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Planned Parenthood advocacy programs manager, Allison Terracio, left, stands outside the clinic to escort patients showing up for abortion appointments as Valerie Berry, program manager for the anti-abortion group, A Moment of Hope, holds up a sign at the entrance in Columbia, S.C., Friday, May 27, 2022.
COLUMBIA, S.C. (AP) — The first of them arrived outside the clinic past 4 a.m., before a steady rain fell and a scalding sun rose, and all along, they had prayed for a moment like this.
It's abortion day at Planned Parenthood and, try as they might, those who lined the street hadn't had much luck changing any minds.
Now, a patient pushes out of the center's doors, limply drags her feet across the parking lot, and heads straight into the arms of an anti-abortion counselor who, a short while earlier, asked her not to do what she came here for.
Anti-abortion movement readies for a win
One of the clinic's rainbow-vested workers, Allison Terracio, sees what's unfolding and cries, "They got one!"
A majority of Americansbacks abortion rights, and Terracio believes the anti-abortion group's sidewalk coterie uses trickery, empty promises and manipulation in the guise of kindness to sway women from something they've already carefully thought through.
She is as alarmed as her opponents are hopeful.
As the patient walks away with the counselor, it feels as if every eye on the block has followed. The circle of praying Catholics, the smattering of evangelicals at every clinic driveway, even the lone protester here, Steven Lefemine, who stands by himself with a sign with a graphic photo of an aborted fetus, all seem riveted by the apparent change of heart.
"This is a glorious thing that's happening here!" 66-year-old Lefemine exclaims.
Anti-abortion protester Steven Lefemine, prays as he arrives to set up outside the Planned Parenthood clinic where patients will be arriving for abortion appointments Friday, May 27, 2022, in Columbia, S.C.
For tens of millions of Americans who see abortion as wrong, it's gone this way for a half-century: One woman swayed to reconsider as dozens of others follow through. One clinic's doors closed only to see desperate patients go elsewhere. One law passed, another overturned.
A movement built of tiny steps and endless setbacks, though, now seems poised for a massive leap.
The possibility of looming success, perhaps undoing the constitutional right to abortion found in Roe v. Wade, isn't talked about much here, though. That's left to others entrenched in this fight. Those here on the front lines of the battle are focused on the task at hand: To change a single mind and, in their eyes, save a single life.
When that happens, Valerie Berry, the 27-year-old program manager for the biggest of the groups here, A Moment of Hope, says she'll feel the tingle of goosebumps or the well of tears. Sometimes, she has burst into a joyous dance.
On this day, she's not there yet with the patient who exited the clinic. But the woman is here beside her, sharing her story and openly discussing if there's some way she can have another baby.
"It's a miracle every time it happens," Berry says. "In some ways, even a conversation is a miracle."
Berry and a colleague lead the woman across the street from the clinic to their group's idling RV, where she says she's about seven weeks pregnant. She tells of a tough upbringing in foster care, an abusive partner who's now out of the picture, the struggles of raising a 3-year-old, the problems with money, the hope of finding a new home and starting a career in music, all the things that seemed impossible even before her period failed to arrive and morning sickness started sapping her will.
Yet for all the reasons the woman lists to end her pregnancy, Berry feels encouraged that she's reaching her. When she suggests the woman come see a doctor allied with her group who can prescribe something for the nausea while she weighs her decision, she is receptive. And when a colleague floats considering adoption, the flat rejection of the idea assures them.
"No," they say the woman told them. "My child will be with me and we'll just tough it out."
The goosebumps return. Berry is tingling. Something miraculous is happening.
Chris, a sidewalk counselor with the anti-abortion group, A Moment of Hope, who only gave his first name, arrives before sunrise to set up for the day outside the Planned Parenthood clinic where patients will be arriving for abortion appointments Friday, May 27, 2022, in Columbia, S.C.
Mark Baumgartner, founder of the anti-abortion group, A Moment of Hope, arrives in an RV outfitted with any ultrasound machine outside the Planned Parenthood clinic on a day when patients will be showing up for abortion appointments, Friday, May 27, 2022, in Columbia, S.C.
Talk to someone who's been immersed in opposing abortion long enough and they'll tell you the disbelief they felt when news of Roe broke and the naïve certainty they had that it would be overturned in a couple of years. They'll tell you about the politicians who collected their votes and never delivered, and the judges seen as allies who went on to disappoint. They'll tell you how the issue ended friendships or landed them in handcuffs or brought them heartache again and again and again.
