The anti-abortion movement is about to win. Even it isn't ready for what comes next.
Tracking down the sources of abortion pills, a brewing internal schism over arresting pregnant people — welcome to the post-Roe future.
By Anna North May 19, 2022, 1:19pm EDT
Illustrations by Julia Kuo for Vox
Demonstrators allude to the future after Roe during the annual 49th March for Life anti-abortion demonstration on Capitol Hill in January 2022.
Tom Williams/CQ-Roll Call/Getty Images
Share All sharing options for: The anti-abortion movement is about to win. Even it isn't ready for what comes next.
Part of the May 2022 issue of The Highlight, our home for ambitious stories that explain our world.
At first glance, the April 2022 arrest of Lizelle Herrera seemed like exactly what anti-abortion advocates have always wanted. After a hospital in rural Starr County, Texas, reported her to authorities, the 26-year-old was arrested and charged with murder, her bail set at $500,000. Though few details are known about her case, Herrera's crime, according to the indictment, was causing "the death of an individual" by "a self-induced abortion." In just a few succinct lines, a Texas grand jury had clearly and publicly affirmed that abortion was murder, a rallying cry for opponents of the procedure for more than 40 years.
The indictment was seen by many as a direct result of the passage of SB 8, a recent Texas law that effectively bans abortions after six weeks of pregnancy. The law represents an extraordinary step for the anti-abortion movement, empowering ordinary citizens to enforce the ban by suing anyone they believed had performed or aided in an abortion.
Abortion opponents have since notched another, even broader victory: A recent leaked draft opinion written by Supreme Court Justice Samuel Alito appeared to show that the Court plans to overturn Roe v. Wade, the landmark 1973 decision establishing Americans' right to an abortion.
Anti-abortion activists have for decades made very clear their desire to stamp out the procedure nationwide, and they are winning: If the Court does indeed overturn Roe, abortion will likely become illegal in at least 23 states. Meanwhile, SB 8 is inspiring a wave of similar, highly restrictive anti-abortion legislation in other states, and anti-abortion groups and conservative lawmakers are said to be simultaneously positioning themselves to put forward a federal abortion ban.
Herrera's indictment, however, was received by anti-abortion groups not as a triumph but as an unwelcome shock. As national uproar grew around the case, Texas Right to Life, the group that helped write SB 8, spoke out against Herrera's arrest. Just days after she was jailed, Starr County District Attorney Gocha Ramirez dismissed the indictment, saying in an April 10 statement that "it is clear that Ms. Herrera cannot and should not be prosecuted for the allegation against her." Ramirez even went so far as to apologize to Herrera's lawyer, saying, "I assure you I never meant to hurt this young lady," the Washington Post reported.
Historically, anti-abortion advocates have called for restrictions and punishments targeted at abortion providers, not patients. "When we're looking at law-breaking, we need to go to the person who is causing the danger," Katie Glenn, government affairs counsel for the anti-abortion advocacy group Americans United for Life, told Vox. In the past, that has meant doctors.
Yet the rise of medication abortion means that people can perform their own abortions in the privacy of their homes, becoming, effectively, both provider and patient. This method, also known as self-managed abortion, is expected to become more common as laws like SB 8 and the likely fall of Roe make in-clinic procedures ever harder to obtain.
Herrera's story, then, represents a jarring look at what could be the post-Roe future: a new phase for the anti-abortion movement, with a growing schism between mainstream groups whose next goal will be curbing access to pills, and hardliners, including one of the activists behind SB 8, who want to see private citizens jailed for terminating their own pregnancies.
The developments, anti-abortion groups and scholars of the movement say, all threaten to turn a half-century of anti-abortion strategy on its head, just as the movement prepares for one of its biggest victories ever.
The anti-abortion movement as we know it today arguably started before Roe, in the 1960s, when states began liberalizing their abortion laws. At that time, individual abortion opponents began to coalesce into groups in liberal states like California and Colorado, said Jennifer Holland, a history professor at the University of Oklahoma and the author of the book Tiny You: A Western History of the Anti-Abortion Movement. But it wasn't until after Roe that the movement became national in scope.
In the years after 1973, anti-abortion groups such as the National Right to Life Committee and Americans United for Life took a two-pronged approach to fighting Roe. First and most visibly, they pushed for abortion restrictions — mostly at the state level — that the Supreme Court would accept, such as bans on certain abortion procedures or laws governing clinic operations. Second, they did "a lot of work to change hearts and minds," Holland said. That meant convincing churches to make anti-abortion politics part of "the rituals of people's faith," which they had not been, even among American Catholics, prior to the 1970s.
