What underground abortions could look like if Roe v. Wade is overturned

What underground abortions could look like if Roe v. Wade is overturned
A demonstrator holds up an abortion flag outside of the U.S. Supreme Court as justices hear a major abortion case on the legality of a Republican-backed Louisiana law that imposes restrictions on abortion doctors, on Capitol Hill in Washington, U.S.REUTERS/Tom Brenner
  • If Roe v. Wade is overturned, abortion access could be limited or outlawed in 34 US states and illegal "underground" abortions could see an uptick.
  • Unlike pre-Roe underground abortions, modern illegal abortions rely on the abortion pill and are much safer.
  • But the prospect of prison time is much greater for patients who have underground abortions today, as the issue has become more politicized since Roe v. Wade passed in 1973.

Judge Amy Coney Barrett's recent confirmation into the Supreme Court could be a potential threat to abortion access and lead to even more "underground" abortions if the procedure becomes illegal in certain states, experts say.

Though underground abortions have continued in the wake of Roe v. Wade due to certain states' time-limiting abortion laws, those numbers could see a steep increase if states don't take individual responsibility to protect abortion rights, Carole Joffe, a sociologist and co-author of "Obstacle Course: The Everyday Struggle to Get an Abortion in America," told Insider.

According to the Center for Reproductive Rights, 34 states could cease to protect abortion rights if Roe v. Wade is overturned and local governments take no action.
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Today, these "extralegal abortions," as Joffe calls them, are primarily done at home using the abortion pill, which induces a miscarriage for those up to 11 weeks pregnant. As long as the pill is available, other more dangerous methods like coat-hanger abortions are far less likely.

Self-managed abortion with pills bought on the internet will likely become the most common underground abortion method if Roe v. Wade is overturned, according to Joffe. This method is less visible than an abortion done in a doctor's office and much safer than people doing "very dangerous things like herbs and introducing blunt objects into their vaginas," Joffe told Insider.

Underground abortion patients could face jail time

Roe v. Wade, the 1973 Supreme Court case that decided a woman has the right to choose whether she gets an abortion, changed the political landscape.
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When the case was first decided, there wasn't yet a widespread movement seeking to penalize people who get abortions.

Between 200,000 and 1.2 million illegal abortions occurred every year in the 1950s and 1960s before Roe v. Wade, but only a small proportion resulted in charges or sentencing, according to The Guttmacher Institute. But in a post-Roe world where anti-abortion advocacy has gained political influence, prison time is more likely.
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In 2006, Barrett, whose confirmation turned SCOTUS to a conservative majority, signed an Indiana newspaper ad that called for Roe v. Wade to be overturned, the Guardian reported.

"Prosecution before Roe was very idiosyncratic, dependent on local factors. But if Roe falls, criminal justice officials, from the virulently anti-choice Attorney General Jeff Sessions on down to local police and district attorneys in many jurisdictions, can be expected to avidly pursue those who break the law," Joffe wrote in a 2017 article for Rewire News Group.

In 2016, The Self-induced Abortion Legal Team, a group of lawyers advocating for reproductive justice, reported that at least 17 people who sought self-medicated abortions since 2005 have faced arrests or jail time.
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A lack of support and increased fear

Though self-managed abortions with the pills mifepristone and misoprostol are relatively safe, they can result in complications that require visiting the emergency room. According to Joffe, people who go to the ER due to abortion complications could get arrested if abortion is illegal in their state and staff calls the police on them.

Even complication-free self-managed abortions result in heavy bleeding since they induce miscarriage, which can be jarring and scary to experience alone.

At the same time, Joffe expects underground networks of abortion advocates to grow in a post-Roe world and rally around those who seek the procedure, a topic she explored in her new book.
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"There's a huge network across the country of allies, volunteers, and people who work in abortion funds who help pay for their abortions," drive hours upon hours to the nearest abortion clinics, and home patients as they recover from their abortions, Joffe told Insider.

These networks are especially helpful for Black and Hispanic communities that are disproportionately affected by anti-abortion laws, since they tend to live below the poverty line and lack access to birth control.

There are still many unknowns about cost and access if Roe v. Wade is overturned, Joffe said, since different states can make their own laws about the procedure. One thing is certain: abortions will continue, no matter Roe v. Wade's future.
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