In a ruling that surprised no one who has watched the Supreme Court devolve further and further into a tool of oppression, the Supreme Court has overruled Roe v. Wade, and with it, the right to abortion at the federal level. Roughly half of all states will likely ban abortion now.
A few weeks ago, I interviewed experts—lawyers, doctors, and midwives—about survival in a post-Roe world. Below is an updated version of that blog to reflect the new reality.
“We are prey.”
It’s the first thing Diane Derzis, the owner of the clinic at the center of the fight over Roe v. Wade, told me when I asked her what people who can become pregnant need to know about the potential end of Roe.
Derzis’ clinic, Jackson Women’s Health Organization, is Mississippi’s only abortion clinic, and it will not be able to provide a full spectrum of reproductive health services if the state of Mississippi has its way.
Derzis says the right will not stop their fight against reproductive choice until they have completely removed reproductive autonomy. “Abortion is just the beginning. They’re coming for your birth control,” she said. “They want a world where women don’t work. They want total control.”
In a world where politicians can force children to give birth or demand that a person die carrying a pregnancy that’s not viable, they’re one step closer to that control.
Derzis and her colleagues are preparing for a post-Roe world. She noted plans to move her clinic to Maryland and New Mexico. The pioneers of the abortion rights movement and those they have mentored will not go quietly into a world where dying of pregnancy complications is routine and children give birth to their rapists’ babies. But they can’t do it all, and they’re realistic about the future.
“Women are going to die,” said Warren Hern, MD, of Boulder Abortion Clinic. Hern specializes in later abortions, often of desperately wanted pregnancies. These abortions typically happen when a pregnant person learns they will die if they continue the pregnancy, or that their baby has fatal or potentially fatal birth defects.
The time to prepare for a post-Roe world is now, when more options are available and most don’t yet have to worry about the criminalization of pregnancy. I talked to abortion experts across the country about what we all need to know to survive in a world where people could be forced to die from ectopic pregnancies and bleed to death giving birth to babies born without brains. Here’s what they said.
Every pregnancy is a danger to the life of the pregnant person
The United States has the highest pregnancy-related mortality rate in the wealthy world. And the issue is getting worse; it is now more dangerous to give birth than it was a generation ago. In this climate, every pregnancy is a potential danger to the life of the pregnant person. The end of Roe means that doctors no longer get to decide what constitutes a threat. It’s left up to politicians who can’t identify basic reproductive anatomy.
Even when women survive, a bad birth—to say nothing of a forced birth—leaves permanent scars.
”The trauma of birth alone when not in the right mental state is devastating and can leave a long-lasting negative impact on both mother and child. Access to quality medical care has never been a real thing for disadvantaged communities in the United States. Are politicians going to support these families, and provide unlimited therapy because women are forced to birth a child they don’t want and can’t take care of?” asked Corrinna Edwards, a midwife, Black maternal health activist, and founder of the Bellies to Babies Foundation.
Every year, pregnancy complications disable 50,000 Americans. That number is destined to skyrocket. Abortion is many times safer than pregnancy.
“Our society has long left Black, Indigenous, and people of color (BIPOC) to save their own lives,” Edwards added. The data consistently show that wealthy white people will still be able to access abortions, but BIPOC communities will suffer.
The fight for reproductive rights has to extend to those who choose to give birth, and the increasingly horrible environments in which they do so.
Stock up on abortion pills
For now, abortion pills via telemedicine are accessible and legal. That could change in a matter of days. Organizations such as Aid Access connect pregnant people to virtual doctors, who can then prescribe abortion pills.
This empowers you to self-manage your own abortion at home, on your own terms. Watch a movie. Hire a doula. Light candles. Whatever feels most comfortable and safest becomes possible during the first trimester. And research shows that self-managed abortions are safe.
We don’t know how long this access will last, and some states are already moving to make telemedicine abortion illegal. In states where clinic abortions become illegal, it will likely become illegal to fill a medication abortion prescription.
It’s a public service to gain access to the pill now—not just for yourself, but for the people around you. You must only be willing to tell a doctor you’re pregnant over the phone, so you can fill a prescription to use in the future.
“Ideally, we want women to get quality, comprehensive care at a clinic,” said Ralph Bundy, MD, of Womancare Centers, Inc.
But a post-Roe world is far from ideal. According to Bundy, the abortion pill is many times safer than a miscarriage, and less likely to cause serious complications.
How long will these pills last if they eventually become inaccessible? No one really knows.
“The general understanding right now is that misoprostol has a shelf life of a minimum of 18 months and mifepristone a minimum of 3 years,” said April Lockley, DO. Lockley is medical director of the Miscarriage and Abortion Hotline, and a fellow with Physicians for Reproductive Health. “After that the effectiveness of both medicines can decline over time, and it's best to keep pills in a climate stable environment—for example, not in a car.”
