On June 24, soon after the U.S. Supreme Court struck down Roe v. Wade, California lawmakers tweeted about plans to expand the state’s legal access to reproductive health care, including abortion.
Meanwhile, 1,500 miles away, in Missouri, a pregnant woman cautiously typed a question into her phone’s search engine:
“How long will I go to jail if I get an abortion?”
Those two scenes represent the new reality of abortion in America, where the legal and social impact of the same medical procedure now ranges from supportive to punitive, depending on where a woman lives and her access to travel.
In the hours after the Roe ruling, legislators in Sacramento considered a suite of bills aimed at helping women gain access to abortion, including proposals to hire a new tier of health workers to help provide abortions and another to protect abortion providers who might face penalties from other states.
That same day, Missouri’s governor and attorney general made theirs the first state to outlaw abortion in a post-Roe world. The Republican-majority legislature had previously overwhelmingly approved a so-called trigger law that bans all abortion in Missouri except when the mother’s life is in danger, with no exceptions for rape or incest.
But while legislators talk and pass laws for and against abortion access, real lives are going forward.
And the stories of women following the abortion rules established in California and Missouri — polar opposites in the national scrum over abortion law — illustrate the different, life-changing paths available for women or girls who are pregnant and don’t want to have a child.
Few options, many hoops
The Missouri woman, whose name is being withheld to protect her from potential ramifications, learned she was pregnant less than 24 hours before the Supreme Court publicly released its ruling on Roe.
She lives in the state’s southern region, a rural, beautiful slice of the country, albeit a slice with little access to routine health care or reliable internet. In fact, she didn’t find out about the Supreme Court’s decision until early Saturday, an anomaly in a world that includes 24-hour news and social media.
In an unstable and unhealthy home, she knew immediately that she wanted to terminate what is still a very early pregnancy. Even after learning of the state’s ban, which took effect on June 28, she views abortion as her only option.
But to get that procedure as a resident of Missouri, she is jumping through many hoops.
For starters, the new ban means the state’s last abortion-provider, which is in St. Louis and already would have been a bit of a trek, was no longer a possibility. So she turned to Google, where a search yielded three options — a Planned Parenthood in Overland Park, Kansas; a Planned Parenthood in Fairview Heights, Illinois; and the Hope Clinic in Granite City, Illinois. Each is nearly 200 miles from the woman’s home.
She then spent about a day on research (after traveling a bit to get solid WiFi) to learn about appointment times, the cost of the service at each location, and what financial assistance, if any, might be available.
Timing, it turned out, will be tricky. In the wake of the Roe ruling, average wait-times at many abortion providers outside Missouri have stretched to two weeks. So the Missouri woman felt she no longer had the luxury of choosing a time that was convenient and, instead, will accept the first available slot.
Ultimately, she chose the Planned Parenthood clinic in Fairview Heights, about 180 miles from her home.
There, the cost for medication abortion is $470 and in-clinic abortions range in price from $470 to $3,500 based on gestational age. She does not have insurance that will cover the procedure and will need financial assistance.
Planned Parenthood in Illinois can provide some financial help. There’s also the Midwest Access Coalition, which can pay for transportation, food, child care, lodging, emergency support, and other services, as well as the Chicago Abortion Fund, which provides financial and logistical support to people in the Midwest.
After learning more details she decided she’ll need at least two days off work and a one-night stay in a hotel. The eight-hour round-trip drive, plus the procedure, will be too much for a single day.
When that time comes, the Missouri woman, who is in her 20s, plans to tell her employer she is sick, hoping the real reason for her absence isn’t found out. Her home town is small, she said, and she wants to keep her decision private.
And even though she is confident in her decision, she is still racked with fear someone in her life will find out.
“I never, ever thought I would need an abortion. And if you’d asked me 10 years ago, I’d be angry with myself for what happened,” said Marcy, 29, who lives in Riverside County and works at a bank in Orange County.
Late last year, Marcy chose not to have a third child. Though she said the the decision to terminate that pregnancy was fraught — and she doesn’t want her legal name used because she believes she would be shunned by some members of her family — she faced no legal or practical roadblocks in California.
“That part was pretty easy,” Marcy said. “And the people I dealt with at the clinic really just listened. They didn’t try to push anything on me. I really appreciate that.”
Marcy used a home test in early December to confirm what she already knew from experience — she was pregnant. Though it would be months before the Supreme Court issued its ruling on Roe, the positive result came just two weeks after her husband moved out.
With two children (now ages 7 and 3) at home, and a support system that she describes as “sporadic,” the news was devastating.
