A dozen states immediately affected
Louisiana, where Sarah lives, has some of the strictest abortion laws in the country. It’s one of several states with so-called “trigger laws” where a ban on abortion was set to come into effect immediately or within days or weeks of Roe being overturned.
The other states are Arkansas, Idaho, Kentucky, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Utah and Wyoming. In total, however, 22 states have laws on the books that will restrict legal abortion.
Louisina’s trigger law was passed in 2006. If Roe v. Wade was overturned, anyone who provided or attempted to provide an abortion in the state could be charged with a felony, resulting in up to 10 years in prison and a fine of between $10,000 and $100,000. Exceptions will only be made when a woman’s life is endangered by the pregnancy.
But the end of abortion in these states isn’t a foregone conclusion, as advocates have launched legal actions to challenge bans. One such lawsuit inspired a judge to put Louisiana's ban on hold, though the stay only lasted until July 8 — the same day President Joe Biden signed an executive order to do "everything in his power to defend reproductive rights."
The executive order calls for protection of access to medication abortion, a strengthening of the legal options available for people seeking care, more access to contraception and education as well as privacy protections.
But Biden’s order can’t restore abortion access in the states where limits and bans have already been implemented.
Women on their own
Sarah had been to the doctor in New Orleans before the Supreme Court decision. Even then, she was told Louisiana’s three clinics were already very busy and her best bet would be to figure out a way to get to Mississippi to have the procedure done.
Her choice was weighing on her heavily enough that her coworker Kate — whose name has also been changed — knew something was going on.
“I knew she was stressed,” says Kate, who Sarah calls her “rock."
“I think I caught her at the right moment … She just kind of opened up that she was pregnant. And you know, she was looking at having an abortion.”
Since Sarah’s car was out of commission from an earlier incident, Kate immediately offered to drive her to her appointment.
On the Tuesday following the decision, the pair drove to Jackson, Mississippi — the next closest place to access an abortion and the center of the latest turmoil around abortion rights. They were bombarded by protesters; security officers and volunteers needed to come to the car and help Sarah through the crowd and into the clinic.
Because the procedure couldn’t legally be done on the same day as her consultation, Sarah and Kate had to make the two-and-a-half-hour drive north to Jackson on Tuesday, drive home and then back to Mississippi again on Thursday for the procedure.
For Sarah, that means the $150 consultation fee was just the beginning. Add to that gas there and back twice and another $450 for the procedure. Luckily the school she works at was on break, or else she would have also had to take time off.
Less than a week after Roe v. Wade was overturned, Sarah was seeing for herself the real costs of living in a post-Roe America — and millions of Americans will have to grapple with those expenses.
Just the beginning
Travel costs and logistics alone for people who live in states with bans, or impending bans, can be prohibitive.
Soon, Louisiana will be surrounded by states that have also banned abortion, including Texas, Arkansas, Mississsippi and potentially Alabama and Florida — making it that much harder for women to access the care they’re seeking.
Limits to local access disproportionately affect lower-income women, says Caitlyn Myers, economist at Middlebury College, because they can’t easily travel to another state to seek an abortion. And that is just where the gap begins to grow.
Gender gaps in the labor market often don’t emerge until people become parents, says Myers.
“And at that point, not much happens to men's earnings and women's really fall off a cliff,” she says. “They fall by about 33%, and this gap opens and they really never recover from that.”
Carrying an unwanted pregnancy to term widens that gap for years to come for lower-income women, says Myers.
“They are particularly economically fragile.”
Lower-income women are unlikely to have paid parental leave or have access to quality child care, especially if they’re shift workers. They’re also not likely to be able to take time out of the labor force when they do have a child.
“The social safety net in this country, for women who don't work, is almost non-existent, like welfare benefits are kind of laughably low,” says Myers, noting that welfare is just $220 a month.
Myers was the lead author on a brief signed by 154 economists and sent to the Supreme Court back in September, outlining the economic hardship overturning Roe v. Wade would bring.
She says that throughout their lifetimes, about a quarter of women in the U.S. have abortions. And because people who can afford it will still be able to seek an abortion in states where it’s legal, the inequality gap is just going to grow.
“This critical group, [currently] of about 100,000, in my estimate, of the poorest women, predominantly living in the banned states, they won't be able to find a way” to access safe abortion, she says.