And yet, here they are, all these years later, in the fight so long some have grandchildren at their side.
They made arguments about biology and fetal development that rarely swayed, then shifted to pleas rooted in civil rights and religion. They lobbied for laws on parental notification and waiting periods and licensing, really anything that might jeopardize an abortion facility's operation, down to the width of its hallways. And, as a raging faction grew restless, some formed human blockades outside clinics or were driven, in the most extreme acts of anti-abortion radicalism, to plant a bomb, set a fire or draw a gun.
The image of an abortion opponent cemented in some Americans' minds became a rabid protester shouting condemnation and clutching a gory sign, who would do anything to advance their cause, down to committing the very crime of murder they believe abortion to be.
Mark Baumgartner, the softspoken founder of A Moment of Hope, knows the caricature many have of anti-abortion figures like him. He shudders when noisy protesters show up here and wishes Lefemine didn't bring his big foam signs. He knows a woman arriving here may see everyone on the street the same, but if he could just have her ear for a moment, he thinks he can convince her.
"They're expecting to get yelled at that they're going to hell," says 53-year-old Baumgartner, who left behind his job as a pilot to create the organization. "We're here to be different."
Mark Baumgartner, founder of the anti-abortion group, A Moment of Hope, watches the door of a Planned Parenthood clinic as members of his group are able to talk with a patient arriving for an abortion appointment, Friday, May 27, 2022, in Columbia, S.C.
This day, megaphone-toting protesters haven't come and, at times, you hear little more than the hum of the idling RV, where A Moment of Hope has a sonogram suite. Mostly, it's the sound of passing traffic punctuated by the occasional last-ditch call to a woman before she enters the doors of the clinic, set in an office park and barely recognizable save for the throng of foes it attracts.
"We have a lot of help available!" "It's not safe in there!" "You can help save a life today!"
At the start, in 2012, it was a one-man crusade. Now, Baumgartner leads a group of employees and volunteers big enough to stand outside Planned Parenthood every minute it's open.
The first woman that Baumgartner approached a decade ago changed her mind, giving birth to a little girl whose picture hangs beside his office desk. It became the first of what the group regards as a "save," when someone they've interacted with who planned to have an abortion changes their mind.
Last year, they estimate about 1,600 women had an abortion at the clinic. They logged 66 saves.
They were the work of the group's "sidewalk counselors" who are positioned at nine checkpoints stretched across the entirety of this sprawling city block. In a synchronized routine, each of them dons a neon vest and a Motorola radio earpiece on which they pause for a morning prayer, then use it to spread word of arriving clinic patients.
If their outstretched hand manages to stop a motorist headed to Planned Parenthood, they'll try to start a conversation and offer a gift bag with a loofah, Lifesavers, granola bars and a 2-inch-long plastic model of a fetus 12 weeks into its development. Pamphlets cite Bible passages, have one of the gory photos the group says it frowns upon, and include the false assertion that abortion is riskier than giving birth. A handwritten note, with cell numbers for Baumgartner and Berry, pleads with the reader.
A member of the anti-abortion group, A Moment of Hope, holds a plastic model of a fetus 12 weeks into its development, as part of a gift bag they try to hand out to patients arriving for abortion appointments at a Planned Parenthood clinic, Friday, May 27, 2022, in Columbia, S.C.
A member of the anti-abortion group, A Moment of Hope, holds a gift bag they try to hand out to patients arriving for abortion appointments at a Planned Parenthood clinic, Friday, May 27, 2022, in Columbia, S.C.
"It is not too late to change your mind," it says. "There are caring people who want to help you."
Inside the group's RV, the woman who emerged from the clinic is deep in conversation with Berry and one of the A Moment of Hope interns, who bonded with the woman over their shared childhoods in foster care. The woman is in her early 20s, dressed in a tie-dye hoodie and carrying a Seagram's ginger ale.
After about 10 minutes, she agrees to go with Berry across town to the OB-GYN's office.
The woman walks back across to Planned Parenthood's lot and Berry stops at the driveway, careful not to pass the invisible line between public and private that could yield a call to police.
As she nears her blue sedan, though, she encounters Terracio. The A Moment for Hope team is alarmed.
They try calling out to her and get no response. Berry sprints to and from the parking lot next door trying to find a better vantage, then furiously texts her.
"You don't have to go back in there!" Baumgartner calls.
