Early this week, Americans were shocked to see a leaked draft of the U.S. Supreme Court’s opinion in the abortion rights case, Dobbs v. Jackson Women’s Health Organization. The draft makes clear that at least five justices are ready to completely overturn Roe v. Wade. The end of the right to abortion is no longer hypothetical — but Americans have not yet grasped the decision’s far-reaching implications. There will be a vast expanse of abortion deserts throughout the South, Midwest and Mountain states, and few in the U.S. will be unaffected.
Here in Texas, we have seen a preview of the new reality. More than eight months ago, the Supreme Court effectively stripped Texans of their right to abortion. It refused to block SB8, the state’s bounty hunter law that authorizes civil damages against anyone who provides or aids and abets abortions in Texas after embryonic cardiac activity can be detected, around five or six weeks of pregnancy — before many people know they are pregnant.
The law has not stopped Texans from trying to get abortions. At the Texas Policy Evaluation Project, we found that pregnant people are rushing to in-state facilities to see if they are eligible for services close to home. If not, they are scrambling to find appointments at out-of-state facilities and traveling hundreds of miles beyond the nearest clinic to get care.
But getting an abortion has come at incredible costs as people navigate major logistical obstacles. In dozens of interviews, people worried about how they will pay the bills that they delayed to cover the cost of abortion care and travel and missing work. After driving hours through the night, would they reach the facility in time? Would they be able to get several days of childcare when they were away from home? The law, they told us, was “unfair,” “cruel” and “inhumane.”
These barriers are insurmountable for some, who are being forced to continue their pregnancies. Those most affected are people who already struggle against structural disadvantages to health care, including minors who cannot involve their parent, immigrants and people living on low incomes who cannot travel, as well as Black and Indigenous people. Many of these groups already experience disproportionately high rates of severe maternal morbidity and mortality, meanwhile, abortion bans will likely worsen health and economic outcomes.
Without Roe, people in nearly half the states will lose their right to abortion almost overnight. Thirteen states, including Texas, Missouri and Utah, have “trigger laws,” which would criminalize abortion soon after the court overturns Roe. A flurry of pre-viability bans — unconstitutional for the past 50 years — have raced through state legislatures, while other states like Arizona and Wisconsin still have criminal abortion bans from the 1960s on the books. Abortion access will be decimated in these states, too.
Abortion pills purchased online or obtained in Mexico can offer a safe and effective option for ending one’s pregnancy. These medications have been in high demand in the face of draconian restrictions, as we have seen in Texas.
But here too Texas offers a cautionary tale. In 2021, the state made it a felony to give or sell abortion pills to induce an abortion — a law that is unconstitutional under Roe. It also barred mailing abortion pills, seeking to prosecute friends and family of pregnant people and the outside groups that do. Other states will likely follow Texas’s lead.
Texas also instructs that no pregnant person is truly protected from the impacts of abortion bans. Medical providers may be too afraid to treat someone facing a life-threatening medical complication, such as an ectopic pregnancy or premature rupture of membranes — for which the treatment is abortion — because they may be seen as violating the law. As criminal laws go into effect, people who help a pregnant friend or family member access abortion may face jailtime — as Texans did pre-Roe. And despite there not being a law that prohibits someone from ending their own pregnancy, Texas recently jailed a South Texas woman, Lizelle Herrera, for just this reason.
In states where abortion care would remain legal after the court’s final decision, pregnant people’s ability to get care is not guaranteed. Facilities will be overwhelmed with people traveling from other states. After SB8 went into effect in Texas, clinics in Oklahoma, Louisiana and New Mexico saw so many Texans that local residents had to wait longer for their abortions or seek care elsewhere. And while states like California, Connecticut and Vermont are passing legislation to enshrine abortion protections into state law, others are one election away from eliminating state protections or enacting criminal abortion bans.
In his draft opinion, Justice Samuel Alito pretends that state abortion bans will simply reflect the views of state residents. But public opinion polls show that most people think abortion should be legal, even in Texas. The court’s statement rings especially hollow as it upholds state laws that engage in extreme partisan gerrymandering and limit voting rights, making it more difficult for people to elect representatives who share their views.
When the court hands down the final Dobbs opinion in about a month, it may use softer language or slightly narrower reasoning than seen in Alito’s leaked draft. But the implications will be the same. The decision will not mollify deep political divisions, end litigation or stop abortions. It instead will worsen health inequities created by long-standing social injustices. People’s rights to bodily autonomy and equal opportunity will depend on where they live.
The American people should be not surprised, but prepared — prepared to learn from reproductive justice and health care groups, engage with elected representatives and vote in elections. They must demand that abortion — and other social — policy reflect the needs and dreams of people who can become pregnant, not the political views of five justices.
Elizabeth Sepper is a professor of law at the University of Texas at Austin.
Kari White is an associate professor of Social Work and Sociology at the University of Texas at Austin and leads the Texas Policy Evaluation Project.