There’s no evidence that abortion pills become dangerous after they expire—just less effective. So in a crisis, they’re worth trying even if they’re out of date.
Lockley suggests people self-managing their abortions contact the Miscarriage and Abortion Hotline, which offers anonymous help from medical professionals, if they have additional questions about home abortions with abortion pills.
Prepare to manage abortion and miscarriage complications
In a world where doctors can report pregnant people to the police for abortions (and for miscarriages suspected to be abortions), more people will be reluctant to seek medical care. Bundy emphasized the need to seek emergency care anytime a person has a serious pregnancy or abortion complication. But he also offered the following advice to people who experience bleeding after a self-managed abortion:
- Slow down and put your feet up. Bundy says that excessive bleeding after a medication abortion often happens when women do too much too soon—or when their partners pressure them to have sex or rush back to household labor and child care. The first line of defense for managing excessive bleeding is to lie down and rest.
- Drink an electrolyte drink. Fighting dehydration may help with excessive bleeding, especially if the bleeding isn’t severe. Stay hydrated, especially if you start bleeding a lot.
- Learn how to do fundal massage. Fundal massage means massaging the uterus, from the top down. It’s the first line of treatment for postpartum hemorrhages, and can also help with blood loss following a miscarriage or abortion. Fundal massage helps the uterus contract back down, which can slow or stop bleeding. You can find your uterus between the top of the pubic bone and belly button, depending on how far along you are. Push down firmly in a downward motion, toward the vagina. You can view a guide to fundal massage here.
Signs of an emergency include a fever, a foul smell from the vagina (a sign of infection), intense pain, or soaking through more than two pads an hour for more than two hours. When in doubt, seek care.
Know that doctors can’t tell the difference between miscarriage and abortion
Medically speaking, miscarriage and abortion are identical.
“If I see a woman in the emergency room, I can’t tell the difference between an induced abortion and miscarriage. And the treatment for the two is going to be the same,” Bundy said.
This reality is what makes the end of abortion rights so scary. Every miscarriage suddenly becomes a potential crime scene. States with restrictive abortion laws are already prosecuting miscarriages.
When a miscarriage becomes a suspected crime, it pits doctors against patients and erodes trust between the two. Trusting your doctor might be a dangerous decision. So women need to know that if they induce an abortion at home and require medical care, a doctor can’t tell the difference—and there’s no reason to disclose.
“It is not a crime to lie to your doctor, or to withhold information from your doctor,” said Jeff Filipovits, a civil rights attorney with the law firm Spears & Filipovits, LLC.
“[In a world where abortion is a crime], there’s no medical reason to tell a doctor about an abortion,” Bundy added.
People who choose home medication abortions and who need medical care may worry about doctors finding out about their use of the abortion pill—or worse, abortion pill testing by the police.
“There are not currently any hospital or clinic-available blood or urine tests to detect [the abortion pill]. If someone used misoprostol vaginally there is a risk there might be some residue or parts of the pill leftover in the vagina if someone sought in-person care and the clinician wanted to do an exam. Otherwise, no, there is no way to tell the difference between a spontaneous and induced abortion,” explained Lockley.
It’s a dystopian nightmare, but it may soon be here: Lie to your doctor, or get a visit from the police.
Learn about Plan B—and stock up
Plan B is emergency contraception. It works much like oral contraceptives, using a high dose of hormones to suppress ovulation. If you do ovulate while taking Plan B, it decreases the likelihood that the egg will successfully implant in the uterus. You don’t need a prescription for Plan B, and it is readily available online.
Plan B may be your only option for avoiding pregnancy if you are raped. Three million Americans have experienced a rape-related pregnancy during their lives. Terrifyingly, pregnancy is much more likely—common, even—if someone you know rapes you. Twenty-six percent of women who report a rape by a current or former partner report becoming pregnant.
The time to stock up is now.
It’s safe for almost everyone, including people who cannot use hormonal contraceptives because of concerns about blood clots.
But the right has been so successful at stigmatizing birth control that even many progressives think Plan B is an abortion pill, or will induce an abortion. Critically for those who personally oppose abortion, it will not trigger a pregnancy loss if you are already pregnant. There’s also no evidence that it causes birth defects.
Some studies suggest that Plan B may not work as well in people over 155 pounds. For instance, a 2015 paper found a significantly higher rate of pregnancy among people over 155 pounds. This is less than the weight of the average American woman, and a critical shortcoming. Not all research supports this finding, though. A 2017 analysis of four studies found no evidence of an effective weight limit for Plan B.
Even where research does suggest a weight limit, Plan B still works—just not as well. It’s also not dangerous, so it’s still worth a try.
