The Supreme Court overturned Roe v Wade. What happens now?

‘Trigger’ bans and anti-abortion laws will ban access and severely restrict care in many states

The US Supreme Court has overturned key rulings enshrining constitutional protections for abortion care, leaving it up to states to determine whether to ban the procedure and potentially forcing women and girls to carry pregnancies to term, marking a stark reversal of precedent that upends bodily autonomy protections in America.

The court’s conservative supermajority dismissed rulings from 1973’s Roe v Wade and 1992’s Planned Parenthood v Casey to uphold a Mississippi law banning abortion access at 15 weeks of pregnancy.

Roughly half of US states will move to immediately or quickly outlaw abortion, including 13 states with so-called “trigger” bans in place – anti-abortion laws designed to take effect without Roe. Legal challenges are likely.

Nine states have laws in place that have banned abortions before the Roe ruling but have never been removed from the books.

Several states have moved to outlaw abortions at six weeks of pregnancy, before many women even know they are pregnant. Many of those measures were blocked by the courts under precedent established by Roe. The Supreme Court’s latest decision is likely to ignite more legal challenges across the US.

Other state-level measures to eliminate access include extreme limits on care that will force providers to close, or amendments to state constitutions that explicitly prohibit the right to an abortion.

In 2022, a wave of anti-abortion legislation in Republican-led states, emboldened by the Supreme Court’s forthcoming decision, proposed eliminating abortion access in most cases and criminalising abortion care by making it a felony for providers to see abortion patients.

Is abortion illegal?

Thirteen states have so-called “trigger” bans in place that aim to outlaw abortion or make it a felony to perform an abortion, laws that were essentially blocked by the precedent established by Roe but could quickly be implemented without it.

Meanwhile, 16 states and Washington DC have enacted laws that protect the right to abortion.

Abortion patients in many states already face requirements for ultrasounds, state-directed counselling and waiting periods, bans on the use of certain health insurance to cover abortion care and bans on telemedicine appointments to obtain prescriptions for medication abortion, the most common form of abortion.

Patients have also faced long waiting times in overstressed medical systems after Texas implemented a ban on abortions at six weeks of pregnancy last year. In December, the Supreme Court refused to intervene in a legal challenge to the Texas law, emboldening other states to pursue other restrictive anti-abortion measures.

Whether a patient can access care – and whether their provider will be criminalised – will largely depend on where they live, creating a national patchwork of abortion protections and anti-abortion laws.

The right to an abortion and the criminalisation of healthcare will rely on a “two-tiered system” of justice, said Jose Garza, the district attorney of Travis County, Texas, who has pre-emptively refused to prosecute cases involving the state’s anti-abortion laws.

In 2020, nearly 70 prosecutors signed a letter pledging against enforcement of criminal abortion laws in their states.

How can states further restrict abortion access?

States that have signalled a readiness to draft strict anti-abortion laws are likely to pass them without constitutional protections affirmed by the Supreme Court, if they survive anticipated legal challenges from abortion rights advocates and civil rights groups.

In 2022, anticipating the Supreme Court’s decision, a wave of anti-abortion legislation in Republican-led states proposed eliminating abortion access in most cases and criminalising abortion care by making it a felony for providers to see abortion patients.

Advocates have also warned that patients and providers could face the risk of prosecution for ending their pregnancies in states where abortion will be outlawed if they are to travel out of state, as well as the possible criminalisation of miscarriages, in vitro fertilisations and certain forms of birth control that may be scrutinised by anti-abortion law enforcement.

Republican lawmakers in Texas have also called for penalties against companies that cover the costs for employees who travel out of state for abortion care.

A model bill from the National Right to Life Committee proposes targeting community abortion funds, abortion advocates and websites and others who provide abortion aid under criminal conspiracy laws, in addition to other severe restrictions.

Will medication abortion be affected?

Most abortions today are performed with a two-drug regimen – mifepristone and misoprostol – that can be taken at home and in many cases obtained by mail. The US Food and Drug Administration has approved the treatment for use up to 10 weeks of pregnancy. In December, the FDA approved its distribution by mail.

Nineteen states require clinicians to be physically present to administer the drug. Those provisions largely prevent the use of telemedicine appointments to get a prescription. Aid groups based outside the US also are seeking to help American patients obtain medication in states where it is prohibited.

Abortion bans could pose significant and potentially dangerous hurdles for people who experience miscarriages. Misoprostol is commonly used for miscarriages, as well as ulcers; patients have reported pharmacists in Texas are already refusing to fill prescriptions, fearing liability under state law that could target providers and physicians who aid in abortions.

What does the Supreme Court ruling mean for other rights?

Scholars have warned that a ruling to undermine Roe could compel right-wing legal efforts to strike down LGBT+ rights, marriage equality and marital benefits, the right to public education and attempts to revisit critical civil rights decisions that similarly relied on 14th Amendment protections, on which the Roe decision was argued.

The court’s decision could lead to other far-reaching consequences, from the withdrawal of physicians in states where abortion care is severely restricted to the closure of clinics that provide other reproductive health services.

Hundreds of physicians, medical groups and abortion-rights organisations have condemned the decision, warning of the severe long-term consequences of carrying unwanted or medically unsafe pregnancies.

Will Congress or the White House protect abortion care?

The White House has opposed state-level efforts to restrict abortion access and has signalled some potential executive actions to provide support at the federal level, including offering abortion care on federal properties.

But those hypothetical decisions could come with significant legal risks; if a Republican president were to end those protections, providers who were previously shielded under federal authority could be prosecuted by states in which they operate, for example.

In September, the House of Representatives passed the Women’s Health Protection Act, which would codify the right to access an abortion and prohibit governments from limiting abortion providers’ ability to prescribe certain drugs. It would also protect abortion medication prescriptions via telemedicine.

The bill has languished in a deadlocked US Senate. Democratic Senator Joe Manchin opposes the bill, effectively killing its chances in the evenly split upper chamber.