(NEW YORK) — As abortion rights increasingly come under threat across the country — with states like Oklahoma enacting “copycat” bills of sweeping Texas legislation that criminalizes abortion and with the Supreme Court poised to overturn abortion protections — advocates anticipate that women seeking abortion options will look outside the traditional health care system more and more.

For many women, that may mean pursuing a so-called medication abortion.

Medication abortions rely on pills, rather than surgery, to terminate the pregnancy. Usually two drugs — mifepristone and misoprostol — are used in combination to induce the abortion. In 2020, the number of medication abortions exceeded the number of surgical abortions for the first time, according to the Guttmacher Institute, a reproductive health policy research organization.

In “self-managed” cases, women do not undergo their abortions in a formal health care setting, according to the Guttmacher Institute.

That’s in contrast with “supervised” cases where women undergo their abortions under the watchful eye of supervising clinicians. Currently, 19 states require clinicians to be physically present when the medication is administered, according to the Guttmacher Institute.

But since the Texas law and its copycats place health care providers who facilitate pregnancies at legal risk — including telehealth clinicians who support the process virtually — supervising health providers could be held legally liable, Elizabeth Sepper, a professor of law at the University of Texas at Austin, told ABC News.

For example, the recently passed Oklahoma legislation could hold any individual — doctors, nurses, pharmacists — that “aids or abets the performance or inducement of an abortion” legally liable. This raises the concern that — to avoid liability — those individuals might turn away women seeking abortions, Sepper told ABC News.

As a result, pursuing a medication abortion increasingly means self-managing the process without medical supervision, Alina Salganicoff, director of women’s health policy at the Kaiser Family Foundation, told ABC News.

Sometimes, that’s meant crossing international borders into Mexico or Canada to obtain pills.

“I think there’s no question that people seeking abortions will look into any option,” Salganicoff told ABC News, “just because you ban an abortion doesn’t mean women won’t continue to seek them.”

More often, that’s meant turning to the postal service.

In July 2020, following a suit by the American Civil Liberties Union, the Food and Drug Administration temporarily suspended restrictions allowing mifepristone to be delivered by mail. Last December, the FDA permanently lifted those restrictions.

There are now numerous companies and international pharmacies devoted to shipping pills, according to Plan C, an information portal for self-managed abortion services. Some companies even ship to a handful of states — like Arizona and Texas — where mailing abortion pills is illegal.

The number of pills currently being sent through the mail is difficult to track, Abigail Aiken, an associate professor in health policy at the University of Texas at Austin, told ABC News.

But requests for the medicines by mail have skyrocketed in Texas since the legislation: one study found that, after the passage of the law, requests sent to Aid Access — the country’s largest telehealth abortion provider — leapt 10-fold in the week after it was enacted. Daily requests remained twice as high as the pre-legislation baseline over the next three months, after which point the researchers stopped tracking.

“I think we can see that making abortion illegal doesn’t limit the need for abortion,” Abigail Aiken, who is also the lead investigator on the study, told ABC News, “it just shifts where individuals can find care.”

Data on information seeking for self-managed abortions acquired by ABC News suggests these patterns in Texas may foreshadow broader trends across the country.

In the week after the Supreme Court’s draft decision leaked to the press, page views and overall users on Plan C’s website increased seven-fold. The number coming from states with Texas copycat laws leapt further still: page views from users in Idaho increased 23-times, and page views from those in Oklahoma increased 18-times, according to Elisa Wells, co-director of Plan C.

The good news about self-managed medication abortions, Aiken told ABC News, is that they appear safe and effective for most women who use them early in pregnancy. Recent U.S.-based studies have reported that up to 96% of women undergoing self-managed medication abortions before 10 weeks of gestation successfully terminated their pregnancy.

But doctors fear that the success rates will likely be lower in women who turn to the medications in lieu of other options who are further along in their pregnancy. The later the pregnancy, the higher risk that something will go wrong for women attempting self-managed medication abortions – including blood infections that can be life-threatening without urgent medical care, experts said.

“I have some concern that … regardless of whether their self-assessment [for gestational age] says they’re eligible, they’ll use the pills — because they’re desperate,” Daniel Grossman, professor of obstetrics and gynecology at the University of California San Francisco, told ABC News.

Then there’s the legal risk. In Texas, women like Lizelle Herrera have already been arrested under murder charges after their abortions came to light. Seeking medical care could similarly leave them vulnerable to criminal prosecution, Sepper told ABC News, which would further discourage them from seeking care.

If women with abortions who need care avoid it out of concern for legal consequences, it could endanger their health, Grossman told ABC News.

Despite all the potential upsides of medication abortions, the risk of undue death is what advocates fear most. Especially, since abortion seekers are disproportionately from groups that already face the highest rates of maternal death, including communities of color.

“We know that when abortion is illegal, it doesn’t make it less common, it just makes it less safe,” Danika Severino Wynn, vice president of abortion access at Planned Parenthood, told ABC News.

“When we push people further into the shadows, it means we are undoubtedly making their care more dangerous,” Wynn said.

