A Post-Roe World : Up First A leaked opinion from the Supreme Court signaled that a majority of the justices may be ready to end constitutional abortion-rights protections. Many states are preparing to restrict access to abortion in a post-Roe v. Wade world. One state provides a glimpse of what that world could look like. NPR correspondent Sarah McCammon reports from Texas, where most abortions have been banned since last September.

A previous version of this episode aired on NPR's Consider This podcast.

A Post-Roe World

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Hey. It's Rachel Martin, and this is UP FIRST Sunday. This past week, we got a rare glimpse into the inner workings of the Supreme Court in the form of a leaked document published by Politico. It was a draft opinion written by conservative Justice Samuel Alito.

MICHELE BRATCHER GOODWIN: It is an opinion that dismantles Roe full scale, not the dismantling by a thousand strikes.

MARTIN: Michele Bratcher Goodwin is a law professor at the University of California, Irvine.

GOODWIN: It is a very strong punch to the gut of that opinion.

MARTIN: In other words, this would end Roe v. Wade and federal abortion protection as we've known it for nearly 50 years. Chief Justice John Roberts confirmed the authenticity of the draft, but he added that it doesn't represent a decision by the court or the final position of any justice. Even so, activists from around the country saw this as a view into the inevitable.






FATIMA GOSS GRAVES: We have been warning for decades about what is happening in this country in terms of abortion access and the attack on Roe.

MARTIN: Fatima Goss Graves is with the National Women's Law Center.

GOSS GRAVES: I think this draft opinion is making it real for people.

MARTIN: The leaked opinion made it real for anti-abortion activists too, like Steve Aden with Americans United for Life.

STEVE ADEN: If this opinion holds, it means that the question of abortion has been returned to the states and the people, and that will result in a vigorous political debate in a place where it belongs - in the statehouses.

MARTIN: Right now, 13 states have what are called trigger bans. These are laws designed to ban abortion if Roe is struck down. And another 13 states have restrictions on the books that could quickly ban most abortions.

ELIZABETH NASH: From Idaho to Kentucky, all the way up to North Dakota and down to Texas.

MARTIN: Elizabeth Nash is with the Guttmacher Institute, an abortion-rights research group that's been keeping an eye on those states.

NASH: So they're across the country. They're a cross-section of the country and would all be in effect within one month of the decision, with most of them going into effect in maybe even as quickly as a day.

MARTIN: Those are all the red states. Democrat-led blue states will still have protections for abortion in place. Some have already signaled they'll be a safe haven for out-of-state travelers. So today, we're thinking about what a post-Roe future could look like. We don't have to work very hard to conjure it up. In Mississippi, the state at the center of the Supreme Court case, there's only one abortion clinic in operation. And since last September, one state has already banned most abortions. Coming up, we go to Texas.


MARTIN: Welcome back to UP FIRST Sunday. I'm Rachel Martin. A version of today's episode previously aired on NPR's Considered This podcast. And a quick warning - the stories coming up deal with miscarriage and sexual assault.

MADY: When I initially found out that I was pregnant, I was like, I cannot have a kid right now. Like, I cannot do that.

MARTIN: That's Mady. We're using her first name only. She's a 21-year-old college student living in Houston. She found out she was pregnant last year after Texas passed a law that makes it illegal to get an abortion after about six weeks. The typical standard elsewhere is around 24 weeks. Mady had already been pregnant for six, so she had to look to neighboring states.

MADY: So I drove all the way to Mississippi through the night with my father. And then after the initial visit, they were like, you can come in on this day at this time next week. And so right after my appointment, we turned around and drove back to Texas.

MARTIN: A week later, Mady did come back and had the abortion. In total, the entire process cost her about $2,000, a price that would be far too high for many women in this country. And since this Texas law - called SB 8 - went into effect last September, it has likely affected thousands of women.

AMNA DERMISH: What we really don't know at this point is how many of those are actually able to seek care out of state and how many are forced to continue a pregnancy against their will.

