More Than Half of States Will Ban Abortion if Roe Is Overturned, Expert Says

Abortion will become illegal in slightly more than half of states if the Supreme Court’s leaked draft decision to overturn Roe v. Wade becomes final, while many of the remaining states are working to ensure that abortion continues to be accessible there, according to one expert.

Most states have limits on abortion around viability, with states in the middle of the country and the South having limits at about 22 weeks, said Elizabeth Nash, interim associate director of state issues at the Guttmacher Institute, a pro-abortion rights organization, during a webinar sponsored by the University of Southern California’s Annenberg Center for Health Journalism. In recent months, however, that landscape has begun to change with Texas’s implementation of an abortion ban at 6 weeks’ gestation and a similar law in Oklahoma that took effect last week.

“If Roe is overturned, if this draft opinion holds, we do expect that 26 states are likely to ban abortion — by that we mean basically the states in the Plains, the Midwest, and the South will try to implement pre-Roe bans, ‘trigger’ bans, or bans that have been adopted in the past couple of years that are total bans or early bans,” Nash said. “Trigger bans” are bans that would take effect immediately after Roe is overturned. If those 26 states ban abortion, “that affects 36 million women of reproductive age who will live in a state without abortion access,” she noted.

Rebekah Fenton, MD, a pediatrician and adolescent medicine specialist in training in Chicago, said that she has “already seen some laws suggesting that they will not only limit abortion but also access to IUDs and Plan B,” the emergency contraception, due to a false belief that such contraceptives can terminate a pregnancy. Instead, “the two things that they’re doing is actually delaying ovulation or, if ovulation has already occurred … preventing the matching of that sperm to the egg,” she said. “So that combination — with any form of emergency contraception — has not yet occurred. After an embryo is implanted into the uterus, there is no form of birth control that can stop the pregnancy from developing.”

How abortion bans — especially those laws being considered that would define abortion as homicide — will affect assisted reproduction is also a question, Nash said. Selective reduction of implanted embryos has been targeted less frequently by pro-life groups than it used to be, but it “could be affected by abortion bans, as well as, potentially, frozen embryos. It depends a little bit on how the state bans abortion … as well as how the state actually defines pregnancy and personhood, and homicide.”

Related to those definitions, the National Right to Life Committee and several other pro-life groups issued an open letter to states Thursday, stating that punishing women who have abortions is not pro-life. “Women are victims of abortion and require our compassion and support as well as ready access to counseling and social services in the days, weeks, months, and years following an abortion,” the letter stated. “As national and state pro-life organizations, representing tens of millions of pro-life men, women, and children across the country, let us be clear: We state unequivocally that any measure seeking to criminalize or punish women is not pro-life and we stand firmly opposed to such efforts.”

On the other side of the abortion issue, “16 states and D.C. have statutory protections for abortion rights,” Nash said, adding that states are also taking additional steps to ensure access to abortion care. For example, “Oregon allocated $15 million for abortion services and infrastructure, and now you’re seeing similar bills pending in California, Massachusetts, New Jersey, and New York,” she said. States have also expanded the provider pool for abortion provision, “allowing clinicians like physician assistants, advanced practice nurses, and certified nurse midwives to provide abortions — Delaware’s governor just signed their law allowing this,” and Maryland enacted a similar law.

States are also trying to ensure that health plans provide coverage for abortions, Nash continued. “Maryland adopted a law that requires abortion coverage in health plans, and California boosted their law by ensuring that abortion coverage is provided without cost sharing.” A few states are also increasing protections for patients and providers at abortion clinics, she added.

State abortion bans could affect training for future ob/gyns in procedures such as miscarriage, Beverly Gray, MD, founder of Duke University’s Reproductive Health Equity and Advocacy Mobilization team, said Tuesday during a webinar sponsored by the university. “The next generation of physicians may not be adequately trained to care for miscarriage, for abortion, or for complications of pregnancy that arise in the mid-trimester, and that’s definitely a concern,” she said. “The impact that this legislation could have on training is huge.”

It could also affect where medical students who want to become ob/gyns apply for residency. They will be “looking to states where they’re able to provide comprehensive ob/gyn care, and that includes abortion care,” Gray said.