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(NEW YORK) — People of color will face the brunt of the impact if Roe v. Wade is overturned by the Supreme Court, abortion rights advocates warn.

The landmark decision that protected a person’s right to have an abortion is in danger of being overturned by the high court’s conservative majority, according to a draft court opinion leaked this week to Politico.

Activists who work in Black and brown communities fear the socioeconomic effects of this potential decision from the highest court in the country. Abortion rights, they say, are an economic and health justice issue.

Abortion rights advocates say there are several factors that may go into a person’s decision to seek an abortion, including health care access and quality, financial support and willingness to be pregnant.

“This is not something where it’s either: make a choice to choose to be a parent or not to choose to be a parent,” said Oriaku Njoku, co-founder and executive director of ARC-Southeast, an abortion fund in Georgia that serves six states across the Southeast region. “There’s so many things like access to food, access to a living wage, access to insurance, your race, your gender, your ability to make money for your family.”

She says that not just the right to have an abortion, but also the right to access an abortion has long been threatened and that many people are struggling with the multifaceted injustices in poverty, health care and stability.

The demographics of abortion patients

In the most recent data from the CDC in 2019, Black women had the highest rate of abortions with 23.8 abortions per 1,000 women.

Hispanic women had 11.7 abortions per 1,000 women, according to the CDC. White women had the lowest rate: 6.6 abortions per 1,000 women. The majority of these women — 56.9% — were in their 20s, according to the data.

The country’s most marginalized will be affected by looming abortion bans: people already impacted by poverty, lack of healthcare access and racism in the healthcare system, advocates say.

“This fight for abortion access that we’re in right now is a fight against white supremacy in this country,” said Monica Raye Simpson, the executive director of the Southern-based reproductive justice group SisterSong.

“When we live in a world in a country where access to health care is already extremely limited to people of color … that is a problem,” said Simpson.

She continued, “To think about what it would mean to take care of themselves, accepting themselves as a family, like all of these are parts of a decision that one has to think about when thinking about creating a family.”

Health care challenges for people of color

Research has shown that racial and ethnic minorities often receive lower-quality health care than white people.

Even when factors like income, age, condition, and insurance are comparable, research has shown that Black and brown people are still failed by the health care system.

These poor health systems contribute to worse health conditions: Black people are at higher risk for heart diseases, stroke, cancer, asthma, diabetes, according to the Department for Health and Human Services.

Experts say America’s poor systems of health make abortions a vital part of health care for people of color.

Black and Hispanic women are more likely than white women to experience health complications during pregnancy and childbirth, according to Blue Cross Blue Shield Association.

A recent report from the Centers for Disease Control and Prevention also found that Black women died of maternal causes at nearly three times the rate of white women in 2020.

The rate for Black women was 55.3 deaths per 100,000 in 2020 and the rate for white women was 19.1 deaths per 100,000, according to the CDC. For Black women, the rate increased nearly 26% from the year prior.

Being pregnant presents some kind of risk. And unintended pregnancies increase the risk for poor maternal and infant outcomes, the CDC reports.

“The real issue is the historic and ongoing disparities and access to quality health care, and sexual and reproductive health information in Black and brown communities,” Njoku told ABC News. “This is denying the next generation a better future. Improving access to health care, education, family planning; I feel like those are better ways to reduce unintended pregnancies than trying to restrict abortion.”

For others, terminating unintended pregnancies can be a financial decision.

The financial implications of pregnancy

Activists say an abortion ban will only push pregnant people into poverty or into debt. Pregnancy and childbirth alone can cost thousands of dollars.

Black and Hispanic people are 1.8 and 1.5 times as likely to be in poverty than white people, according to 2019 census data.

The Economic Policy Institute also found that Latinas earn 57 cents and Black women earn 65 cents for every dollar earned by white, non-Hispanic men.

“When there are barriers placed on someone’s ability to access abortion care, it pushes them farther into pregnancy, and has pretty devastating financial implications for folks who have to pay out of pocket if their insurance doesn’t cover abortion care,” said Morgan Hopkins, the executive director of campaigns and strategies for abortion rights group All* Above All.

“It only gets more expensive the further into pregnancy you go,” Hopkins said.

However, many reproductive rights activists say that even while Roe is the law of the land, abortion is still hard to access for many across the country.

“Codifying Roe is not going to make abortion more accessible,” said Njoku. “It’s not going to change the fact that we live in places where there are abortion deserts … it’s not going to change the fact that people are crossing state lines to get abortions.”

According to reproductive care researchers at the Guttmacher Institute, abortion access has long been limited for those in states with stronger abortion restrictions, that already push people to travel out of state.

In states with anti-abortion rights legislation, the organization found a high correlation between the “proportion of women whose nearest provider was in another state and the proportion who obtained out-of-state care not found in a state with supportive abortion policies.”

For some, it can be an expensive but necessary task.

“If this leaked draft becomes final, it will be earth-shattering and felt hardest for those same communities that are already being disproportionately impacted,” Hopkins said.

“If someone is forced to carry a pregnancy to term, it impacts their economic security and their ability to live the life that they want and raise the family that they maybe already have,” Hopkins said. “The impact will be devastating.”

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