A draft Supreme Court decision, leaked late on Monday, showed a majority of justices were prepared to overturn its landmark 1973 Roe v. Wade ruling that legalized abortion nationwide in the United States. The court on Tuesday confirmed the authenticity of the leaked document but called it preliminary. The court is expected to issue its ruling by the end of June in the case involving a Republican-backed Mississippi law - blocked by lower courts - that banned abortions starting at 15 weeks of pregnancy.

Twenty-two states have laws or constitutional provisions in place that show an inclination to ban abortion as quickly as possible if Roe v. Wade is overturned or significantly weakened by the Supreme Court, which has a 6-3 conservative majority.

Forty-four U.S. states prohibit abortions after a specified duration of a pregnancy except in instances in which the health of the woman is threatened, there are fetal abnormalities or the pregnancy resulted from rape or incest. These limits range from six weeks since the woman’s last menstrual period in Texas to the third trimester in Virginia. Twenty states prohibit abortions after the fetus achieves viability - at between 24 and 28 weeks of pregnancy - meaning it is able to survive outside the uterus.

The medical abortion pill

Before the COVID-19 pandemic, the U.S. Food and Drug Administration (FDA) allowed certified clinicians to dispense the medical abortion pill only in a healthcare setting, requiring an in-person visit from the patient. That requirement was suspended during the pandemic, increasing access to telehealth medical abortions. The FDA permanently lifted the requirement in December 2021, though this federal policy is complicated by state policies that restrict medical abortion via telehealth outright or through in-person requirements.

Research in the 1970s determined that surgical abortions performed before six weeks of pregnancy were less successful than those performed between seven and 12 weeks. Since then, surgical procedures have overcome this limitation. The development of abortion medication is another option for abortion earlier in a pregnancy. This method has become more commonly used over the past decade, with medical abortion before nine weeks of pregnancy increasing 123% between 2010 and 2019.

Who would be most affected?

Many of the states most likely to ban abortion if Roe is overturned tend have a higher-than-average percentage of women living in poverty or without health insurance.