws are emboldening other states

These restrictions inordinately affect people who are already struggling financially. Myers said that one of the many things that troubles her in the Dobbs case is the argument that abortion has “become this obsolete medical service” and that “women now effortlessly balance work and motherhood.” She noted that many states that probably will ban abortion if Roe falls are the same states “where the social net for working mothers is frayed. No expansion of Medicaid, welfare benefits are laughably low.”

“You’re talking about people who may never have traveled before, never been on an airplane, have small kids at home, and they’ve got to get to California or Colorado,” Keiser said.

And an overturned Roe could immediately trigger similarly severe limitations in states where Texans currently seek abortions, leading to an impassable cul-de-sac of care. Abortion providers in neighboring states already are oversubscribed with clients from Texas, which is expected to worsen with the intensification of the national divide on abortion.

The combined number of abortion facilities in the four states neighboring Texas is less than the 22 facilities Texas still has; there are just two in Arkansas, three in Louisiana, four in Oklahoma and six in New Mexico. In a post-Roe nation, even if these states weren’t poised to enact more restrictive laws against abortion (and most are), they would likely be unable to meet surging demand.

Several of these states are among the 19 that prohibit telemedicine for abortion, overriding the FDA’s recent decision to relax requirements for medication abortion, Aiken said. “They either require the person to be in the presence of the dispensing physician or ban mailing the abortion pill, or both,” she added. The FDA’s decision doesn’t automatically supersede state law.

The disparate rules for access to abortion drugs have already created a patchwork of care — one that could get more complex if Roe falls.

“Access to medical abortion and all abortion is a ZIP code lottery,” said Aiken. Things will continue to get worse if the “blatantly unconstitutional” S.B. 8 bill is allowed to stand, she said. “We could see Roe be diminished or overturned, and other states will enact Texas-like legislation.”

Conclusion (Post-Roe data)

Estimates suggest that if the Supreme Court strikes down Roe, states such as Louisiana and the Dakotas with trigger bans poised to take effect would see a steep decline in abortions — more than 40 percent in some areas. In states that don’t have trigger bans but are classified as high-risk for making abortion illegal, the pattern is similar but much more widespread. With a reversal of Roe, rates of abortion in these high-risk areas are predicted to drop by almost 33 percent. Nationally, the rates are predicted to decline by 12.8 percent, representing 93,546 to 143,561 pregnant people not getting abortion care.

“The overall picture is that abortion access was already bad and whatever the Supreme Court decides is going to make it much worse,” Foster said. “All of the Turnaway findings are relevant here.”

But Upadhyay doesn’t see a total return to a pre-Roe landscape: “Things have changed somewhat with medication abortion, and there will be many more who have safer means to end pregnancies on their own.” The catch, she said, is “that they would still be at great legal risk.”

It’s not all hopeless. Myers said that although abortion providers may face dramatic increases in demand in the immediate aftermath of an overturned Roe, capacity will grow in the long run. Places where abortion remains legal will likely become destinations for people in the Deep South and Midwest who need abortions, and more providers begin offering the procedure, she predicted.