Under South Carolina law, a woman arriving for an abortion would have already undergone a waiting period and advised to read a lengthy document detailing fetal development, from when a heartbeat is detected to when fingernails grow to when the unborn can hiccup for the first time.
Terracio, a 45-year-old who also serves as a county councilwoman, says those due in to take an abortion pill or undergo a brief surgery have already thought through what they wanted. Nothing Baumgartner and his crew can offer, she says, will change the circumstances of the prospective mother's life.
"I'm not in the business of convincing anybody of anything," Terracio says.
Planned Parenthood advocacy programs manager, Allison Terracio, is reflected in a table as signs sit in the clinic's office in Columbia, S.C., Friday, May 27, 2022. Under South Carolina law, a woman arriving for an abortion would have already undergone a waiting period and been pointed toward a lengthy document detailing fetal development.
At the property's edge, no one can hear what Terracio is saying to the woman, but she is now turned away from her car toward the clinic's doors. Baumgartner is growing pessimistic, talking of the "spiritual battle" that is underway and how "powers of darkness" are at work.
"It's like the jaws of hell," he says. "She's trying to snatch this one"
Berry begins doubting her decision to have the woman follow her to the doctor's office instead of just driving her. She says she always wants to be sure not to overstep and make someone feel uncomfortable. She wanted to give the woman space, she said, and in the moment and yards that now separated them, it seemed everything they'd talked through suddenly dissipated.
The door of her blue sedan never opens and, with a few steps of her Crocs, it's clear she is headed back inside. But if she came out before, Berry rationalizes, surely she could again. The last sentence she musters before the woman disappears through the clinic's doorway feels tinged with hurt and concern and desperation.
"Whenever you're ready, we'll be right here, OK?" she calls.
Allison Terracio, right, Planned Parenthood advocacy programs manager, talks with a woman who went over to speak with members of the anti-abortion group, A Moment of Hope, after she arrived for her abortion appointment in Columbia, S.C., Friday, May 27, 2022.
Inside the buildings where abortions are offered, workers say women who pass a throng of protesters will say: "They don't know my life. They don't know what I'm going through." Outside, the sidewalk counselors say the arriving women often tell them: "Thank you for stopping me. I was hoping I would see some sort of sign not to go through with this."
Inside, this is seen as a fundamental woman's right, a type of healthcare that deserves no stigma attached. Outside, those who oppose abortion see it as pure evil that must be stopped.
Both sides see the truth as plain.
For so many who have been drawn to the anti-abortion cause, it's baffling and frustrating how often their appeals feel unheard. It's not 1973 anymore: They wonder how anyone could deny the scientific leaps, the advances in fetal viability, the way a heartbeat from inside the uterus can be heard and an image seen. To those with whom they disagree, they ask: Where is the line? When they hear talk of a fetus, an embryo, a clump of cells, they wonder, at what point will someone acknowledge it's a baby?
So they return, time and again, to the pews where they pray for change, to the statehouses where they lobby, to the marches and protests where they chant. And they return here, to Middleburg Drive in South Carolina's capital, beneath the magnolias and atop sunbaked swaths of asphalt, to plead their case.
Anti-abortion protester Steven Lefemine, holds a sign as the anti-abortion group, A Moment of Hope, wearing green vests, tries to talk with patients arriving for abortion appointments at Planned Parenthood next to a group of Catholics praying off to the side, Friday, May 27, 2022, in Columbia, S.C.
Anna Kelley recites the Rosary while praying outside a Planned Parenthood clinic as patients arrive for abortion appointments, Friday, May 27, 2022, in Columbia, S.C.
The clinic door has shut and the woman with the blue sedan, the one who seemed to take to heart what the A Moment of Hope team told her as she sat in their RV, is inside.
At the foot of the closest driveway to Planned Parenthood, tension is high. Baumgartner is scratching his beard. An intern is frozen and pensive. Berry is tapping off a string of last-ditch messages to the woman.
"I promise we're not gonna force you to do anything ... Even if they can make it possible for you to have an abortion today, would you let us talk more? I can see you're really hurting ... Would you be willing to wait to do it for a couple days or a week to let us help you? I actually saw a 7-week baby on an ultrasound this week. The heartbeat, head, etc. were clearly visible. It's not nothing ... I can tell you're a caring person. Because of that, the guilt on your conscience will hang heavy ... Praying right now you'll be overwhelmed by God's love and know we love you and can help you every step of the way."
