Thursday, November 30, 2023
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A Post-Roe America

by News Desk

If the Supreme Court overturns Roe v. Wade, more than 20 states — home to roughly half the country’s population — are likely to outlaw nearly all abortions. For women living in Mississippi, the closest place to receive a legal abortion might then be Illinois.

Yet the number of abortions performed in the U.S. would fall by much less than half, experts predict. One widely cited analysis, from Caitlin Myers of Middlebury College, estimates that the decline in legal abortions will be about 13 percent. The number of all abortions — including illegal abortions, like those using medications sent by mail to places with bans — will probably decline by even less.

I find these numbers surprising. The Supreme Court appears to be on the cusp of revolutionizing the country’s abortion laws while having a more modest effect on abortion rates.

Today’s newsletter tries to explain how this could be, with help from Claire Cain Miller and Margot Sanger-Katz, two Times reporters who have been covering the subject. Our goal is to preview what a post-Roe landscape might look like.

The Supreme Court is expected to issue its abortion ruling this month or in early July. An early draft opinion, obtained by Politico, suggested that the court was leaning toward a full overturning of Roe, allowing states to ban abortion. But the outcome remains uncertain.

The first point to understand is that abortion is already rarer in the states that may outlaw abortion than in states where will remain legal. New York’s recent abortion rate, for example, has been about twice as high as Texas’, four times as high as South Carolina’s and about 17 times as high as Missouri’s, according to C.D.C. data.

“A lot of these states that will ban abortion have very restricted access already,” Margot said, pointing to Missouri, Mississippi and the Dakotas. “The clinic closures there just wouldn’t lead to a lot of change, relative to current conditions.” In 2019, The Times published a piece explaining, “For millions of American women, abortion access is out of reach.”

Public opinion probably plays a role, too: In conservative states, more people oppose abortion, which means that a smaller share of women and couples choose to get an abortion when confronted with a difficult choice.

The second big factor is that abortion practice has begun to change in ways that can make it harder to regulate.

More than half of legal abortions are now conducted through medication rather than a surgical procedure. In 2020 (the most recent year with available data), the share was 54 percent, up from 37 percent in 2017, and it has almost certainly continued to grow in the past two years. Claire and Margot have written a helpful explainer about medication abortion, which is generally both safe and effective, although typically must happen earlier in pregnancy than surgical abortion.

State bans are likely to apply to all forms of abortion, and conservative states are already trying to crack down on medication abortion, as my colleague Kate Zernike has reported. But stopping the pill-based form isn’t so easy. “The pills are pretty easily accessible online, and the laws are very hard to enforce because they are sent privately via mail,” Claire said.

One large provider is Aid Access, an international organization run by a Dutch doctor, Rebecca Gomperts, that is committed to keeping abortion accessible even in places where it is illegal. Aid Access often connects Americans with European doctors, and people can order pills even if they are not pregnant, to have them on hand if they want them later. (In 2014, Emily Bazelon profiled Gomperts in The Times Magazine.)

Carole Joffe, a professor at the University of California, San Francisco, who has studied the history of abortion, said that the fall of Roe would lead some women to seek out physically dangerous methods of ending their pregnancies — “like having the boyfriend hit them in the belly or throwing themselves down stairs or taking dangerous herbs.” But, Joffe added, “There is now a very safe extralegal option.”

Even with these caveats, the overturning of Roe will reduce abortion access. The effect is likely to be largest among lower-income women and Black and Hispanic women. Many will not have the resources to travel to another state and may not have access to doctors, nurses, friends or relatives who can help them navigate the process of ordering abortion pills.

“In effect, the United States without Roe would look very different for different people,” Claire and Margot have written.

This is one part of the debate in which the two sides agree on at least some of the facts, if not their significance. Abortion opponents sometimes emphasize that Roe has reduced the population of nonwhite Americans. “A highly disproportionate percentage of aborted fetuses are Black,” Justice Samuel Alito wrote in the leaked draft opinion that calls for overturning Roe.

Across much of the South — including Mississippi, Georgia, Texas, Alabama, North Carolina, Florida, Tennessee and Arkansas — more than half of the women who got an abortion in 2019 were Black or Hispanic, according to the C.D.C. A large share were also younger women, with nearly 40 percent nationwide younger than 25.

“These are people who may be working in jobs that aren’t paying well or they may be in school,” Kari White of the University of Texas at Austin, told The Times. “They may feel they don’t have the resources to raise a child.”

The overturning of Roe would be a radical legal change. But it would not end the political fight over abortion any more than Roe did.

For decades, abortion opponents have been trying to restrict abortion access, and they have often succeeded in Republican-run states. If Roe were to fall, advocates of abortion access would continue their efforts, including in states that outlawed abortion. And the rise of medication abortion has made possible a strategy that did not exist decades ago.

What if? Emily Bazelon asks whether abortion rights might have been more enduring if more advocates had emphasized women’s equality rather than the right to privacy.

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