What happens if Roe v. Wade is overturned? Why Texas is a bellwether for the nation
Access to legal abortions in Texas could be almost completely eliminated this year if the Supreme Court overturns Roe v. Wade, an outcome that seems increasingly likely after the news outlet Politico published a leaked draft of a majority opinion from the nation’s highest court.
Some abortions remain legal in Texas, although access has already been restricted by Texas laws passed last year, including one that bans most abortions after fetal cardiac activity can be detected. That usually happens when people are about six weeks pregnant, which is before some people have even realized they are pregnant.
Because Texas has already limited access to abortions, experts said the state provides important lessons for what the nation can expect if Roe v. Wade is ultimately overturned, and if abortion is completely or partially outlawed by individual states. The draft opinion that was published Monday is not final, and although Chief Justice John Roberts has confirmed it is authentic, justices could still amend or edit the text of the opinion.
“What we expect to see is that Texas will be the bellwether,” said Farah Diaz-Tello, the senior counsel and legal director at If/When/How, a group that supports abortion access. “What we’ve already seen in Texas is going to transpire across more states in the country.”
If Roe v. Wade is overturned, most abortions in Texas would become a felony. Any person who performs or attempts to perform an abortion could face up to 20 years in prison, or life in prison if the abortion is completed, as well as civil penalties of up to $100,000. A pregnant person who receives an abortion would not be charged with a crime under the law.
Most experts interviewed by the Star-Telegram said the end of Roe v. Wade, and any subsequent abortion bans, would have an impact on women’s health, and particularly on women who are more likely to get abortions in their lifetime. The majority of women who have abortions are poor or low-income, according to the Guttmacher Institute. Guttmacher, which supports access to abortion, produces a regular survey on the demographics of people who get abortions in the U.S.
But it’s unlikely that Texas will see a return to the years before 1973, when Roe v. Wade was decided, when some women ended their pregnancies by using hangers or forms of physical force. Instead, experts said they expect pregnant people to die because of pregnancy complications or during childbirth.
At-home abortions
Experts who have studied at-home abortions in the U.S. have said that it’s unlikely Texas will return to an era when people who want to end their pregnancy would turn to desperate actions like using a coat hanger, or asking someone to punch them in the stomach, as has been documented by historians in the years before 1973.
That’s because a major difference between 2022 and the years before Roe was decided: The availability of medication abortions, often known as abortion pills. Medication abortions usually involve taking two drugs — mifepristone and misprostol — in a regimen that was first approved by the Food and Drug Administration in 2000. Since then, abortion pills have grown increasingly popular among people seeking to end pregnancies. As of 2020, more than half of all legal abortions in the U.S. were completed via pill, according to research from Guttmacher.
Under Texas’ trigger law, abortion by any method, whether via a pill, a vacuum, or dilation and evacuation, would be outlawed. But because nonprofits and online pharmacies are able to distribute abortion pills via the U.S. mail, many legal experts believe that it will still be feasible for people looking to end their pregnancies to do so at home using pills.
Mailing abortion pills is already illegal in Texas. But research has shown that people are continuing to request abortion pills online outside of the formal medical system.
“I think what I would anticipate is that people will continue to access (abortion pills) in the same ways that they have been already,” said Diaz-Tello.
Although abortion pills have a low risk of complications, there could still be a risk for some people who choose to use them. The risk of complications will increase for people who wait until later in pregnancy, or who are afraid to seek medical care in case of emergency because of the laws in place.
“The higher the gestational age, the more complex medical conditions that a person has, all of these are going to put people more at risk,” said Dr. Sarah Prager, a professor of obstetrics and gynecology at University of Washington’s medical school. “If having an out-of-clinic abortion is something that somebody wants, that’s one thing, but many people don’t want that and would much prefer to be seen by a medical professional.”
Pregnancy complications
An abortion ban in Texas leaves doctors worried about whether they’ll be able to intervene to save a pregnant person’s life when something goes wrong during pregnancy. There are rare but life-threatening cases in which a pregnant person might need an abortion to save their lives, and in which there is no chance of the pregnancy resulting in a healthy child regardless of whether the abortion is performed.
Texas’ trigger law does include an exception for cases in which the life of the mother is in danger. But doctors and legal experts have previously said that exception leaves a lot of room for uncertainty, and could open up health care providers to legal liability or criminal charges. When a woman’s water breaks before the fetus is viable, and in the case of fatal fetal anomalies, an abortion of the fetus is often or always the recommended course of action, experts said.
“I think a lot of physicians are not going to want to provide care, because they’re going to be too afraid that it’ll be illegal,” Prager said. “And we’re going to see people die. We just will.”
Do you have questions about abortion in access in Texas? Do you want to share your experience? Please reach out to reporter Ciara McCarthy by calling or texting 817-203-4391 or emailing cmccarthy@star-telegram.com. Nothing you share will be published without your permission.
This story was originally published May 3, 2022 at 4:43 PM.