No reply comes. Berry's teammates are spread across hundreds of yards and most only know morsels about the woman from a group text. They heard she exited the clinic and went on the RV. Now, Berry texts again with a bleak update. "Please pray," she writes, and up and down the block, they silently do.
"Lord, change her mind." "Give her the courage to leave." "God, save her from the evil of this."
When the woman exits about two hours later, she gets in her blue sedan and stops at the edge of the driveway. She tells the sidewalk crew she gagged trying to swallow pills to induce abortion. She had the pregnancy ended by surgery instead, and when she says it out loud, she begins to sob.
Shonda Johnson, a 48-year-old housekeeper at a veterinary hospital who volunteers for A Moment of Hope, rubs the woman's back and listens as she said she felt guilty. Thirty-two years ago, Johnson came to this very site for the very same reason, a decision she later came to see as wrong.
"When I saw those tears rolling, I knew exactly where she was," she says.
Shonda Johnson, a volunteer for the anti-abortion group, A Moment of Hope, comforts a woman who leaves Planned Parenthood after going through with an abortion, Friday, May 27, 2022, in Columbia, S.C.
When word reaches Berry, she chokes up. She grieves the baby that won't be born. She prays for the woman's healing. She second-guesses the choices she made. She keeps texting the woman in the weeks to come, and plans are made to meet, though it never happens. She used to feel beaten up for days after a moment like this, but she now believes it still may lead the woman closer to God.
In the long fight against abortion, there have been many days like this one. But they'll return when the clinic reopens. They'll return even if Roe falls. Many expect the fight to continue to their grave.
They've never felt more hopeful. A change, they are sure, is coming.
Considering the fraught and deeply political ways in which abortion is discussed and legislated in the U.S. today, it’s easy to forget the issue was not always a partisan, or even a moral, one. Rather, attitudes toward abortion have changed over the centuries, often evolving alongside political and historical moments that reflect shifts in power and privilege.
In Colonial times, abortion was not a matter of federal or ethical significance, but a common decision made and acted upon by pregnant people and their midwives. Two centuries later, abortions were outlawed in every state. The matter of who gets to make decisions about abortion—whether it be the federal government, state legislators, or individuals—has historically been tied up in changing philosophies about bodily autonomy, the legacy of slavery and Jim Crow, the advent of the medical industry, and, eventually, the merging of religion and politics to form the party system we know today.
The question of who has access to abortion is also closely connected with race, socioeconomic status, and proximity to power. Because history has shown that the legal status of abortions does not deter people from having them, the criminalization of abortion most directly impacts those without access to financial resources; in other words, wealthy Americans have always had better and safer access to abortions, regardless of whether abortions are legal or not.
In order to trace the history of attitudes and policies around abortion in the U.S.—starting in colonial times and ending in the present—Stacker consulted historical records, scholarly research, court documents, medical journals, news reports, and data from the Guttmacher Institute, a reproductive rights research and advocacy organization.
A note on the use of gendered language in this article: In recent years, the language used to talk about gender has shifted to meet the understanding that gender is a spectrum. Likewise, matters historically categorized as “women’s issues,” such as pregnancy and abortion, don’t only impact cisgender women, but also trans, nonbinary, and gender-nonconforming people.
In an effort to stay true to the language used in historical accounts cited in this article, we have employed language as it was used during those times. However, for the parts of this article that refer to present-day issues, we have used more expansive terminology.
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British common law followed the colonists to North America and formed the basis of the original laws and customs in the American Colonies. Abortion, like birth, pregnancy, and other processes involving women’s bodies, fell largely in the domain of communities of women.
Knowledgeable midwives were responsible for guiding women through birth and did so with the participation of the woman’s female family and friends. This communal form of birthing, now referred to as “social childbirth,” benefitted the woman giving birth both psychologically and in terms of safety, according to the book “Lying-In: The History of Childbirth in America.” Since the group of attending women usually included those who had either given birth themselves or witnessed several births, they could provide a wealth of knowledge, experience, and comfort to the birthing woman.
Abortions in early America were ubiquitous—some historians estimate between 20% and 35% of pregnancies in the 19th century were aborted. They were also uncontroversial from a moral and legal perspective, up until the quickening, which was when a pregnant woman could first feel the fetus move or kick in the womb, usually around 20 weeks into the pregnancy.