Julia Kuo for Vox
It also meant finding new spokespeople for the cause. In the '80s and '90s, Holland said, anti-abortion groups began looking for "other victims of abortion" who could become advocates for abortion restrictions. The most successful of these were women who had undergone abortions, and whom the movement could cast as victims of an exploitative industry eager to capitalize on their desperation. The message was that "abortion physically hurts, but it also psychologically traumatizes, and more broadly, feminism and sexual modernism has deluded women into thinking that this isn't the case," Holland said.
Medical and professional groups including the American Psychological Association and the American College of Obstetricians and Gynecologists have repeatedly refuted claims that abortion harms pregnant people. The landmark Turnaway Study, published in 2020, also found that women who received abortions fared better on several measures of health and family well-being than women who sought the procedure but were denied. Still, the narrative of abortion as harmful has persisted, and some of the most visible anti-abortion advocates over the years — including Norma McCorvey, the plaintiff in Roe who became a vocal abortion opponent only to disavow that position on her deathbed — have been women who have previously terminated a pregnancy.
This is one reason that the restrictions backed by abortion opponents have typically targeted clinics and providers, rather than seeking to punish the people who have abortions. Even a few years before Roe, anti-birth-control movements sought legal restrictions on contraception as a "punishment for promiscuity," Holland said. But by the 1970s, "the world's changed, the feminist movement has shifted the ground of debate," she added, making the idea of punishing women for unwanted pregnancies unpopular. Anti-abortion advocates began to cast the abortion-seeking woman as a victim because, Holland said, "it's so unsympathetic for the movement if she's not."
By targeting what they called the "abortion industry," opponents racked up major political and cultural successes. Measures such as the 1976 Hyde Amendment, which bars federal funding for most abortions, chipped away at abortion access, especially for low-income Americans and Black people, Indigenous people, and other people of color. A more radical arm of the movement sprang up, too, in the 1980s and 1990s, using civil disobedience and sometimes violence to intimidate patients and providers. Crimes such as the 2009 murder of George Tiller, a Kansas physician who performed abortions later in pregnancy, forced clinics to adopt heavy security and may have discouraged physicians from entering the field. Later, in the 2010s, restrictions on doctors and clinics — including laws governing hallway width at clinics or requiring hospital admitting privileges for providers — closed dozens of abortion facilities across the South and Midwest.
Anti-abortion advocates were also able to make full-throated opposition to abortion essentially a requirement for any Republican running for national office. Making abortion a political platform took time: As Holland pointed out, Ronald Reagan nominally opposed abortion but, in 1981, nominated Sandra Day O'Connor to the Supreme Court even though advocates said she was insufficiently conservative on abortion. As pressure mounted from anti-abortion groups, later Republican presidents, such as George W. Bush, toed the line. Donald Trump, who had previously supported abortion rights and was by no means a social conservative, promised during his campaign to appoint Supreme Court justices who would oppose Roe — a clear appeal to increasingly powerful anti-abortion activists.
He was as good as his word, making three appointments to the Court and giving conservatives a 6-3 majority by the end of 2020. Trump's presidency ushered in a period of extraordinary political gains for abortion opponents. By May 2021, the court announced that it would hear Dobbs v. Jackson Women's Health Organization, a case involving a 15-week ban on abortion in Mississippi. The case was a clear opportunity to revisit Roe, and advocates and court-watchers were wondering just how far the newly conservative-leaning Court would go. Would the justices really vote to overturn the decision in its entirety, or perhaps simply weaken it to give states more leeway to pass restrictions?
Then, on May 2, Politico published a draft opinion in the case, leaked by an unknown source, that confirmed what abortion rights supporters most feared: The Court was preparing an impassioned repudiation of the 1973 decision that made abortion legal across America. "Roe was egregiously wrong from the start," Alito wrote. "We hold that Roe ... must be overruled."
Anti-abortion activists celebrated the news. "It was just breathtaking for us," said Sarah Zagorski, communications director at Louisiana Right to Life. "We felt very excited, very hopeful."
The Court has yet to issue an official decision in the case, and it's possible that some justices will break with Alito's opinion in the coming days or weeks. But as Vox's Ian Millhiser reports, it is highly likely "that the Court's final opinion will look a whole lot like Alito's first draft."
If Roe is overruled, about half of states have laws that will automatically ban abortion, either completely or at six weeks' gestation. These laws, which would take effect by the end of the summer, will govern 40 million women of reproductive age.
