Photo-Illustration: The Cut; Photo: Yasin Ozturk/Anadolu Agency via Getty Images

Life After Roe Starts Now

The Supreme Court decision ensures a health-care crisis that will ripple out across the country.

Photo-Illustration: The Cut; Photo: Yasin Ozturk/Anadolu Agency via Getty Images

After nearly 50 years, the Supreme Court has officially discarded Roe v. Wade. Nothing about this moment is surprising, though knowing what’s coming does nothing to soften the blow. Anti-abortion extremists have been driving policy in this direction for years, emboldened by the sympathetic Trump administration and the appointment of increasingly hard-line conservatives to the Supreme Court. And, in May, a leaked draft of the Court’s majority decision in Dobbs v. Jackson Women’s Health Organization made its intent clear. Still, it’s impossible to overstate just how devastating the loss of abortion rights will be.

In its final form, the conservative majority’s ruling — issued on June 24 — overturned Roe and Planned Parenthood v. Casey as “wrongfully decided” because “the Constitution does not confer a right to abortion.” Starting now, individual states are free to restrict or outlaw abortion as they see fit, ensuring legislative chaos and a health-care crisis that will ripple out across the country.

“Attempts to justify abortion through appeals to a broader right to autonomy and to define one’s ‘concept of existence’ prove too much,” Alito writes. “Those criteria, at a high level of generality, could license fundamental rights to illicit drug use, prostitution, and the like.” But the question of abortion rights, he continues,”is different” because the procedure “destroys what Roe termed ‘potential life’ and what the law challenged in this case calls an ‘unborn human being.’ None of the other decisions cited by Roe and Casey involved the critical moral question posed by abortion.”

Since 1973, Roe’s landmark ruling has barred lawmakers from limiting abortion services before viability 23 to 24 weeks into a pregnancy, at mimimum. In Dobbs, Mississippi successfully defended a law capping abortion services at 15 weeks of pregnancy, a medically arbitrary deadline. As a result, the Guttmacher Institute predicts that abortion will soon become expressly or effectively illegal across more than half the country.

While the availability of abortion medication cushions the blow somewhat, right-wing lawmakers are working to criminalize every form of abortion, mail-order pills included. With scarcity compounded by the threat of punishment, few will be unaffected by Roe’s fall — though it’s clear who will suffer most: The typical abortion patient lives at or below the poverty line and tends to cite socioeconomic concerns as the motivating factor behind their decision. Black women are disproportionately represented in this group, as are single mothers. These patients likely lack insurance that allows for regular medical attention throughout a pregnancy, which carries a fatality risk about 14 times higher than an abortion’s. Women of color, particularly Black and Indigenous women, are far more likely to die from perinatal complications than white women.

Those living in states where lawmakers have spent the past five decades whittling away access may now find themselves forced up against an erratically ticking clock. Many of the old laws that have spent years dormant or enjoined may now take effect on different timelines, leaving patients to figure out if abortion is still legal where they live, under what circumstances, and for how long. In Mississippi, for example, a trigger ban will outlaw abortion in almost every scenario shortly after the attorney general certifies today’s decision. A dozen other states have similar measures on the books, some of which can be enforced immediately; nine states never repealed their pre-Roe restrictions. The past few weeks have also seen Republican-controlled legislatures scramble to jam new bans into place, creating a mess of overlapping policies that experts expect could take months, even years, to untangle.

Texas provides a glimpse into that future: Since a citizen-enforced six-week ban effectively ended abortion services there in September, clinics in neighboring states have had to stretch their already thin resources to accommodate overflow. In Oklahoma, wait times for an appointment jumped from a couple of days to about four weeks — and that was while clinics there were still open. Last month, the governor signed a law outlawing abortion at fertilization, adding Oklahoma residents to the growing pool of people seeking services elsewhere. What happens when 24 other states go the same route? Already, providers in blue areas anticipate a massive spike in out-of-state appointments. Meanwhile, conservative legislators have been thinking about ways to enforce their laws beyond their states’ borders and penalize patients directly, threatening the health and well-being of anyone with a uterus.

It’s impossible to tell just how many people died because of botched abortions pre-Roe, though the WHO estimates that 4.7 to 13.2 percent of the world’s current maternal deaths result from unsafe abortions. Domestically, multiple studies show that the more restrictions on abortion a state enacts, the higher its maternal- and infant-mortality rates tend to be. (Mississippi, incidentally, has the highest infant-mortality rate in the country.) That’s not necessarily because people are seeking out unsafe avenues to end their pregnancies; more likely, it’s because their state governments balk at subsidizing reproductive health care in all its forms. According to Pew Research, about a quarter of annual maternal deaths occur six weeks to a year after pregnancy ends — but in Mississippi, the legislators advocating for forced birth are the same ones who repeatedly refuse to extend Medicaid coverage to postpartum care, while targeting the contraceptives that help keep unwanted pregnancy rates low in the first place.

Without the right to safe and legal abortion — a right the majority of U.S. adults continue to support — people become obligated to have children they can’t afford or just don’t want at a high cost to their own health and well-being. It’s a reality conservatives downplay or flat-out ignore. Alito’s opinion, for example, claims that “the costs of medical care associated with pregnancy are covered by insurance or government assistance” and that “leave for pregnancy and childbirth are now guaranteed by law in many cases.” In truth, about 80 percent of U.S. parents lack paid leave, while a hospital birth costs $4,500 out of pocket, on average, with insurance.

It’s not only extremists who argue that what comes next might not be as severe as reproductive-justice advocates fear. The New York Times recently suggested that because relatively few people in states like Missouri and Mississippi were getting abortions compared to people in states like New York, owing to existing restrictions, the absence of abortion services in those areas might not move the needle much. The number of legal abortions may only decline by 13 percent — or less, with many patients using abortion medication by mail — but behind that percentage are countless people who stand to lose their jobs, drop out of school, stay in abusive relationships, become poorer, or even die.

Despite positioning themselves as “pro-life,” conservatives show painfully little concern for the children and families their laws will force into existence. They hold up adoption as a solution, betraying both ignorance and a lack of empathy for the reality of pregnancy and birth. They keep slashing away at Medicaid, and they bristle at programs — universal day care, paid family leave — that would help new parents work and raise children at the same time. Last month, more than 200 Republicans voted against emergency FDA aid that would ease the national baby-formula shortage. The day before, they threw out abortion abortion rights, the conservative majority also dealt a huge blow to gun-control laws and expanded Second Amendment rights on the heels of the second-deadliest elementary-school shooting in U.S. history. If the goal is to protect life, this isn’t the way.

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Life After Roe Starts Now