Politics

Roe Is Overturned. What Happens Now?

A guide to your basic questions about a post-Roe world.

A gavel illustrated with a cloud of red that looks like blood
Photos by Tingey Injury Law Firm/Unsplash and StMax89/iStock/Getty Images Plus.

On Friday, the Supreme Court overturned the landmark 1973 decision Roe v. Wade, which established a woman’s right to abortion, with its ruling in Dobbs v. Jackson Women’s Health Organization. Justice Samuel Alito’s opinion in the case largely tracks with a draft that leaked last month ​​and rolls back federal protections for reproductive freedom. What happens now?

Is abortion illegal?

No, not nationwide. But many states have bans or restrictions that were designed to go into effect as soon as Roe was overturned.

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What exactly does restricted mean?

At the most basic level, it often means banning abortions after a certain number of weeks—in some cases, around six weeks, before many people even know they’re pregnant. But there are a wide variety of restrictions. Common ones include:

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• Overly burdensome regulations for the abortion providers and their faciliites

• State-mandated abortion counseling (often with the intent of dissuading patients from receiving abortions)

• Mandated waiting periods between a counseling appointment and the abortion procedure or provision of abortion medication

[Read: Doctors in Alabama Already Turn Away Miscarrying Patients. This Will Be America’s New Normal.]

How do I know what restrictions are applicable to where I live?

You can see each state’s specific regulations here: This is a map, from Planned Parenthood, that shows both existing regulations and the likelihood of future restrictions, including those that could result from trigger laws.

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What is a trigger law?

Thirteen states have trigger laws, which are abortion bans or restrictions that have been passed (or could quickly be passed) to take effect the minute Roe is overturned. Kentucky, Louisiana, and South Dakota have full bans on abortion that will be triggered now that Roe is overturned. (The only exception, in all three states, is if the patient’s life is in danger.)

Other states with trigger laws on the books are Arkansas, Idaho, Mississippi, Missouri, North Dakota, Oklahoma, Tennessee, Texas, Utah, and Wyoming.

When do those laws go into effect?

In Idaho, Tennessee, and Texas, the bans will go into effect 30 days after Roe is overturned. (In Texas, existing law already prohibits abortions after about the sixth week of pregnancy.)

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In seven other states, the governor, attorney general, or legislative general counsel would first need to certify that the Dobbs ruling does indeed mean abortion can be banned—a simple formality that could take as little as an hour. These seven states are Arkansas, Mississippi, Missouri, North Dakota, Oklahoma, Utah, and Wyoming. (Oklahoma already fully banned abortions in May.)

[Read: The Most Unexpected Consequence of the Texas Abortion Ban]

In states where abortion is or will soon be banned, are there exceptions?

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Generally, the bans have exceptions for cases in which the patient’s life is in danger. But high-risk pregnancies are common, and when dealing with complications that don’t necessarily amount to black-or-white scenarios, doctors are left grappling with extremely difficult questions. This means we’re likely to see cases in which doctors, afraid of being criminally prosecuted, act against their own medical judgment and refuse care to patients until they are near death.

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Some abortion bans will include exceptions for rape and incest. But according to the Guttmacher Institute, such exceptions are rare and often require patients to report an assault to law enforcement or navigate other difficult bureaucratic processes. Some may also have exceptions for “fetal anomalies,” when a pregnancy complication means a fetus will not survive to a full term or after birth.

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So, doctors could get in legal trouble for helping with an abortion?

Yes, even if it’s really a miscarriage that a patient needs assistance with.

Will people who get abortions in these states face criminal prosecution?

There are plenty of indications that a post-Roe world could see pregnant people punished both with fines and jail time. So far, most of the trigger laws impose penalties—often, felonies that can carry substantial prison sentences—on abortion providers, as well as, on occasion, those who “aid and abet” the abortion. But in South Carolina, people who have abortions could face a fine and up to two years in prison. And even before the overturning of Roe, in recent years, some women have been imprisoned for ending their own pregnancies in the U.S., charged with the crime of “feticide.”

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According to Politico, some lawmakers are pushing bills that would go further—as in Louisiana, where one bill would classify abortion as homicide. If the legal thinking shifts toward this more extreme interpretation, these laws could lead to prosecutions for women who drink or use drugs during pregnancy (even if they didn’t know they were pregnant) or those who have miscarriages or stillbirths.