In a statement on the leaked draft, Morgan Hopkins, interim executive director of campaigns and strategies for the reproductive justice group All* Above All, warned, "The implications of this potential outcome would be earth shattering."
As the Supreme Court considers the future of Roe, lawmakers in red states have been working on their own to restrict abortion. SB 8 bans abortions as early as six weeks' gestation — before many people know they are pregnant. The architects of SB 8 appear to have designed the law specifically to evade legal challenge, as Millhiser has reported: Rather than empowering state officials to enforce the ban, it puts the onus on private citizens to sue anyone who performs an abortion or "aids and abets" performance of the procedure. Plaintiffs who win will get $10,000, and possibly even more, from defendants.
Laws like SB 8 have had an immediate effect on people seeking abortions. In the first 30 days after it was enacted, abortions in Texas dropped by 60 percent. Still, despite that precipitous drop, two recent studies have found that the number of abortions received by Texans dropped by only about 10 percent. That's because Texas residents either traveled out of state or self-managed their abortions with medication.
The first route is becoming increasingly difficult as states across the South and Midwest enact or plan their own restrictions: What once might have required a drive to a neighboring state now often means an expensive flight to one of the coastal regions where restrictions are fewer. Oklahoma, one state that saw an increase in Texas patients following SB 8, now has a ban of its own. The second option, meanwhile, is growing in popularity. According to one study published this year by University of Texas researchers, online requests for abortion medication from the nonprofit Aid Access were up 174 percent in the three months after the passage of SB 8.
Kent Nishimura/Los Angeles Times/Getty Images
Above: Abortion rights activists and anti-abortion activists shout at each other during a Bans Off Our Bodies rally and march to the Supreme Court of the United States on May 14, 2022, days after a leaked draft from the Supreme Court revealed a potential decision to overturn the precedent set by the landmark case Roe v. Wade. This photo: Demonstrators displayed coat hangers to allude to the days before Roe, when dangerous methods such as coat hangers were used to perform abortions on pregnant people unable to procure legal abortions.
Though the concept of an at-home abortion is still associated in some people's minds with frightening pre-Roe images of coat hangers, self-managed abortion with medication today is simple and, according to many experts, generally safe. The pregnant person typically takes a drug called misoprostol, which causes uterine contractions, alone or with another drug called mifepristone that stops the pregnancy from progressing. These medications, when prescribed by a doctor, are FDA-approved up to 10 weeks into pregnancy. When people "self-manage" their abortions, they get those pills from a friend or online, rather than from a clinical provider.
People who want to self-manage an abortion can get pills through Aid Access — an initiative started by Rebecca Gomperts, a doctor from the Netherlands, to dispatch the medication from abroad — effectively sidestepping state regulations on US abortion providers. They can also use the website Plan C Pills to find information about online pharmacies that will ship pills to them, sometimes from across state or national boundaries (Plan C Pills does not dispense medication). Others get the medication from relatives or friends. A growing number of telehealth companies also allow patients to obtain the medication from doctors remotely, but their operations are restricted in many red states.
Kat, who asked that their last name not be used because of the sensitivity around self-managed abortion, ordered pills online in 2021. They live in Texas and do abortion activism, so they knew access might soon be limited; they got the pills just in case of an unintended pregnancy. When they did become pregnant last year, taking the pills was a simple process, Kat said. They experienced pain, nausea, and vomiting, but said they knew to expect these symptoms.
"Emotionally, I was just relieved that I was able to have access to self-managed abortion and be able to just do it at home," Kat said. During the process, their friends checked in on them and dropped off food. "It was nice to know that I was still being supported," they said.
Self-managed abortions like Kat's collapse the distinction between patient and provider. They also pose a challenge for the anti-abortion strategy of enforcing restrictions through penalties imposed on doctors and clinics — what happens if there's no clinic to regulate or doctor to punish?
Mainstream anti-abortion groups have so far responded to self-managed abortion by backing laws that would prosecute providers of abortion medication. In Texas, for example, a law passed last year, SB 4, imposes new criminal penalties for providing abortion medication by mail. The law also includes an extradition provision for out-of-state providers who are found to have sent medication into Texas, but it's not clear that anyone has actually been extradited under the law. Indeed, authorities in states or countries that are friendly to abortion rights may have little interest in apprehending their residents and sending them to Texas for trial. "Having the law enforcement authorities on that side collaborate with and cooperate with Texas, because it is such a politically charged issue, may not be as practical," John Seago, legislative director of Texas Right to Life, acknowledged.
