The US Supreme Court overturned Roe v. Wade—which has protected the right to choose to have an abortion in America for almost 50 years—in late June 2022. Since that decision, at least 10 states have completely banned abortion, and four other states have outlawed the procedure after six weeks of pregnancy. Many other states are expected to follow suit. Based on data from the CDC, the Guttmacher Institute, and other sources, our firm, Dalberg Advisors, estimates that as many as 300,000 people per year may lose access to abortion across 26 states as a consequence of this decision. This represents approximately 40 percent of people in the US who legally have abortions each year, although exact estimates are hard to come by. We expect that bans will disproportionately impact Black, Hispanic, low-income, immigrant, and other historically marginalized people, the majority of whom may not be able to travel to access care (based on historical patterns of travel and patient demographics in “banned” states). Without access to safe abortions, people face impossible choices such as risking their lives with unsafe abortions or carrying unwanted pregnancies to term.

The current approach to delivering care was largely built when abortion was legal in all 50 states. It will fail patients and providers alike in a post-Roe reality. Today, independent or affiliated clinics, which often operate on razor-thin margins, deliver about 95 percent of abortion services. Providers in the 24 states that are unlikely to ban abortion are already struggling to absorb increased demand, as more and more people travel from states where clinics are closing down. Opening a new clinic is time-consuming and requires overcoming a series of hurdles, from sourcing funding to identifying space and navigating complex legal restrictions. Current options for fully remote care (i.e., accessing abortion pills by mail and/or via telehealth screening) are not always well understood by patients and often only serve a subset of those in need. Existing, tenacious efforts by abortion providers to adapt systems to this new reality (through for example, targeted expansions and better patient navigation) are under-resourced and not at scale.

The abortion care ecosystem needs more resources and different strategies to adapt to this new reality. We can learn from and scale bright spots of success in strategies being tested across the country and in other parts of the world—such as Latin America, which has seen a “green wave” of abortion legalization in recent years. These bright spots can offer a roadmap for preserving access to safe abortion in the post-Roe era. This article focuses on four strategies that have shown particular promise in other countries or in smaller-scale settings in the US:

  1. Equip patients with the information to safely and legally exercise their agency to make care choices, without threat of reprisal.
  2. Increase access to remote medication abortion where it is medically appropriate and alongside in-person options for care.
  3. Invest in patient accompaniment models, particularly for remote care.
  4. Invest in long-term ecosystem building.

Read the full article about abortion care by Shruthi Jayaram, Eliza Ennis, Saalar Aghili, and Erin Barringer at Stanford Social Innovation Review.