Although quickening was the point at which many considered a fetus to be viable, even the abortion of a “quick fetus” was never “firmly established as a common-law crime,” Justice Harry Blackmun would later write in the Supreme Court’s majority opinion on Roe v. Wade. Abortions were most often seen as a decision to be made by a pregnant woman and her midwife, and were most often induced using herbs known for “restoring the menses,” historian Leslie Reagan wrote in her 1997 book “When Abortion Was a Crime.”
There was no real legislation regarding abortion until the early 1800s. The legal right to an abortion prior to quickening was reaffirmed in the 1812 Massachusetts court case Commonwealth v. Bangs. This pre- and post-quickening distinction would set a precedent for a series of laws passed in the 1820s and 1830s, starting with an 1821 Connecticut abortion law.
This law was the first to officially criminalize medicinal abortion after quickening. However, it only penalized the provider of the abortifacient, not the pregnant woman, and was largely seen at the time as a means of protecting women from often-lethal abortion medicines.
Despite new restrictions around the sale of abortifacients, abortions became more commercialized by the 1840s, with doctors and pharmacists advertising their services—both medicinal and instrumental—in newspapers. The shift from abortions being performed at home, often using home-grown herbs, to being performed or accessed more publicly, was already underway.
But it wasn’t until halfway through the 19th century that matters of pregnancy, birth, and abortion shifted away from a social- and community-oriented model steered by midwives, and toward a male-dominated medical model controlled by doctors.
The single most influential factor in this societal shift was the founding of the American Medical Association in 1847. In the years before the AMA began, more medical schools opened and white male physicians with medical training sought to distinguish themselves from the types of medical practitioners people were used to relying on—namely midwives, herbalists, and local healers—by dismissing their work. These alternative providers were seen as both a threat to the authority of the burgeoning medical establishment and, in a business sense, as competitors for potentially lucrative services.
When the newly formed AMA was met with derision by the general public, who did not take the group seriously, the association tried a new tactic to boost its appearance of professional credibility: the criminalization of abortion.
In 1857, the AMA established a Committee on Criminal Abortion, which launched a campaign to discredit midwives’ work and elevate the AMA’s practices to an “elite” status. To achieve this end, the AMA argued for making abortion a matter that should be decided and performed by physicians, not women and midwives.
At around the same time, changes in the Catholic Church’s official position on abortion coincided with discussions amongst AMA members about whether the life of a fetus began at quickening or conception.
While Pope Sixtus V, who came to power in 1585, decreed abortion to be considered homicide—a crime that warranted ex-communication from the Church—this stance only lasted about three years, as Sixtus’ papacy ended shortly thereafter. In 1591, Pope Gregory XIV reversed this decree, instead asserting that abortion was only homicide after “ensoulment,” which occurred at quickening, or what Pope Gregory XIV determined to be roughly 24 weeks.
This remained the Church’s official stance on abortion for the next 278 years until it was forbidden once more in 1869 by Pope Pius IX—a stance that remains in force today.
The Catholic Church’s reversal on abortion coincided with the AMA’s campaign to restrict abortion. The AMA’s Committee on Criminal Abortion quickly adopted a moral argument that sought to cast doubt upon women’s knowledge of their own bodies and pregnancies. It circulated a report that lampooned “a belief, even among mothers themselves, that the foetus is not alive till after the period of quickening.”
The campaign to place abortion and birth in the hands of white male doctors was bolstered by language that stoked racial fears about declining birth rates amongst white populations, an influx of immigrants to the U.S., and the recent emancipation of formerly enslaved Black people, according to historian Leslie Reagan.
Horatio Storer, who orchestrated the AMA’s campaign to criminalize abortion, wrote that the settling of the American West and “the destiny of the nation” rested on “the loins” of wealthy white women—a mission being jeopardized by these women having too many abortions.
This was not the only way in which the AMA’s white supremacist stance impacted reproductive rights. In 1876, James Marion Sims, who is generally regarded as the founder of modern gynecology, became president of the AMA.
Sims became famous for surgically repairing certain complications from childbirth—innovations he made after doing unanesthetized forced experiments on several enslaved Black women in the mid-1800s. In 2021, the AMA acknowledged this legacy, writing that Sims’ experiments “reinforced essentially racist misconceptions in medical science, specifically regarding the biological differences of feeling pain between Blacks and whites that still persist to this date.”
By 1880, every state had passed legislation that made abortion a crime, except in cases where the mother’s life was at risk. This kicked off the “century of criminalization”—from 1880 to when Roe v. Wade was decided in 1973—forcing abortions underground.