“I’m not a big crier, but I just sobbed,” Marcy said. “I just felt like everything was falling apart.”
At first, she didn’t think of abortion. She asked a trusted aunt to come over for dinner, planning to ask about legal advice related to her soon-to-be ex-husband.
“I think she figured out I was pregnant when I got up from the table to go throw up,” Marcy said, laughing.
Her aunt was blunt, asking a simple question: “What are you going to do?”
“That’s when I realized I had options,” Marcy said.
Like the woman in Missouri, Marcy soon searched online to find potential abortion providers, making an appointment at a Planned Parenthood clinic — one of more than 100 in the state — that is about 10 miles from her apartment.
In California, Marcy’s online search carries no legal weight. Abortion is legal in the state for any reason up to the time the fetus is viable, and information about abortion, contraception and other reproductive health care is widely available.
But many worry that in Missouri such an online search could be used as evidence of a crime. The state’s ban makes it a felony for a health worker to provide an abortion in non-emergency situations, with a penalty of up to 15 years in prison and possible loss of a medical license. It’s not yet clear how online searches, phone calls or any other electronic trails might be used in any future prosecutions.
After her online search, Marcy called the clinic. She was asked, among other things, what service she was seeking. At the time, Marcy said, she didn’t know.
Nine days later she met face-to-face with a nurse practitioner. That conversation included questions about Marcy’s general health and how her previous pregnancies had gone. Though she was provided with what she described as “equal doses” of factual information about what to expect if she had the baby or gave it up for adoption, she pressed for information about how to terminate her pregnancy.
“I’ve had two babies. I kind of know how that process works and what I need to do if I want to see my doctor,” Marcy said.
“I was asking about how abortion would work.”
During that initial meeting, Marcy said she had an ultrasound and learned that she was seven weeks pregnant.
Three days later, at home, she took the first of two pills needed to complete a medically induced abortion. A day later, when she took the second pill, she stayed home from work and watched “The Wedding Singer” with her aunt.
Two days after that, she spoke on the phone with her nurse practitioner, who asked how she was feeling and about any side-effects from the drug. She also took another pregnancy test; it came back negative.
In all, Marcy said, she spent about $200 on co-pays; insurance covered the rest. If she hadn’t been able to afford the procedure, Planned Parenthood would have covered the costs, as would state insurance.
Marcy said she still wishes the episode never happened, but maintained the actual process of ending her pregnancy was “as smooth as something that awful could be.”
“I don’t regret the choice,” Marcy said. “I wish I hadn’t had to make it, but I don’t regret it.”
So, how much jail time would the woman in Missouri get?
The answer, for now, is none. The state’s abortion ban specifically exempts pregnant women from prosecution.
But it’s unclear if that will always be true. This year, before the Roe ruling, Missouri officials proposed making it illegal for residents to travel out of state to terminate their pregnancies, and abortion opponents in other states are considering pushing for similar laws.
With abortion a state-by-state issue, leaders in states like California and Missouri are loudly pushing legislation that figures to expand their differences.
“We know that states like Missouri are already targeting women seeking abortions in states like California where abortion remains legal,” California Gov. Gavin Newsom said on June 24, as he signed AB-1666, which protects health workers in his state from punishment imposed by other states.
“This legislation seeks to protect women and care providers from civil liability imposed by other states, and sends a clear message that California will continue to be a safe haven for all women seeking reproductive health care services in our state.”
If true, that could be a bigger deal going forward. A new study from the Center on Reproductive Health, Law and Policy at UCLA School of Law, found that in a post-Roe America, as many as 16,000 women a year will travel to California for abortions, and as many as 9,700 of those women will chose to do that in Los Angeles and surrounding counties.
Unless, of course, abortion stops being a state-by-state issue.
Days after the Roe ruling, leading Democrats and Republicans called for national laws that would codify their party’s preferences on abortion. And if Republicans win control of Congress and the White House in 2024, many experts believe a national ban is a possibility.
Missouri Gov. Mike Parson, a Republican, described his state’s abortion ban only as a key step — not a final step — in a longer battle.
“Thanks to decades of conservative leaders, Missouri has become one of the most pro-life states in the nation, and our administration has always fought for the life of every unborn child,” Parson said.
“Our efforts have produced what generations of Missourians have worked and prayed for … We have won our fight to protect innocent life.”
In an interview, Missouri state Sen. Lauren Arthur, a Democrat who represents a Kansas City-area district, suggested the next step is a national fight.
“I appreciate that blue states are trying to assert protections,” she said. “But there’s a real chance that minority rule is going to make it such that no woman anywhere is safe.”