Roe v.

Wade is a landmark decision ruled by the Supreme court favoring abortion rights
under the constitution. The landmark legislation made access to abortion a federal right in the
United States. On Friday, June 24, 2022, the US Supreme Court overturned Roe v. Wade.
The decision dismantled 50 years of legal protection and paved the way for individual states
to curtail or outright ban abortion rights.

The question is whether abortion is a constitutional right or not. However, after Dobbs v.
Jackson Women's Health Organization in 2022, it is no longer a constitutional right in the
United States.

What it means, what's next:

Because of t
rigger laws put in place before the

ruling, abortion is now outlawed in many states automatically and through state action
following the decision. In addition, Justice Clarence Thomas wrote that other landmark
rulings should be reconsidered, including established
rights to contraception access, same-sex relationships, and
same-sex marriage.

What will happen now across the country?

Nine states have already implemented their abortion bans. Another dozen states are in the
process. The legal chaos occurs as injunctions against individual state laws are lifted, and pre-
Roe Bans are getting interpreted. In a few states, new rulings will issue before the law so it
can go into effect. Governors who are hostile to abortion but whose States have not yet
banned abortion are contemplating whether to call special sessions of the legislature to
consider new abortion bans.

Abortion providers in all the banned and several in-process states have stopped providing
abortion care or reduced the type of care they offer. People with previously scheduled
appointments are scrambling to find new ones in states where some

abortion is still available. These include abortion-safe states and states like Florida,
Ohio, and Georgia, and there are new Gestational limits for abortion but not yet
complete bans.

Abortion clinics in states where abortion remains legal, including Illinois and Kansas, are
working hard to expand appointment availability by hiring new staff, increasing the physical
plant of their facilities, and adding additional clinic appointments. Clinics in the in-process
states are doing their best to manage immediate increased patient demand even as they are
preparing for a future in which they may not be able to continue offering abortions.

Who will be most impacted by this decision? What will happen if people can't access
abortions?

The only alternative to abortion is childbirth, which has a

14 times higher risk of death than that abortion. So, in
denying a person access to a wanted abortion, states are
forcing people to assume significant medical risks against
their will. A recent study out of Colorado ominously
predicts a rise in the maternal mortality rate, especially
among Black women who already experience an
unacceptably high death rate in childbearing.

What does this mean for the doctors who perform abortions in states where it will be curtailed
or outlawed?
In all the states where abortion is banned, physicians stopped providing abortion care
immediately after the decision or will do so after their state law takes effect.

In some states where abortion got banned, traveling

physicians provide significant medical care. These
physicians will likely provide care in one of the
places where abortions remain legal, and the
demand is increasing. However, other skilled and
dedicated physicians have provided abortion care
for decades to women in their communities. Some
of these physicians offer different types of health
care and

will continue to do so without the abortion care their patients need. Those physicians who
only provide abortions will need to decide whether to retire or relocate.

Other clinical staff includes nurses, social workers, patient counselors, and medical assistants
who are also losing their jobs and the ability to provide economically for their families.
Women in communities across the abortion-banned states have relied on these teams of
healthcare providers to care for them during a significant time in their lives. It is cruel what is
happening to pregnant people and to the dedicated staff that makes up the abortion providers
of this country.

What is the difference between emergency contraception and medication abortion?

Emergency contraception (EC) and medication abortion are not the same: they use different
drugs that work differently on the body. EC stops the pregnancy from happening. Medication
abortion ends an already existing pregnancy. One brand of EC, Plan B, is available over the
counter without a prescription. Medication abortion requires a clinical consultation (either via
a telehealth visit or a visit to a clinic). EC can be used up to 72 hours after unprotected sex,
while we use abortion medication between the time of a missed period (usually four weeks)
and 11 weeks after the first day of the last menstrual period.
How will this rule affect women's access to each?

At this time, abortion bans include bans on medication

abortion. Emergency Contracepting Pills did not get listed in
abortion bans. However, many politicians hostile to abortion
also disagree with emergency contraception, and we may see
efforts to restrict access to EC in the future. The FDA could
help expand access to EC by approving the second EC
option, Ella, as an over-the-counter drug. Plan B is less
effective for people of higher body weight, and Ella helps
ensure these people also have access to an EC option.

Now, clinicians who prov

ide medication abortion via telehealth can only allow the service in states where abortion
remains legal. Abortion-supportive states that wish to ensure access to abortion in states
where it is banned could protect clinicians in their state who provide abortion care to people
in complying states. The Federal government could explore ways to preserve this practice.
Until then, people who need medication abortion in states where abortion is banned can self-
source these medications from international telehealth providers or pharmacies.

Almost 90 percent of abortions occur in the first 12 weeks of

pregnancy. These are some reasons why women need to have
abortions later in pregnancy.

Many people do not know they are pregnant until after the 12th
week: some are still bleeding, others are on medications causing
cycle changes, and others do not have pregnancy symptoms.

Another reason people pass the 12th week of pregnancy is that gathering the money to pay
for the abortion is extremely hard. Currently, the

Federal government and 33 states prohibit people from using

Medicaid to pay for abortions. Yet the majority of people who
need abortions live at or below poverty. To gather the money,
they forgo paying rent or food bills and delay their ability to obtain an abortion when they
first want one. And after they pass the 12 weeks mark, the cycle perpetuates itself. The cost
of abortion begins to increase as clinical care becomes more complex, thus requiring more
money and causing more delays.

For still other people, the abortion decision follows learning something about their health
status or of the fetus. Medical complications in pregnancy increase as people become
pregnant, and some do not onset until later in pregnancy. Issues with the growth of the fetus
occur as the fetus develops and are not diagnosable until later in pregnancy.

What will happen now if a mother's life is in danger?

We do not have data on how often a pregnancy threatens a person's life because this care has
often occurred in hospital settings, which do not routinely advertise that they do abortions.
Physicians treating these

pregnancies, including maternal-fetal medicine and complex family planning physicians,

rarely discuss these cases publicly because of the social discomfort with abortions later in
pregnancy. Limited research on hospital policies regarding abortion care demonstrates
significant barriers to obtaining institutional support for abortions, regardless of the reason.

Now that abortion is banned in some states, it is likely that access to abortion care in life-
threatening circumstances will be even harder to provide. The media is already reporting
cases denying pregnant patients the care needed. We can expect to see more of this since the
penalty for violating an abortion ban is criminal jail time for the physician and other legal
consequences for the institution. The Federal government can help ensure that needed care is
provided by identifying and prosecuting denials of care under the federal Emergency Medical
Treatment and Labor Act and covering such heroic care under the exceptions to the federal
Hyde amendment.