With abortion outlawed in every state, people seeking to terminate their pregnancies were forced to do so in frequently unsafe conditions. People who resorted to self-inducing abortions using a notoriously grisly array of techniques—the infamous coat hanger among them—were often poor, and could not afford the steep fee of employing an “abortionist” to perform the procedure.
A study of low-income women in 1960s New York City found that, of those who reported having an abortion, 77% had attempted to self-induce. The danger of illegal abortions disproportionately impacted people not just across class lines, but also along racial lines. The illegal abortion mortality rate for women of color was 12 times higher than for white women between 1972 and 1974.
Even those who paid someone to perform their abortion were often injured in the process; the phenomenon was so common, in fact, that most big-city hospitals had septic abortion wards—sometimes referred to as “septic tanks”—specifically meant for people ailing from botched abortions. While the exact number of illegal abortions in the years leading up to Roe is unknown, due to underreporting, estimates from the Guttmacher Institute place the number anywhere between 200,000 and 1.2 million per year in the 1950s and ’60s.
The plenitude of people seeking abortions can be attributed in large part to the fact that contraceptives were not accessible for most of the 20th century. In 1965, Griswold v. Connecticut made the use of birth control legal for married couples. And it wouldn’t be until 1972, one year before Roe v. Wade, that Eisenstadt v. Baird legalized contraceptives for unmarried people, removing penalties around pre-marital sex for the first time.
A wide range of people performed underground abortions during the first half of the 20th century: both untrained providers and discreet physicians, with motivations ranging from greed and a desire to exploit vulnerable people, to compassion for those in need of assistance.
But not all underground abortion providers fit the stereotype of the “back-alley butcher.” Some reproductive rights activists developed ways of helping people access safe and affordable abortion care. The Jane Collective of Chicago, group of pro-abortion activists, famously formed in the ’60s and set up a call line, which connected those seeking abortions with the group’s own provider. After a while, the women realized they could learn to perform the procedure themselves, allowing them to expand their services to more people at a much lower cost. In the years leading up to 1972, when members of the collective were arrested for administering abortion services, Jane provided roughly 11,000 abortions to people in the Chicago area.
The 1960s ushered in a new era of social and political change—the civil rights, women’s liberation, and anti-Vietnam War movements converged to create a sense of optimism and energy, particularly among younger generations. The sexual revolution in particular began to shift conservative norms around what kinds of sexuality were acceptable, and questions about women’s sexual empowerment entered mainstream conversation. The advent of the birth control pill coincided with these new beliefs and allowed (married) people to control their fertility more effectively than ever before.
By the late ’60s, the work of activists, changing attitudes around sex, and the impact of Griswold v. Connecticut were beginning to have an impact on how lawmakers and the general public viewed abortion. Over the course of that decade, abortion had gone from a taboo subject people whispered about, to something shouted about in protests.
Activists argued the precedent set by Griswold, which protected married people’s right to contraception through their right to privacy, should, by the same token, extend to abortion. In 1967, Colorado reformed its abortion law, triggering a string of other states to do the same in the years leading up to 1973. In 1970, the AMA formally reversed its earlier stance when it voted in favor of legal abortion.
New York repealed its abortion law altogether in 1970, allowing for abortions up to 24 weeks, or at any point in the pregnancy if the life of the mother was in danger. The state, and particularly New York City, quickly became a hub for out-of-state people seeking abortions. Estimates from health officials between 1970 and 1972 attribute roughly two-thirds of all abortions performed to non-New York residents.
While this dramatically improved the safety outcomes for those who had the means to fly to New York, pay the cost of the procedure and lodging, and fly home—mainly wealthy white women—people with fewer resources in more restrictive states continued to suffer from unsafe and unregulated abortion services.
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On Jan. 22, 1973, the Supreme Court handed down its 7-2 decision on Roe v. Wade, rendering restrictive abortion laws across the country unconstitutional.
Despite the overarching implications of the ruling, public reaction was reportedly muted. This was, in part, due to the fact that abortion had not yet become a partisan or deeply politicized issue. In fact, many of the justices who voted in favor of Roe were conservatives and Richard Nixon appointees, including Justice Harry Blackmun, who delivered the majority opinion. The news of the Roe decision was largely overshadowed by the fact that Lyndon B. Johnson, who had served as president just four years earlier, died that same day.
Then-President Nixon’s private reaction to the Roe v. Wade decision was infamously captured in a secret audio recording by one of his aides: “I know there are times when abortions are necessary … I know that—when you have a Black and a white, or a rape,” he said. Nixon didn’t make a public comment about the ruling. In the immediate aftermath of the decision, the majority of the criticism of Roe came from the Catholic Church.