“They're going to get blocked off from … a critical means of reproductive autonomy that other American women enjoy. And their lives will be impacted as a result.”
Studies show the impacts are felt for decades.
“Women are more likely to be poor, their current children are more likely to face insecurity and suffer, more likely to stay tethered to [their] abuser — there's all these range of impacts,” says Leila Abolfazli, director of federal reproductive rights at the National Women’s Law Center.
“Part of it is just common sense — what it's like when someone is struggling to make ends meet and then they're forced to carry a pregnancy to term — and in a country that really falls short on the range of things that it could do to support women and families.”
Private companies filling the gap
Several companies have stepped up in the initial days after the decision and promised to cover travel costs and expenses — up to several thousand dollars — for anyone seeking an abortion.
Those companies include big names like Dick’s Sporting Goods, JP Morgan Chase, Amazon, Bank of America and Bumble.
However, that would mean having to disclose personal health information to your employer. And it could lead to legal complications in states like Texas and Oklahoma that have laws prohibiting assisting others in getting an abortion.
Texas Senator Rep. Briscoe Cain has said he’s looking at ways to prosecute companies helping their employees get abortions out of state. He wrote a letter in May to Lyft CEO Logan Green demanding he rescind his comments about helping employees get access to care.
In the letter, Cain promises to introduce legislation barring corporations from doing business in states where they pay for abortion-related expenses.
That’s “regardless of where the abortion occurs, and regardless of the law in the jurisdiction where the abortion occurs,” writes Cain.
Even before Roe v. Wade was overturned, coverage for an abortion was complicated. The Hyde Amendment, which has been in effect since the 1970s, forbids federal money being used to fund abortions — except in cases of rape, incest or when a person’s life is in danger.
A 2019 report on abortion coverage by the Kaiser Foundation found the cost of the procedure varies depending on where and when it takes place and how it’s done.
The median cost at 10 weeks gestation was $500, while at 20 weeks gestation it costs about $1,200.
In more than 30 states, Medicaid programs don’t cover abortions outside of the Hyde exceptions. And many states impose abortion coverage restrictions on insurers, such as limiting coverage to cases of life endangerment.
Some insurance plans may cover out-of-state procedures in the wake of the recent Supreme Court decision, but it’s complicated and too soon to tell, says Abolfazli.
“Our system wasn't set up for a major health care service to be [lawfully] dependent on the state you’re in when people do travel for health care, and especially now they'll be traveling for abortion care,” says Abolfazli.
Long-term financial consequences
As the immediate costs and barriers stack up, it becomes clear to see how easy it is for women who are denied access to an abortion to fall behind.
A landmark "Turnaway" study began in 2007 and followed more than 1,000 women from 21 states over several years. Some participants had access to abortions, while others were denied.
Led by demographer Diana Greene Foster, the research team from the University of California, San Francisco regularly interviewed the participants.
“The harms of being denied an abortion last for years,” says Foster in an email.
Most of the women followed in the study were in their 20s, already had children and felt at the time they weren’t in a position to have another.
“Five years after seeking abortion, those who were denied were more likely than those who received abortions to report that they lack enough money to pay for basic living needs,” says Foster.
Women who were denied an abortion were almost four times more likely to have a household income below the federal poverty line and were three times more likely to be unemployed than the women who’d been able to access an abortion.
And the impact showed in their older children. Mothers who had been turned away from receiving an abortion didn’t bond as well with their children, who were also more likely to be identified as living in poverty.
The mothers were more likely to not have enough money to pay for basic necessities such as food, housing and transportation and they were more likely to stay in contact with violent partners.
“It's not theoretical,” says Abolfazli, at the Women’s Law Center. “It's real people's lives, and we keep seeing the stories and it's so gutting, because it's so preventable, right? Like, this is a man-made crisis to its core.”
An uncertain future
Abolfazli believes it will be decades before the right to choose returns in full, meaning decades of economic hardship for women without another option.
As the window for legal and safe abortion closes for so many, Sarah knows she was lucky. And she knows the even harder reality that awaits those who come after her, who will struggle to do research, consult a doctor or get a procedure in a safe environment.
“I feel like it will still happen, but more women will be at risk to die,” she says.