A combination pack of mifepristone and misoprostol tablets, provided by Plan C Pills, which are used in tandem in most medication abortions. Plan C Pills does not dispense the medications, but connects patients to online pharmacies.
Elisa Wells/PLAN C/AFP via Getty Images
What's ahead for the anti-abortion movement may be far messier and more decentralized than the clinic-focused strategy it once pursued. Essentially, abortion opponents could have to get into the business of drug enforcement. Some make this connection explicit. "We saw a video of a woman who's like, 'I ordered 12 packs of these, and I'm gonna hand them out to my friends,'" Glenn said. "How different is that from drug dealing?" She also mentioned concerns about people bringing abortion medication across the border from Mexico, where abortion is decriminalized.
The focus on pills coming across state borders is somewhat reminiscent of the war on drugs that the US began in the 1970s — an effort that is largely considered a failure, leading to mass incarceration of Black and Latinx people and other people of color without putting a stop to drug trafficking. "It's unclear how this is going to work out any differently," said Mary Ziegler, a law professor at Florida State University who studies the history of the abortion debate. "How are you going to stop the pills from crossing your borders?"
Given these difficulties, some experts on abortion politics believe it's only a matter of time before lawmakers and advocates turn to penalizing people for taking the pills, not just distributing them. "There are going to be scenarios where somebody gets themselves abortion medication in the mail and there's nobody else the state could go after," Ziegler said. "There's going to be increasing tension between this commitment that's been consistent so far not to punish women and pregnant people, and the commitment to actually enforce the law."
For many supporters of abortion rights, Lizelle Herrera's arrest in Texas was an ominous sign that it's already happening. Little is publicly known about the abortion referenced in the indictment. Most notably, no one seems sure what law Herrera is supposed to have broken: SB 8 contains language explicitly excluding the person getting the abortion from any civil liability, and the Texas penal code specifically states that people who get abortions cannot be charged with murder. Herrera has not spoken to media, and her lawyer did not respond to requests for comment from Vox.
Abortion rights advocates fear that SB 8 and laws like it will essentially create an army of civilian bounty hunters who have a financial incentive to spy on their neighbors and report them to police if they even suspect any involvement in an abortion. "When you create these types of restrictions, it opens up these doors for people to be very overzealous in how they approach somebody who's had an abortion," said Zaena Zamora, the director of Frontera Fund, an abortion fund that raised money for Herrera's defense. The restrictions can also sow confusion, potentially leading to erroneous reports or arrests. "Unless you're in this work and know this law, it's really difficult to have a full understanding of the implications of the legality around abortion in Texas," Zamora said.
Moreover, said Jill Adams, executive director of If/When/How, a reproductive justice legal and advocacy group, "When we have laws like SB 8 that implore people to surveil their neighbors and their fellow community members, it brings this air of judgment and stigma and shame over abortion and people who have abortions. And that stigma increases the likelihood of criminalization. It's all tied together."
For now, mainstream anti-abortion groups say they remain committed to punishing providers, not patients. "We firmly believe that women should not be prosecuted for abortion, whether self-managed or through an abortion provider," said Amy O'Donnell, director of communications for the group Texas Alliance for Life.
But Republican state lawmakers, some backed by more radical abortion opponents, are beginning to break with this ideology. Earlier this year, for example, Louisiana state Rep. Danny McCormick (R) introduced a bill that would allow people who get abortions to be charged with homicide, an offense punishable by life in prison without parole.
"Abortion is murder," McCormick, who has not responded to a request for comment from Vox, said at a May hearing. "As lawmakers, we have a responsibility to end it."
Louisiana Right to Life and other mainstream anti-abortion groups have spoken out against the bill, and the provision was later removed amid an uproar. Such legislation is "so contrary to what we believe as an organization," Zagorski, the group's communications director, told Vox. "We instead want to work to protect women and protect the baby."
At least one newer anti-abortion group did support the provision, though: the Foundation to Abolish Abortion, a nonprofit espousing a vision of America in which abortion is completely banned, and people who break the law "by hiring someone to murder their child or doing it themselves risk arrest, along with those who assist them."
Some in Texas, too, support the idea of such criminalization. Mark Lee Dickson, an increasingly powerful anti-abortion activist who helped pioneer the citizen enforcement mechanism that became a core part of SB 8, told the Texas Tribune that "five to 10 years" from now, he could see Texas prosecuting people who get abortions. "If a human being is a human being from the point of conception, then we've got to have equal justice accordingly," he told the publication, comparing "the mother who drowns her 2-month-old in a bathtub and the mother who intentionally ends the life of her child in the womb."