Abortion access improved quickly after Roe v. Wade. The septic abortion wards that had sprouted up in hospitals to treat complications from unsafe abortions were closed and replaced by clinics. Complication rates went down, and because of improved access to abortions early on in the pregnancy, the rate of abortions after the first trimester dropped from around 25% in 1970 to 10% in the first 10 years post-Roe.
The decade after Roe v. Wade saw the beginnings of a shift in political and social allegiances around the issue of abortion. Prior to Roe, and even in the few years after, evangelical Christians did not oppose abortion—in fact, many Southern Baptists supported legal abortion. Abortion was not a major political issue for the right at that time, and most Catholics, the most outspoken anti-abortion voter bloc, tended to vote Democratic prior to 1970.
A few key events changed the priorities and demographics of the political parties. The first, and perhaps most influential, was the elimination of tax exemptions for segregated private schools. Referred to as “segregation academies,” these schools cropped up in the aftermath of the Brown v. Board of Education decision, as white evangelical families pulled their children out of public—now integrated—schools. After Black Mississippi families sued in 1970, the IRS was pressured to crack down on segregation academies by removing their tax-exempt status in the late ’70s.
Another Supreme Court case contributed to a growing backlash amongst white evangelical Christians: Engel v. Vitale, a 1962 ruling that prohibited public schools from sponsoring schoolwide prayer. As the Republican party increasingly became the socially conservative “party of family values,” the issue of abortion became a convenient—and more socially acceptable—proxy through which the right could channel its discontents around desegregation, growing sexual liberalness, and civil rights. Adopting an anti-abortion stance also helped the Republican Party convince more socially conservative Catholics to break with the Democrats.
By the end of the 1970s, these issues had converged to aid the rise of the Moral Majority, a right-wing movement headed by televangelist Jerry Falwell. The Moral Majority merged fundamentalist social and political conservatism and mobilized the Christian right, aiding in the election of Ronald Reagan in 1980 and ushering in a new era of American politics.
On May 2, 2022, Politico published a leaked Supreme Court initial draft majority opinion overturning Roe v. Wade. Although final rulings sometimes differ from initial drafts, the document inspired panic and protest amongst supporters of legal abortion and preliminary celebration for opponents of Roe.
But legal challenges to Roe began long before the Supreme Court decided to hear Dobbs v. Jackson Women’s Health Organization back in 2021. Starting in the 1980s, cases like Harris v. McRae and Webster v. Reproductive Health Services were already introducing restrictions to the access Roe initially promised.
Harris v. McRae restricted Medicaid funding for abortions to cases of rape, incest, and life endangerment, while Webster v. Reproductive Health Services upheld Missouri’s limitations on who could perform abortions, as well as where.
The 1992 ruling for Planned Parenthood v. Casey both reaffirmed Roe while also introducing a loophole through which states could restrict access to abortions: As long as state laws did not pose an “undue burden” on people seeking abortions before the point of fetal viability, those restrictions could be acceptable. This reworked the trimester framework established by Roe, which ensured access to abortion during the first two trimesters and allowed for states to decide on restrictions or bans on third-trimester abortions.
In 2000, the Supreme Court heard Stenberg v. Carhart, which challenged a Nebraska ban on a late-term abortion method called dilation and extraction—controversially referred to as “partial-birth abortion.” The Court ruled the ban was unconstitutional, because it posed an “undue burden” on those seeking an abortion, as defined in Planned Parenthood v. Casey. But only seven years later, this decision was contradicted by the Supreme Court’s Gonzales v. Carhart ruling, which upheld the passage of the Federal Partial Birth Abortion Ban Act. The act criminalized the dilation and extraction abortion method, the first time a specific technique was banned.
Since Planned Parenthood v. Casey and Gonzales v. Carhart, states have passed increasingly restrictive laws around abortion, including banning other specific abortion methods, and introducing mandatory waiting periods and counseling, gestational limits, parental consent for minors, and compulsory ultrasounds.
For many people living in states with restrictive abortion laws, the reality of getting an abortion over the past several years has already resembled a pre-Roe world: where having the means to drive or fly across state lines and pay for abortion services, as well as other associated travel costs, is often a dealbreaker.
