‘Everyone who is vulnerable in some way’ will bear the brunt if court overturns Roe, specialists say

Teenagers. People of color. Low-income workers. Undocumented immigrants. Victims of domestic violence. If the Supreme Court strikes down Roe v. Wade, ending the constitutional right to abortion, those and other marginalized groups will bear the brunt of the consequences, according to reproductive rights experts.

“Everyone who is vulnerable in some way that makes leaving a state more difficult or impossible — that’s who this overturning is going to fall more heavily on,” said Shoshanna Ehrlich, a gender and sexuality studies professor at the University of Massachusetts Boston.

A leaked draft opinion obtained by Politico suggests the court’s conservative majority is poised to overturn the 1973 landmark ruling. The court’s final decision, which is expected next month, would likely result in a patchwork of different abortion laws across the country, with about half of states, largely in the South and the Midwest, restricting or banning the procedure entirely.

In a post-Roe future, experts say, the wealthy and well-connected would likely retain access to safe abortions. People without the means to travel to a state where abortion is legal, however, would be forced to carry unintended pregnancies to term. Some could resort to dangerous and illegal methods to terminate their pregnancies, especially if states take measures to restrict access to mail-order abortion pills.

“People with privilege have always been able to access safe abortion. Sometimes it wasn’t legal, but it was safe,” said Khiara Bridges, a professor at the University of California, Berkeley School of Law who specializes in race and reproductive rights. “They could go to obstetricians who they had relationships with who would perform abortion services for them. They could travel. They could go to other states. They could go out of the country to access the abortion care.”

“People who are unprivileged will not have that ability,” she added. “They’re going to be the ones who are actually constrained by abortion restrictions and are not able to travel.”

Bridges, one of the authors of an amicus brief in the abortion-rights case before the Supreme Court, Dobbs v. Jackson Women’s Health Organization, said the burden of restricted abortion access will fall heaviest on Black women, who obtain abortions at more than three times the rate of white women, according to the 2019 data reported to the Centers for Disease Control and Prevention.

Black women’s higher rates of abortion are a direct reflection of increased marginalization and vulnerability, Bridges said, which often includes a lack of access to reliable and affordable contraception and health care.

“An abortion ban would move out of reach services that Black people disproportionately need,” she said.

Low-income women of color already face barriers to abortion care. The Hyde Amendment, which prohibits federal funding for abortion services, disproportionately affects Black, Latino, and Indigenous women, who are more likely to rely on public insurance programs, like Medicaid or the Indian Health Service.

If abortion is criminalized and states begin prosecuting people who terminate pregnancies, Bridges expects that poor people of color will be arrested and convicted at higher rates than their white counterparts. Criminalizing abortion would also increase the risk of involvement with the child welfare system among families of color, Bridges said.

“When people don’t have the ability to control the size of their families or the spacing of their children, it’s just devastating for the family. It’s devastating for the community,” Bridges said. “Long term, we should just expect more violence when it comes to dismantling families, separating parents from children, and traumatizing children by removing them from the parents who love them.”

For people who are denied abortion and forced to carry unintended pregnancies to term, research shows the consequences are far-reaching. The decade-long Turnaway Study, led by researchers from the University of California San Francisco, found that women who were refused an abortion had far greater odds of living in poverty and being unemployed. They were also more likely than women who received abortions to remain in violent relationships with their male partners.

Additionally, women who were denied abortions reported more life-threatening pregnancy conditions, including preeclampsia and postpartum hemorrhage.

A study published last year in the journal Demography by a sociologist at the University of Colorado at Boulder estimated a total abortion ban in the United States would lead to a 21 percent increase in pregnancy-related deaths nationwide following the first year of a ban, including a 33 percent increase among Black women. According to the CDC, Black women are three times more likely than white women to die from pregnancy-related causes.

“Abortion is significantly safer than continuing a pregnancy to term,” said Dr. Colleen McNicholas, chief medical officer of Planned Parenthood of the St. Louis Region and Southwest Missouri. “For folks who are not able to access abortion when they want, the complicated social structure of their lives gets harder.”

McNicholas, who works at the only health center that provides abortions in Missouri, said her patients are typically dealing with several intersecting challenges, such as financial insecurity and unstable housing.

“Taking [abortion] away really perpetuates the possibility of keeping folks in poverty, of keeping them in a place where they are unsafe and unhealthy,” McNicholas said.

Since Texas enacted the nation’s most restrictive abortion ban last year, Planned Parenthood of the St. Louis Region and Southwest Missouri has seen a 200 percent increase in patients arriving from outside its service area, McNicholas said, from states as far as Ohio, Indiana, and Michigan, because patient demand is high and clinic appointments are fully booked. She expects those numbers to keep rising as more states move to restrict abortion.

Antiabortion advocates have signaled their fight to end abortion rights will go to the states.

“Though this ruling would overturn Roe, it would not outlaw abortion,” wrote Myrna Maloney Flynn, president and CEO of the antiabortion group Massachusetts Citizens for Life, in a statement. “Unfortunately, abortions will continue to be available across the country in many places, including here in Massachusetts. There will be much work left to do to protect our most vulnerable citizens and support women and men faced with unplanned pregnancies.”

If Roe is repealed, people seeking to end unintended pregnancies who lack the resources to travel would have more options for help than they did in the pre-Roe era, said Gillian Frank, a historian of sexuality and religion and cohost of the podcast “Sexing History.” The National Network of Abortion Funds, with more than 80 member organizations across the country, assists people in paying for abortion-related travel, child care, and medical costs. Few grass-roots organizations like those existed in the past, Frank said.

It’s unclear, however, whether those groups would be able to meet the coming need, he said.

“We are in a different moment than in the pre-Roe era,” Frank said. “We have 50 years of precedent, 50 years of organizations and institution building, 50 years of grass-roots reproductive-justice organizations who have set up things like travel funds, who have set up all sorts of safety nets.”

“Whether they will hold, whether there will be enough, I do not know,” he added. “But there are mechanisms in place to help people travel, to help people stay outside of their hometowns, to help them get away and to get this procedure.”

Deanna Pan can be reached at deanna.pan@globe.com. Follow her @DDpan.