What Does It Mean to Overturn Abortion Rights? How the End of Roe v. Wade Would Impact Reproductive Health

The drafted ruling would have a major impact not only on reproductive rights, but also the physical and mental health, finances, and livelihoods of people across the country.

WASHINGTON, DC - DECEMBER 01: Abortion rights advocates demonstrate in front of the Supreme Court of the United States Supreme Court of the United States in Washington, DC, United States on December 01, 2021. The justices weigh whether to uphold a Mississippi law that bans abortion after 15 weeks and overrule the 1973 Roe v. Wade decision.
Photo: Yasin Ozturk/Anadolu Agency via Getty Images

Fact checked on May 3, 2022 by Rich Scherr, a journalist and fact-checker with more than three decades of experience.

The Supreme Court is poised to overturn Roe v. Wade—the landmark decision that protects a person's constitutional right to abortion—according to a leaked document obtained and published by Politico Monday evening.

The initial draft majority opinion, written in February by Justice Samuel Alito, suggests the justices will rule in favor of Mississippi in Dobbs v. Jackson Women's Health Organization—a case that is reviewing the legitimacy of Mississippi's 15-week abortion ban.

If Roe is overturned along with Planned Parenthood v. Casey—a subsequent ruling that also maintained abortion rights—the federal right to safe, legal abortions will disappear. Instead, states will be allowed to determine the legality of abortion on their own; in some parts of the country, that would mean drastic restrictions or bans on abortion.

"Things are going to get a whole lot worse for a lot of women," Alison Gash, PhD, an associate professor in the Department of Political Science at the University of Oregon specializing in reproductive health, told Health.

As of right now, a person's constitutional right to abortion still exists; the draft opinion is not final until it's published—which, according to Politico, could come within the next two months. But should Roe and Casey be overturned, it will have a major impact, not only on reproductive rights, but also the physical health, mental health, finances, and livelihoods of people across the country.

Here's what a post-Roe world might look like.

How Abortion Rights Would Change

Since 1973, Roe has protected people's right to have an abortion up to the point of fetal viability, which occurs around 24 weeks of pregnancy. The 1992 Casey ruiling reaffirmed Roe and held that states are prohibited from banning most abortions. If Roe and Casey are overturned, these federal protections would dissolve and the legality of abortion would be decided on the state-level.

About 26 states are expected to ban or restrict access to abortion the moment Roe is overturned. Thirteen of those states—Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Utah, and Wyoming—have "trigger laws" that were crafted to go into effect immediately if Roe is overturned. "Basically, abortion would become illegal in those states and you wouldn't be able to access abortion within state borders," Aziza Ahmed, JD, MS, a professor of law at the University of California, Irvine who specializes in reproductive rights, told Health.

Still other states have anti-abortion laws that predate the Roe decision that would go into effect after the landmark ruling is overruled. And additional states have publicly said they are prepared to pass restrictions in the event Roe is undone.

The legality of abortion pills would be threatened in a post-Roe world too. Since January, as many as 20 states have already proposed bills restricting or banning access to abortion pills—despite the fact that the pills were approved by the U.S. Food and Drug Administration.

How long it would take for all of the individual bans and restrictions to pass depends on multiple factors. In states with "trigger laws" geared toward abortion rights, the change could happen immediately—The New York Times reported that clinics could begin closing within days. In other states—like those for which bills have not been drafted or with state legislators that push back against the court—it could take some time, said Gash.

How Abortions Could Change for Pregnant People

Pregnant people living in states with abortion bans and restrictions will no longer be able to get an abortion within their communities. And as neighboring states pass restrictions, pregnant people will have to travel further and further to access care.

Meanwhile, certain states—like California and New York—will become safe harbors or destinations for abortions. In these states, lawmakers are working on legislation protecting the right to an abortion and also funding abortions for out-of-state pregnant people. Abortion funds across the country are also securing resources to help pregnant people afford to travel for care.

But at some point, abortion providers in pro-abortion states will likely become overwhelmed, forcing many pregnant people to wait longer for urgent abortion care or travel even further to get the reproductive health care they need. "It's getting more difficult for women to be able to access abortion care services in the states that have them because the lines, the wait lists, to get into those place are pretty long," said Gash.

As long as abortion care is accessible in the U.S., Gash said people will likely seek care nationally. Given that there is a narrow window in which an abortion can be performed, some pregnant people who can afford to do so may choose to travel internationally—to Canada, for example—to get an abortion in a timely manner.

Other Impacts on Health Care and Reproductive Rights

Should Roe ultimately be overturned, it may also have even more far reaching implications including limiting access to contraception. In the draft opinion that leaked, Alito stated that the ruling on Dobbs is not meant to construe any further limitations on anything other than abortion.

But Roe and the right to contraception are intimately linked. The precedent of Roe v. Wade hinged on the precedent from Griswold v. Connecticut, which is the precedent that established a right to privacy and that a woman has a right to access to contraception, said Gash.

The Supreme Court has previously diminished access to contraception through Burwell v. Hobby Lobby, a case in which the justices ruled that employers do not have to offer contraception in their employer health care plans due to the company's religious beliefs. "We already know that the court is fully capable of enacting those limitations," Gash said, adding she eventually expects conservative lawmakers will look at contraception next, along with same-sex marriage.

Bans and restrictions on abortion may also make pregnancy even more dangerous for people: Already, the U.S. has the highest maternal mortality rates among developed nations—a rate that increased by 20% during the pandemic, according to data from the Centers for Disease Control and Prevention. This is most pronounced among low-income and people of color due to biases in the health care system. "Depending on who you are and where you are, pregnancy can be extremely unsafe and can be deadly," Ahmed said.

And when people can't access abortion, research shows they are more likely to experience poverty, stay with an abusive partner, have higher rates of depression, anxiety, and suicidal ideation; and develop serious health complications.

Ultimately, the overturning of Roe and Casey will not only drastically diminish reproductive rights, but it may also put the lives of pregnant people in peril. "Even while it might accomplish the anti-choice goal of decreasing abortion numbers," said Ahmed, "it's going to undermine the general welfare of women and people who need abortions."

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