MARTIN: Dr. Amna Dermish is an OB-GYN and a regional medical director at Planned Parenthood in Austin. She says that six-week window leaves hardly any time for women to get a legal abortion in the state.

DERMISH: Even then, if she were to have a positive pregnancy test, she barely has a week and a half to find a clinic, undergo a 24-hour waiting period and then have access to an abortion.

MARTIN: Which is why this new law effectively outlaws abortion. John Seago with the anti-abortion rights organization Texas Right to Life put it this way.

JOHN SEAGO: We are actually, in Texas, getting a glimpse of what a post-Roe world would look like. We are experiencing close to an abortion-free state, and that has never happened since 1973.


MARTIN: Not only does the law in Texas make abortion expensive and inconvenient, it also endangers the lives of patients. That's what NPR correspondent Sarah McCammon found when she visited Texas a few months ago. Sarah's going to take it from here.


SARAH MCCAMMON, BYLINE: Ana and Scott were planning their wedding in Central Texas for this coming May when Ana realized her period was almost two weeks late.

ANA: And I just remember laughing to myself because I was like, wow, for as responsible as I think I am all the time, like, I had no idea that I was pregnant and that late.

MARTIN: We're just using Ana and Scott's first names because of the sensitivity of this story. It was September, and SB 8 had just taken effect. It bans most abortions in Texas as soon as any cardiac activity can be detected, usually around six weeks of pregnancy, or about two weeks after a missed period. That didn't give Ana and Scott much time, but they were open to having a baby, so they moved up their wedding plans to December. When that day arrived, Ana was 19 weeks pregnant. And she was in her wedding dress when she noticed something was wrong.

ANA: It felt like something was coming out of me, so I freaked out. Like, I literally wet my dress and the seat that I was in.

MCCAMMON: Ana's water had broken too early for the baby to survive. She and Scott spent the night of their wedding in the ER trying to take in heartbreaking news.

ANA: Basically, the doctor looked at me and was like, well, the baby's underdeveloped. Even with the best NICU care in the world, they're not going to survive.

MCCAMMON: And as painful as it was to hear that, the doctors told Ana there was another urgent concern.

ANA: You're at a high chance of going septic or bleeding out, and unfortunately, we recommend termination, but we cannot provide you one here in Texas because of this law.

MCCAMMON: In her situation, Ana's doctor says a patient would normally be offered a few options - wait and watch for signs of danger or terminate the pregnancy. She says termination would be safest and most likely to preserve Ana's future fertility. But under Texas law, abortions are only allowed at that stage for severe medical emergencies, defined as when a patient is, quote, "in danger of death or a serious risk of substantial impairment of a major bodily function." Ana's doctor asked us not to use her name because she worries about frivolous lawsuits in the current environment.

UNIDENTIFIED DOCTOR: If you were given this on a board exam, you would say, what would you tell this patient? And your answer would be, expectant management or offer a termination. Those are essentially the two choices that is standard of care in the United States.

MCCAMMON: As long as fetal heart tones were detectable, doctors told Ana they couldn't offer her a termination unless her life was in imminent danger. It's impossible to know how many patients and doctors are facing similar conversations in Texas, but Ana's doctor says many of her colleagues are feeling frustration and disbelief as they navigate complex situations. The law contains no exception for pregnancies conceived through rape or incest, which can also create unexpected and wrenching decisions for patients and doctors. Dr. Andrea Palmer is an OB-GYN in Fort Worth. She recently took care of a woman who discovered she was pregnant after being drugged and raped at a party. Before the assault, she and her husband had been trying for a baby.

ANDREA PALMER: She was not able to discern whether the baby was the product of consensual sex with her husband or the product of her sexual assault.

MCCAMMON: Genetic testing could have answered that question, but not in time to legally get an abortion close to home. Palmer says her patient couldn't afford to travel out of state and didn't want to risk waiting and finding out the worst, so she got an early abortion in Texas while it was still legal.

