What Does It Mean to Overturn Abortion Rights? How the End of Roe v. Wade Will Impact Reproductive Health

The Supreme Court overturned Roe v. Wade on Friday, eliminating a pregnant person's federal right to safe and legal abortion. The decision will transform what reproductive rights look like in the United States.

The decision follows a draft majority opinion—written in February by Justice Samuel Alito and leaked by Politico in May—suggesting that the court would rule in favor of Mississippi in Dobbs v. Jackson Women's Health Organization, a case reviewing the legitimacy of the state's 15-week abortion ban.

In upholding the Mississippi law and preventing a pregnant person from obtaining an abortion past the 15-week gestation period (except for "medical emergencies" or "severe fetal abnormality"), the Court upheld the 15-week abortion ban and in its decision, explictly overturned Roe along with Planned Parenthood v. Casey, the two foundational precedents that protect access to abortion in every state.

Without a federal law protecting abortion, states will now be allowed to determine the legality of abortion on their own. In some parts of the country, that will mean drastic restrictions or bans on abortion altogether. The dissolution of Roe and Casey will have a major impact, not only on reproductive rights, but also the physical health, mental health, finances, and livelihoods of people across the country.

"Things are going to get a whole lot worse for a lot of women," Alison Gash, PhD, an associate professor in the Department of Political Science at the University of Oregon specializing in reproductive health, told Health.

Here's what you need to know.

How Abortion Rights Will Change

Since 1973, Roe had protected a person's right to have an abortion up to the point of fetal viability, which occurs around 24 weeks of pregnancy. The 1992 Casey ruling reaffirmed Roe and held that states are prohibited from banning most abortions. The upheaval of Roe and Casey means these federal protections no longer exist, and the legality of abortion can be decided on the state-level.

According to the latest data from the Guttmacher Institute, 26 states are "certain or likely" to ban or restrict access to abortion now that Roe has been overturned.

Thirteen of those states—Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Utah, and Wyoming—have "trigger laws" designed to ban abortion within 30 days of the ruling.

"Basically, abortion would become illegal in those states and you wouldn't be able to access abortion within state borders," Aziza Ahmed, JD, MS, a professor of law at the University of California, Irvine who specializes in reproductive rights, told Health.

The legality of abortion pills may be threatened in a post-Roe world too. Since January, as many as 20 states have already proposed bills restricting or banning access to abortion pills—despite the fact that the pills were approved by the U.S. Food and Drug Administration. However, Attorney General Merrick Garland made clear in a statement on Friday that "states may not ban Mifepristone [the first of two medications that make up the abortion pill] based on disagreement with the FDA's expert judgment about its safety and efficacy."

How long it would take for all of the individual bans and restrictions to pass depends on multiple factors. In states with trigger laws geared toward abortion rights, the change could happen immediately—The New York Times previously reported that clinics could begin closing within days. In other states—like those for which bills have not been drafted or with state legislators that push back against the court—it could take some time, said Gash.

How Abortions Will Change for Pregnant People

Pregnant people living in states with abortion bans and restrictions will no longer be able to get an abortion within their communities. And as neighboring states pass restrictions, pregnant people will have to travel further to access care.

Meanwhile, certain states—like California and New York—will become safe harbors or destinations for abortions. In these states, lawmakers are working on legislation protecting the right to an abortion and also funding abortions for out-of-state pregnant people. Abortion funds across the country are also securing resources to help pregnant people afford to travel for care.

But at some point, abortion providers in pro-abortion states will likely become overwhelmed, forcing many pregnant people to wait longer for urgent abortion care or travel even further to get the reproductive health care they need. "It's getting more difficult for women to be able to access abortion care services in the states that have them because the lines, the wait lists, to get into those place are pretty long," said Gash.

As long as abortion care is accessible in the U.S., Gash said people will likely seek care nationally. Given that there is a narrow window in which an abortion can be performed, some pregnant people who can afford to do so may choose to travel internationally—to Canada, for example—to get an abortion in a timely manner.

Other Impacts on Health Care and Reproductive Rights

Bans and restrictions on abortion will also make pregnancy even more dangerous for people: Already, the U.S. has the highest maternal mortality rates among developed nations—a rate that increased by 20% during the pandemic, according to data from the Centers for Disease Control and Prevention. This is most pronounced among low-income and people of color due to biases in the health care system. "Depending on who you are and where you are, pregnancy can be extremely unsafe and can be deadly," Ahmed said.

And when people can't access abortion, research shows they are more likely to experience poverty, stay with an abusive partner, have higher rates of depression, anxiety, and suicidal ideation; and develop serious health complications.

Ultimately, the overturning of Roe and Casey will not only drastically diminish reproductive rights, but it may also put the lives of pregnant people in peril. "Even while it might accomplish the anti-choice goal of decreasing abortion numbers," said Ahmed, "it's going to undermine the general welfare of women and people who need abortions."

Overturning Roe may also have further implications including limiting access to contraception. "We already know that the court is fully capable of enacting those limitations," Gash said. The Supreme Court previously diminished access to contraception through Burwell v. Hobby Lobby, a case in which the justices ruled that employers do not have to offer contraception in their employer health care plans due to the company's religious beliefs.

And in a concurring opinion, Justice Clarence Thomas argued that the Supreme Court "should reconsider" cases protecting the right to contraception for unmarried people, same-sex marriage, and same-sex intimacy. And while concurring opinions cannot act as binding precedent for future cases, they can be relied on and cited to support future opinions.

While it's unclear what comes next, a range of executive actions were prepared in anticipation of the ruling.

"This decision must not be the final word. My administration will use all of its appropriate lawful powers, but congress must act. With your vote, you can act, you can have the final word," President Joe Biden said Friday in remarks from the White House. "This is not over."