On May 2, 2022, the leaked draft of a US Supreme Court majority opinion suggested that the nation’s highest court was set to overturn Roe v. Wade, the landmark decision that legalized abortion in the United States in 1973. The decision would dismantle 50 years of legal protection and pave the way for individual states to severely curtail or ban abortion rights.

The leaked draft has sent shockwaves across the nation, set off a firestorm of protests —and left citizens with many questions about what this could mean for the future of women’s rights. We asked Tracy Weitz, a national expert on abortion care, policy, culture, and politics, to answer some of our questions.

Weitz will be joining AU’s College of Arts and Sciences this fall as a Professor of Sociology. She has been a visiting scholar at the University of California at San Francisco (UCSF), a senior fellow at the Center for American Progress, and the US Programs Director at the Susan Thompson Buffett Foundation. Weitz co-founded and directed UCSF’s Advancing New Standards in Reproductive Health (ANSIRH) research program, which influenced the California legislature to pass AB154, which permits nurse practitioners, certified nurse midwives, and physician assistants to perform aspiration abortions. Six additional states have since implemented the same policy change. While at UCSF, Weitz also served as the founding executive director for the UCSF National Center of Excellence in Women’s Health.

Q. What will happen if the Supreme Court overturns Roe v. Wade, and where would abortion access be most likely to change?

A. For decades, abortion rights opponents have made it hard to offer abortion care through increased regulation, as well as harassment and intimidation. As such, abortion access has been eroding for some time. Already 40 percent of US women live in a county without an abortion-providing facility, and eight states have only one or two remaining abortion clinics.

When the Court overturns Roe, what limited access exists will be eliminated. Immediately, 15 states will fully ban abortion; another six will likely follow. In eight states, state Supreme Courts may stall abortion bans temporarily but state-wide ballot initiatives and judge recalls may limit these stays. The results of November elections in two states will determine the fate of abortion rights there. So, access will be chaotic as all this shakes out. Eventually abortion will likely remain available in only 19 states and the District of Columbia. Most of these safe states are located on the west coast or in the northeast. Only Illinois, Minnesota, Colorado, and New Mexico can be counted on to serve the middle part of this country. Depending on what happens in North Carolina and Virginia, abortion may be completely inaccessible in the entirety of the South. Somewhere around half of all US residents will lose abortion access in their state.

Q. Who will be most impacted if Roe v Wade is overturned? What will happen if people can’t access abortions?

A. 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 risk against their will. A recent study out of Colorado ominously predicts a significant rise in the maternal mortality rate, especially among Black women who already experience an unacceptably high rate of death in childbearing.

Research from the Turn Away study demonstrated other deleterious impacts of being denied a wanted abortion. This study followed ~1000 self-identified women for five years after receiving or being denied a wanted abortion. They found that denying these women an abortion creates economic hardship and insecurity that lasts for years. Compared with women who obtained their desired abortion, women denied the abortion had lowered credit scores as well as increased debt, bankruptcies, and evictions. Women turned away from getting an abortion were also more likely to stay in contact with a violent partner. The financial well-being and development of prior and subsequent children was also negatively impacted. Finally, giving birth was connected to more serious long-term health problems than having an abortion.

Q. Can you tell us a bit about the people who choose to get an abortion — and the reasons why?

A. Abortion is a health care option most frequently needed by people affected by the structural inequalities of poverty, racism, and xenophobia. Almost 75 percent of US abortion patients live at or below 250 percent of the federal poverty level. More than 50 percent of abortion patients are women of color, and 60 percent already have children.

People’s reasons for abortion are as complex as their individual lives, and I fundamentally believe no one should have to justify their reason for abortion; simply wanting to no longer be pregnant is enough.

Q. Are you concerned about the fate of other rights that are not explicitly outlined in the Constitution, including the right to access contraception? Do you think this is a real possibility, and what would this mean for our society?

A. I am not a legal scholar, so I cannot predict what the Court will do to other legal rights based in the constitutional right to privacy. What I can speak to is that most social conservatives do not draw a hard-line distinction between abortion and contraception.

The Hobby Lobby Supreme Court decision allowed a corporation to not cover contraceptive methods that its owners believed were abortifacients, namely emergency contraception and intrauterine devices (IUDs). So, it is likely that some state legislatures will seek to limit access to some contraceptive methods or to further limit contraceptive access to people whose sexual lives they disagree with. Too frequently, people see abortion as the exception in law and policy. I would suggest that it is exemplar. The 50-year effort to overturn Roe is part of a larger effort to reverse the wider progressive gains in social, economic, gender, and racial advancement.  

Q. What is the bottom line? As someone who has focused on abortion care and policy for your entire career, what do you think American should know right now?

A. I have heard a lot of people concerned about the risk of people dying from unsafe abortion. One positive advancement since the pre-Roe days is the availability of abortion pills that people can use to end a pregnancy safely with minimal clinical involvement. Today in the United States, these pills are dispensed by abortion clinics as part of a health care visit, increasing through telehealth. As abortion providers become unavailable in many places, people will turn to the internet to order these pills directly, either through an international telehealth service like Aid Access or from an online pharmacy operating outside the United States.

Data from studies around the world show us that such self-sourcing of abortion pills is safe, effective, and acceptable for people. So even as the public expresses their anger about the elimination of the fundamental rights of people to bodily autonomy, they should not exaggerate the medical risk of self-managed abortions. Deaths will happen, but likely resulting from people carrying pregnancies to term against their will. Self-managed abortion with pills is safe — that is what I want people to know. What is so wrong is that people who would prefer to receive this care from a trusted health care provider will instead have to shop for drugs online, potentially putting themselves at criminal risk for breaking the law.