PALMER: The thought of carrying something in your body and of raising a baby that could have been by a man who was sadistic and sick and awful enough to drug and rape a complete stranger - I just cannot imagine that somebody who claims to have love in their heart would ever wish that particular bit of hell on another human being.

MCCAMMON: Palmer says her patient gave permission to share her story anonymously so people could hear how complicated and difficult these decisions can be.

SEAGO: Yeah, I mean, it's absolutely horrific.

MCCAMMON: John Seago is legislative director with Texas Right to Life, which helped push SB 8 through the state Legislature last year. He says the law's supporters believe abortion is an act of injustice no matter what.

SEAGO: Even in the worst circumstances, another act of violence on an innocent victim is not the best solution that we have.

MCCAMMON: Seago says when it comes to medical emergencies, medical associations should do more to help doctors understand what's allowed under the law. But groups like the American College of Obstetricians and Gynecologists say the law is vaguely worded and leaves providers vulnerable to being sued. In the ER on their wedding night, Ana and Scott say their doctors could do little to help them.

ANA: And I remember being like, why can't you just do this? You know, they couldn't even say the word abortion. Like, I could see the fear in these doctors' eyes that they were just so scared to even talk about it. Like...

SCOTT: They were typing stuff out on their phones and showing it to us.

MCCAMMON: Ana's doctor wasn't working that night in the ER, but one of her partners filled her in the next morning. The doctor says she called Ana right away.

UNIDENTIFIED DOCTOR: She asked, so the state of Texas just wants me to get sick enough that I have to be admitted to the hospital? And I said, yes, that's essentially what's happening.

MCCAMMON: They needed a plan to get Ana to a place where she could get the procedure as quickly as possible. They ruled out some nearby states, including Oklahoma and Arkansas, with mandatory waiting periods as long as three days.

SCOTT: So there's two options. There's New Mexico, and there's Colorado. Would we rather have her go into labor on a plane or out by Midland?

ANA: Like, in a car.

SCOTT: In a car.

UNIDENTIFIED DOCTOR: And I said, absolutely not.

MCCAMMON: That's Ana's doctor again.

UNIDENTIFIED DOCTOR: ...Because West Texas is at least eight or nine hours of desert with hours with no cellphone reception, no gas station in, you know, the middle of a medical crisis. So I requested she take a flight and make it a direct flight if possible.

MCCAMMON: But Ana says that plan came with its own set of risks.

ANA: Oh, God. When I talk about this, this is the hardest thing. I had to come up with a game plan with my OB in case I went into labor on the flight. And I made sure that I bought us front row seats so I could be close to the bathroom in case it happened. And (crying) like, no one should ever have to do that.

MCCAMMON: But even through tears, Ana says she knows she was lucky to have several thousand dollars in savings to cover the cost and to get an appointment in Colorado at all. Clinics across the region say they're struggling to accommodate the surge in demand from Texas patients, and they're fearful that many more states could implement similar laws if the U.S. Supreme Court overturns decades of precedent guaranteeing abortion rights. Since her ordeal, Ana says she fears for the lives of other women.

ANA: I don't call any of these people pro-life because I've never felt like I didn't matter, that my life was expendable than I did in that moment. Somebody is going to die eventually.


MARTIN: That story came from NPR correspondent Sarah McCammon. Meanwhile, Republican-led states are moving forward. Idaho passed a Texas-style law that's currently tied up in court. Last Tuesday, Oklahoma's Republican governor signed a law modeled after the one in Texas as well, and the state recently passed a near-total abortion ban that would become law in August if Roe is overturned.


MARTIN: Today's episode was produced by Lee Hale and edited by Jenny Schmidt with help from Ammad Omar, Jason Fuller, Lauren Hodges and the team at NPR's CONSIDER THIS podcast. Additional reporting came from Wade Goodwyn. Our supervising senior producer is Bruce Auster, and our supervising producer is Liana Simstrom. We'll be back tomorrow with all the news you need to start your week. Enjoy the rest of your Sunday.

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