Such comments are early hints at a larger schism in the anti-abortion movement between those who remain committed to the narrative that women are victims of abortion and those who are ready for a more hardline approach. The split between mainstream groups and hardliners could grow even wider later this year, if abortion opponents suddenly find themselves with more power than ever before.
For decades, anti-abortion groups have been fighting back against a Supreme Court decision they saw as deeply immoral and unfair. Sometime this spring or summer, they're almost certainly going to win. At that point, abortion opponents will be the ones in power, necessitating a huge in strategy and thinking. "Since the '70s, they've been really talking about abortion as a genocide that the state is allowing," said Holland, the University of Oklahoma professor. "What happens when the state is not doing that anymore, and the most visible and onerous state action is on their behalf?"
Indeed, Roe v. Wade allowed the anti-abortion movement to use the same kind of anti-government rhetoric that has become popular in the Republican Party at large, since it was the government — or, at least, the Supreme Court — that was allowing abortion to continue. Now, to some degree, Big Government will work for abortion opponents, and anything it does to surveil or punish people for abortions will be on the anti-abortion movement to explain and defend.
At the same time, Holland points out, "their work won't be done." While the overturning of Roe will lead automatically to dozens of state-level bans, many anti-abortion activists have set their sights higher, on a nationwide federal ban on the procedure. "We want to see the end of abortion across the country," said Zagorski of Louisiana Right to Life.
Such a ban would likely be politically unpopular — a majority of Americans don't want to overturn Roe, let alone ban abortion in every state in the country. But whatever happens next, one thing is a near certainty: It is about to get even harder than it already was to get an abortion in America.
Laws such as SB 8 may not be able to stop self-managed abortion nationwide or even within a given state, but they've already made it a frightening and difficult experience for people. The prospect of civil liability means "you cannot turn to your family members" for help or support during an abortion because they could be sued for aiding and abetting, said Renee Bracey Sherman, founder and executive director of the abortion storytelling group We Testify. "You feel isolated and alone."
Abortion rights advocates also have campaigned for years to make self-managed abortion an accessible option for Americans, but they never intended it to be the only option, nor did they want a world in which people would be unable to consult their doctors if something went wrong. "Some people won't want to self-manage their abortion," Bracey Sherman said, "or they're later in their pregnancy and so they're unable, which is why we still need clinics."
Now the abortion rights movement is confronting a future in which clinics, already scarce, will simply cease to exist across much of the US. The new reality is likely to exacerbate an existing situation in which Americans with money can find a way to get an abortion, but lower-income people — especially those who are Black, Indigenous, queer, or immigrants, all of whom face discrimination in health care systems and in access to insurance — cannot.
Advocates worry, too, that people already marginalized in America's health and criminal justice systems will be most likely to face penalties under the new abortion restrictions. "It is this same groups of people who are surveilled, suspected, targeted by law enforcement in all realms of their life, who are the ones who are going to be disproportionately criminalized for self-managing abortion," Adams said. That includes "Black, Indigenous and other people of color, immigrants, trans and gender non-conforming folks, and certainly people living in poverty, as well as people living in rural areas and young people."
At least for now, abortion rights advocates' policy options for mitigating these concerns are limited. Much of the next wave of activism will take place outside the confines of a statehouse or courtroom.
"People are going to have to rely so much on their personal networks to access the care," said Kelsea McLain, an activist and abortion storyteller. "It's going to be like pre-Roe: whether or not you had a safe abortion depended on whether or not you knew someone in your life that maybe had a safe abortion, and they knew who to refer you to and what number to give you."
As in the pre-Roe days, meanwhile, activists may need to be willing to risk lawsuits or jail time in order to help others get abortions. "I think there'll be lots of civil disobedience, people figuring out how to get people pills illegally," Ziegler said. It will be a new level of risk, and commitment, for a generation of abortion rights supporters used to having the law on their side.
People's homes — along with their doctor's offices, family gatherings, and anywhere they could seek help or support — could become sites of surveillance and suspicion, where one slip-up could mean a lawsuit, public humiliation, jail time. The whole country is entering uncharted territory in the abortion debate, but people who seek to end their pregnancies are already there, numerous but isolated, forced to map the new reality themselves.
Anna North is a senior correspondent covering the politics and policy around child care, schools, reproductive health care, paid leave, and more for Vox.
More from the May 2022 issue of The Highlight
The glories of dining out alone
We pulled pandas back from the brink of extinction. Meanwhile, the rest of nature collapsed.
View all stories in The Highlight