The US Supreme Court may be preparing to overturn the landmark ruling that has guaranteed the right to an abortion across the country for nearly 50 years, but some states already live in a post-Roe vs Wade reality.

A draft ruling leaked last week indicated the court was set to repeal. Its official opinion is due to be issued by July.

Since Roe vs Wade took effect in 1973, state legislators have enacted 1,373 abortion restrictions — 48 per cent of those in the last decade. This includes restricting insurance for the procedure, leaving millions of women enrolled in the government-backed Medicaid insurance programme without abortion coverage except in very limited circumstances.

Other restrictions have included limiting or banning medication abortions — abortion via pills — as well as regulating which facilities or clinicians can perform abortions, and mandating waiting times before the procedure can be carried out, according to research findings analysed by the Financial Times.

Tighter restrictions mean more people travel for abortions

One impact of greater restrictions is a rise in demand for out-of-state procedures.

In Texas there was an 11-fold increase in the number of people travelling out of state for abortions after it passed a ban in September on all abortions after six weeks of pregnancy, according to researchers at the University of Texas.

Waiting times for appointments increased in neighbouring states like Kansas and New Mexico just a few months after the ban, according to a study by the Texas Policy Evaluation Project.

As more states ban or restrict abortion, so-called haven states are likely to experience similar strains on their providers, say abortion policy experts. As a result, it is likely to become more difficult to get an abortion even in states where the right is protected, according to academics at the University of Colorado.

Waiting times for abortion appointments can currently exceed two weeks in half of all states, including those with many providers, like New York and California, according to data collected by a team at Middlebury College in Vermont and the Texas Policy Evaluation Project.

Poorer women bear brunt of the restrictions 

Travelling to undergo an abortion can add to the expense of the procedure.

The US has a similar abortion rate to other developed nations. Overall, one in four American women has undergone an abortion, according to the American Journal of Public Health. Younger women and black women are more likely to seek one, data from the US Centers for Disease Control and Prevention show, but the highest incidence is found among poorer women.

Some 75 per cent of women who have sought an abortion either live below the poverty line or in the low-income bracket, according to the Guttmacher Institute, a research group that supports abortion rights.

If Roe vs Wade is overturned, safe abortions could become financially difficult for some as the cost of travelling to another state would add to the already high cost of the procedure, say abortion policy experts.

“As abortion provision becomes more regulated . . . patient charges may continue to increase,” says research published by the University of California, San Francisco. Already over the past five years, costs have risen by 13 per cent for medicated abortion and by 21 per cent for a first-trimester procedure, the UCSF research shows.

The majority of abortion patients — 53 per cent, according to the latest data collected by the Guttmacher Institute — pay for the procedure themselves. Medicaid, a government-funded health insurance programme for people on low incomes, was the second most common payment method, used by 24 per cent of patients.

Denied an abortion, women live in poverty

Financial stress plays a major role in women’s decision-making. When asked why they were having an abortion, 73 per cent said they could not afford a baby, according to Guttmacher Institute data.

A study by ANSIRH, a research group at UCSF, found that women who were denied an abortion were more likely to live in poverty for the next four years. They were also more likely to have more debt than women who ended their pregnancies, and to suffer bankruptcy or eviction compared to women who were able to end their pregnancies.

The rate of abortion in the US has declined considerably since the 1980s — from 29.3 abortions per 1,000 US women in 1980 to 11.4 abortions per 1,000 women in 2019, according to CDC data; research suggests this is directly linked to a sharp drop in unintended pregnancies. This can be credited to the wider availability of contraception methods which since 2010 have been covered by insurance under the Affordable Care Act, according to a study published in the American Journal of Public Health.

Most Americans support abortion under certain circumstances

The general consensus over abortion has not shifted much in the 50 years pollsters Gallup have been researching public opinion. Most Americans support abortion under certain circumstances and only about one in five think there should be a total ban.

When specific circumstances are involved, such as the mother’s health being in danger, a pregnancy caused by rape or incest, or serious birth defects, more than 50 per cent of people say they are in favour of allowing access to abortion.

If Roe vs Wade is overturned, abortion will be banned automatically in 22 states which have pre-Roe or trigger laws, and it is likely to be banned in four more that have passed anti-abortion restrictions in the past two years, according to the Guttmacher Institute. Even in these 26 states, support for greater restrictions is muted: fewer than a third of those who took part in an ABC News/Washington Post poll earlier this month believe their own state should make abortions harder to get.