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[Read: We’re Not Going Back to “Before Roe]

Can you get in trouble for having an abortion out of state?

No. There’s no federal ban, and states have no jurisdiction over other states. It will remain legal to travel to a state without a ban to receive an abortion procedure or medication abortion.

What does that mean? What’s different about medication abortion?

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Decades of studies have found that medication abortions—which consist of taking two pills, over a few days, and are appropriate for pregnancies up to 10 weeks—are very safe and highly effective. As a result, in December, the FDA lifted the requirement for patients to obtain the first of the two pills from just a clinic or doctor’s office. (The FDA will continue to regulate the drugs to ensure the ones on the U.S. market are safe.)

That means that patients in some states with abortion bans will still be able to seek out prescriptions, via telemedicine, from doctors in blue states. (Some providers may require patients to pick up the medication in person or at a mailing address in the state where they practice, and some states with bans are also prohibiting the delivery of abortion pills by mail.) If states pass laws with penalties for the patients who receive abortions, it’s possible that patients could face legal repercussions for an at-home abortion, even if they obtained the pills in a legal way.

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What else should I know about medication abortions?

More than half of abortion patients now get medication instead of undergoing in-clinic procedures. As mentioned above, the FDA recently ended the in-person requirement for getting the pill. There is a growing marketplace for this mail-order treatment.

[Read: Everything You Need to Know About Medication Abortion]

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However, some states have already curtailed legal access to the two pills prescribed for the abortion medication, and many are eyeing severe restrictions or full bans. These restrictions include requirements that clinicians be physically present when an abortion pill is taken, as well as laws against mail-order pills.

Should we be stocking up on medication?

While you can order the pills online or obtain a prescription and pill order from an overseas doctor, to legally obtain them in states without bans, you must first consult with a medical provider, who can then prescribe them for you. (State requirements vary on how you can receive them.)

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That being said, many women in states with bans will be able to obtain abortion pills when needed. In Mexico and some other countries, misoprostol—the second medication in the two-step regimen, which expels the contents of the uterus—is sold over the counter as ulcer medication. Taken alone, it is around 80 percent effective for abortion. It is also safe. (The FDA does not regulate medications sold outside the country).

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The organization Plan C offers a guide to procuring the pills, even when you live in a state with restrictions, and more information on the growing online market.

Many of the online groups are based abroad and are therefore generally out of reach of U.S. regulators. While some activists worry about the potential risks of an unregulated black market, others point out that such medications are far safer than other forms of self-managed abortion.

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Uh, OK, well then what should I do if I am a person who could get pregnant but does not want an unwanted pregnancy?

The easiest way to personally prepare for the post-Roe world is to get an IUD or begin taking another form of effective contraception. Plan B—emergency contraception—is still legal.

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Contraceptives are still legal everywhere?

Yep. Birth control, including the morning-after pill, is still legal everywhere. But there are reports that some anti-abortion groups and lawmakers have begun planning to attempt to ban emergency contraception. (Among these groups, the push is directed at both Plan B–type pills and IUDs.)

Will this ruling affect other elements of reproductive care?

Yes, banning abortion will lead to major medical risks in particular for miscarriages, given that miscarriages may have to be completed (for the safety of the patient) with a medication that evacuates the uterus. This is necessary to prevent infections. The medication most commonly used to evacuate the uterus after a miscarriage is misoprostol, the second part of a medication abortion. In Texas, we have already seen pharmacists decline to prescribe these drugs out of concern for legal repercussions.

[Read: Four Ways Blue Cities in Red States Can Protect Abortion Access Post-Roe]

If I live in a state where abortion is now banned, how do I find a provider?

You can locate one in a nearby state here or here. You can find other resources with more information about accessing abortions and getting financial and logistical assistance here and here. If you need legal help, you can find that here.

If I want to help people who live in one of those states access an abortion, how can I?

Experts say the best way is by donating to local and regional abortion funds, which help with the logistics and finances of receiving an abortion out-of-state.

How common are abortions?

In 2020, there were a little over 930,000 abortions in the United States, according to the Guttmacher Institute. More than 14 percent of women of typical childbearing age had abortions in 2020. In other words, the overturning of Roe will have devastating effects on tens of thousands of people.

Read more of Slate’s coverage on abortion rights here.

For more on the legal fight that led to the original Roe versus Wade decision, listen to the latest episode of Slow Burn.

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