Some things will change, however, if the Supreme Court overturns Roe v. Wade. The distances people will need to travel to receive abortion care will increase manifold. Current estimates from the Guttmacher Institute indicate that 26 states are likely or certain to ban abortion if Roe is overturned. These states are concentrated in the South and Midwest, and would effectively create hundreds of miles-long abortion deserts in parts of the U.S. Residents of Louisiana, Florida, and Texas in particular could see an increase of hundreds of miles to the nearest legal clinic.
But accessing an abortion in the event of a 26-state ban does not mean returning to the days of back-alley butchers and coat-hanger abortions. Abortion services have evolved significantly since the century of criminalization, and have become increasingly safe and simplified. Reliance on surgical abortion has decreased: as of 2020, over half of all U.S. abortions are medication-based. The most common medication abortion is an FDA-approved combination of two drugs—mifepristone and misoprostol—which are usually administered during the first 10 weeks of pregnancy.
Self-managed abortions—abortions performed by the individual at home—using mifepristone and misoprostol are likely to become more popular. Through-the-mail abortion pill and telemedicine consultation services like Plan C, Hey Jane, AidAccess, and Women on Web have emerged to improve access in abortion deserts.
The right to an abortion is codified in state laws or constitutions in 16 states, including New York, Illinois, California, Oregon, and Colorado, as well as Washington D.C. Many of these states are preparing for a surge in the number of out-of-state visitors seeking abortions, or have already seen an uptick in recent years as restrictions on abortions have tightened in neighboring states.
Associated Press photographer David Goldman contributed to this report.
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Planned Parenthood advocacy programs manager, Allison Terracio, left, stands outside the clinic to escort patients showing up for abortion appointments as Valerie Berry, program manager for the anti-abortion group, A Moment of Hope, holds up a sign at the entrance in Columbia, S.C., Friday, May 27, 2022.
Anti-abortion protester Steven Lefemine, prays as he arrives to set up outside the Planned Parenthood clinic where patients will be arriving for abortion appointments Friday, May 27, 2022, in Columbia, S.C.
Chris, a sidewalk counselor with the anti-abortion group, A Moment of Hope, who only gave his first name, arrives before sunrise to set up for the day outside the Planned Parenthood clinic where patients will be arriving for abortion appointments Friday, May 27, 2022, in Columbia, S.C.
Mark Baumgartner, founder of the anti-abortion group, A Moment of Hope, arrives in an RV outfitted with any ultrasound machine outside the Planned Parenthood clinic on a day when patients will be showing up for abortion appointments, Friday, May 27, 2022, in Columbia, S.C.
Mark Baumgartner, founder of the anti-abortion group, A Moment of Hope, watches the door of a Planned Parenthood clinic as members of his group are able to talk with a patient arriving for an abortion appointment, Friday, May 27, 2022, in Columbia, S.C.
A member of the anti-abortion group, A Moment of Hope, holds a plastic model of a fetus 12 weeks into its development, as part of a gift bag they try to hand out to patients arriving for abortion appointments at a Planned Parenthood clinic, Friday, May 27, 2022, in Columbia, S.C.
A member of the anti-abortion group, A Moment of Hope, holds a gift bag they try to hand out to patients arriving for abortion appointments at a Planned Parenthood clinic, Friday, May 27, 2022, in Columbia, S.C.
Planned Parenthood advocacy programs manager, Allison Terracio, is reflected in a table as signs sit in the clinic's office in Columbia, S.C., Friday, May 27, 2022. Under South Carolina law, a woman arriving for an abortion would have already undergone a waiting period and been pointed toward a lengthy document detailing fetal development.
Allison Terracio, right, Planned Parenthood advocacy programs manager, talks with a woman who went over to speak with members of the anti-abortion group, A Moment of Hope, after she arrived for her abortion appointment in Columbia, S.C., Friday, May 27, 2022.
Anti-abortion protester Steven Lefemine, holds a sign as the anti-abortion group, A Moment of Hope, wearing green vests, tries to talk with patients arriving for abortion appointments at Planned Parenthood next to a group of Catholics praying off to the side, Friday, May 27, 2022, in Columbia, S.C.
Anna Kelley recites the Rosary while praying outside a Planned Parenthood clinic as patients arrive for abortion appointments, Friday, May 27, 2022, in Columbia, S.C.
Shonda Johnson, a volunteer for the anti-abortion group, A Moment of Hope, comforts a woman who leaves Planned Parenthood after going through with an abortion, Friday, May 27, 2022, in Columbia, S.C.
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