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Where Roe v. Wade has the biggest effect

People rallied in support of abortion rights at the state Capitol in Sacramento, Calif., in May 2019.
People rallied in support of abortion rights at the state Capitol in Sacramento, Calif., in May 2019. (Rich Pedroncelli/Associated Press/File)

Tammi Kromenaker runs the Red River Women’s Clinic, the only clinic that provides abortions in North Dakota. Without Roe v. Wade, the Supreme Court decision that established a constitutional right to abortion, the state would ban her clinic, or any other within state lines, from performing the procedure.

“Roe is the only thing keeping abortion legal in North Dakota,” Kromenaker said.

In neighboring Minnesota, though, abortion would remain legal, even without the protection of Roe. There, the right to abortion is protected in the state constitution.

Roe upholds abortion in very different ways around the country. Without it, the fallout would be highly uneven, according to new research by scholars at Middlebury College and two reproductive health research groups.

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Today, there is at least one abortion clinic in every state, and most women of childbearing age live within an hour’s drive or so of one, the new analysis found. In more than half of states, including the entire West Coast and Northeast, that would still be true without Roe. In other states, like Missouri and Mississippi, with one clinic each, some women are effectively already living without Roe’s protections, because the driving distance to the nearest clinic is prohibitively long.

Without Roe, significantly more women — concentrated in the South and Midwest — would be living without an abortion clinic nearby: Eight states have passed trigger laws that would ban abortion almost immediately, and at least 13 more states would probably ban it, legal experts say.

The nation’s abortion rate would be at least 13 percent lower without Roe v. Wade, the new analysis found. In some counties, it would be more than 40 percent lower. There could be 140,000 fewer abortions a year, it found. Low-income people who couldn’t afford to travel to a legal clinic would be most affected.

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“Wide swaths of the country face potential dramatic increases in travel distances to states where abortion would likely remain legal,” said Caitlin Knowles Myers, an economist at Middlebury and one of the paper’s authors. “Affluent women generally find a way to get there, but 75 percent of abortion patients are poor or near-poor.”

The estimates in the new paper are based on two elements: research of how recent clinic closings in Texas affected abortion rates among women whose driving distance to providers increased; and two sets of assumptions about which states might outlaw abortion if Roe were overturned.

The current Supreme Court is considered unlikely to overturn Roe immediately, but changes on the court and state actions limiting or trying to ban abortion have spurred advocates and providers, including Planned Parenthood, to begin planning for a post-Roe world.

Eventually, clinics might open on state borders so women in states with abortion bans could more easily reach them, researchers and women’s health experts say, and an underground market for abortion-inducing pills could arise.

But in some parts of the country, abortion rates would fall almost instantly.

It would still be possible to cross state lines to get an abortion. But as distances increase, abortion rates decline.

Missouri has one abortion clinic, in St. Louis. Without Roe, it would close, but driving distances wouldn’t greatly change, since a clinic in Illinois, where abortion is protected by a state statute, is about 10 miles away.

In Louisiana, by contrast, the estimates suggest that abortion rates would drop sharply. That’s because several neighboring states also have trigger laws, meaning the nearest clinic could be hundreds of miles away.

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In other states, abortion clinics wouldn’t close immediately, but legal experts at the Center for Reproductive Rights say 21 states would most likely move quickly to restrict or ban abortion. Their assumptions are based on analysis of historical and recent legislative action in those states and, in some cases, on state court rulings.

This state variation is a leading goal of abortion opponents, said Clarke Forsythe, senior counsel at Americans United for Life. “The blue states can legislate according to public opinion in the blue states, and the red states can legislate according to public opinion in the red states,” he said.

Today, 83 percent of women of childbearing age live within 50 miles of an abortion clinic, found the new paper, which will be published in the journal Contraception. Without Roe, if all 21 states that have indicated intentions to make abortion illegal did so, about half of women this age would live that close to a clinic, and a quarter would live more than 200 miles from one.

Long travel distances are most likely to affect low-income women, research has found. These women, who account for a growing share of abortions, might have a harder time arranging and paying for transportation and child care, and taking time off work.

Women who could not get to an abortion clinic would not necessarily give birth. Some women miscarry. Many might turn to alternate ways of ending their pregnancies, researchers said. Two pills that end a pregnancy of up to 10 weeks, mifepristone and misoprostol, can be administered at home. Although medication abortion would be illegal in states that banned abortion, the pills could be clandestinely driven or mailed across state lines.

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Illegal abortions might be more easily accessible and safer than they were pre-Roe, reproductive health researchers and historians say. But they warn that some women might still seek dangerous methods if legal abortion were curtailed and enforcement of laws were strict.

Over time, some people might practice abstinence or safer sex because of the knowledge that an abortion would be harder to obtain. Also, abortion providers would probably open new clinics in places that women in states without clinics could more easily reach.

In North Dakota, Kromenaker has already made contingency plans. Fargo, where her clinic is based, is only a few minutes from the Minnesota border, where abortion would remain legal. She said she would keep her clinic open, providing patients with pre-abortion care and other services, and open an abortion clinic across the border.

“Folks across the country are already working on these plans in these haven and hostile states,” Kromenaker said.

But in some areas, the nearest state with legal abortions may be too far to make an easy trip feasible. Also, existing clinics might be unable to meet an increase in demand. In Texas, just more than half the decrease in in-clinic abortions was because of overcrowding and wait times, the researchers found. Some women might have forgone abortions, turned to alternate methods, or had second-trimester abortions as a result, they said.

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Calla Hales, who runs four abortion clinics in North Carolina and Georgia, said her patients travel 2 1/2 hours on average. It can be a formidable challenge, even with Roe in place.

“As it is now, there are patients who don’t get their intended abortions due to financial and logistical hardships,” Hales said. “The fall of Roe would absolutely increase this.”