Ulipristal acetate is an alternative to Plan B that may work in people weighing more than 155 pounds. The catch is that it requires a prescription. If you think you might need it one day, consider getting and filling a prescription now, while you still can.
Consider the risks and benefits of abortion herbs
A number of websites urge that abortion herbs are not safe and should never be used. But women have used herbs to abort pregnancies for thousands of years.
“People should understand that herbs are not inherently unsafe,” said Lockley.
The challenge is finding a knowledgeable practitioner. Your Facebook friend who spent 30 minutes googling the topic is not a trustworthy authority. And the fact that something is natural does not make it safe. All substances have risks, and herbs can interact dangerously with some medications.
“Communities have been taking care of themselves for hundreds of years with plants, and for many Black and Indigenous people plant medicine is a part of our culture. Unfortunately, due to white supremacy and oppression, much of that community care and knowledge has been lost. However, there are still community herbalists out there that have that knowledge and help take care of people. When people ask me about using herbs for a missed period or for an abortion, I let them know they should talk with a local herbalist who has experience and expertise in those areas.
“There is no good reason except racism to not have access to safe abortion options including traditional herbs that have always been used by BIPOC communities,” added Edwards.
People interested in learning about herbal abortion should explore their options now, and consult only with knowledgeable experts—herbalists, community midwives, and others with a history of counseling patients about herbal abortion options.
Learn about alternatives to the morning-after pill
A copper IUD is the safest and most effective option for emergency contraception. Unlike Plan B and some other emergency contraceptives, it has no weight limit. This is likely the reason that so many states are scrambling to ban this form of birth control. You don’t have to tell a doctor you’re using the IUD for emergency contraception if you’re in a state with questionable legal regulations. Just get to a provider who can insert one within five days of intercourse.
Know how to deal with the police
Roe, at its core, upholds the right to privacy. Without that privacy, seemingly innocuous medical decisions—whether and when to see a doctor for a positive pregnancy test, whether to have a dilation and curettage (D&C) for a miscarriage or let the pregnancy pass naturally—become legal landmines. Decisions about pregnancies are no longer just between families and their doctors; the police may soon become the primary arbiters of whose miscarriage warrants sympathy and whose miscarriage warrants punishment. They may be those deciding whether a pregnancy is truly a threat to the life of the mother—or even if such a threat matters.
This renders anyone who can become pregnant a potential criminal. There doesn’t even have to be a pregnancy. The line between an early miscarriage and a heavy period is not clear. It is impossible for someone experiencing a heavy or late period to prove they were not recently pregnant. This means a person could be charged with illegally ending a pregnancy even if they didn’t, and even if they were never even pregnant.
Knowing how to talk to the police is critical.
”You do not ever have to give a statement to the police,” said Filipovits. “You are always free to remain silent and to decline to be interviewed. If you wish to decline an interview, politely state that you do not wish to discuss your medical issues with the police. Do not allow yourself to feel pressured into answering any questions. Police officers are allowed to lie and pressure suspects into giving a confession. Do not give into this pressure. Do not answer any questions without first consulting with an attorney who you trust. It is a crime to lie to the police. It is not a crime to decline to answer a police officer’s questions. Remain calm, polite, and firm: You do not wish to answer questions. If the police officer indicates that you are required to answer questions, the police officer is lying to you. Do not answer their questions.”
Talk to others about Roe
Derzis is dismayed by how little people truly understand about Roe v. Wade, how it affects them, and how it has fundamentally changed women’s lives. She says her clients—the very people currently benefiting from abortion rights—generally do not know about the leaked Supreme Court opinion. Even when they do, they don’t think SCOTUS will actually overturn Roe, or they believe that a bad SCOTUS decision somehow won’t affect them.
Already, clinic closures have pushed pregnant people to choose later abortions than they ever would have chosen before. Derzis says most of the patients at her clinic are waiting about five weeks, thanks to an influx of abortion-seekers from Texas.
Derzis says that the wealthy people currently attacking Roe will always have access to abortion if they or a loved one wants one. It’s everyone else who has to worry. But too often, the people who stand to lose the most know the least. They don’t vote. They don’t understand what’s at stake.
Now is the time to talk to friends and colleagues, and to urge them to deeply contemplate that the end of Roe won’t just criminalize abortion. It could criminalize pregnancy—which, of course, criminalizes being a woman.
Learn as much as you can now before they try to make knowledge illegal, too.
Consider donating to the National Network of Abortion Funds to help people access abortion now, before it’s too late.
Don’t give up
Things are terrifying. But authoritarianism relies on demoralization. The right hopes we will give up and roll over—because frankly, that’s what the left usually does. Don’t spend all your energy talking about how the world is ending. I’ve written more here about what we can learn from the right. It’s going to be a long fight, but we can win it. Even now.