DETROIT — More people in Michigan would be affected by changes to abortion access than nearly any other state if Roe v. Wade is overturned by the U.S. Supreme Court, resulting in those with the least resources being impacted the most, experts say.
The Supreme Court is weighing a case that requests overturning the nearly 50-year-old legal right to abortion, which would effectively outlaw abortion in many states. The case is pending at a time when two-thirds of Michigan's likely general election voters say they want it left in place, according to a new Detroit News-WDIV poll. The poll of 600 likely voters had a margin of error of plus-minus 4 percentage points.
If Roe is overturned, the state would revert to a nearly century-old law that has prompted pushback by some of the state's top officials and a petition drive for a state constitutional amendment from activists.
Anti-abortion groups hope a repeal of Roe v. Wade would help families decide to keep their pregnancies. But for the majority of Michigan residents who want the law to remain untouched, "this is the time to be worried, to be upset," said Dr. Sarah Wallett, an OB/GYN and the chief medical officer with Planned Parenthood of Michigan.
Numbers gathered in 2021 by the New York-based Guttmacher Institute, a pro-choice research group and a leading provider of abortion data, show if Roe were overturned, it would affect 2.2 million Michigan women ages 15 to 49, putting the statewide impact behind only Texas, Florida, Ohio and Georgia.
Depending on the specifics of the ban, it could mean an average trip of 260 miles to seek an abortion, roughly four hours in one direction to reach a destination outside of Michigan. Under current legal status, Guttmacher notes the average person drives between 11 and 19 miles one way to seek an abortion.
Michigan borders states that also would restrict abortion if Roe is overturned, meaning those seeking abortion would go primarily to Illinois, Guttmacher data shows. Illinois has some of the least restrictive abortion laws in the country after the state established abortion as a "fundamental right" in 2019. Clinics there are preparing for an influx in out-of-state patients if Roe falls, the Chicago Tribune reported last month.
Others could travel to Pennsylvania, where abortion is legal up to 24 weeks, but the situation might change if Democrats lose the governorship in this November's election. They could also go to Minnesota, where outright banning abortion would likely require a constitutional amendment or a decision from the state supreme court, according to the Minneapolis Star-Tribune.
Genevieve Marnon, legislative director for Right to Life Michigan, said if the the Roe precedent is overturned, she hopes it will lead to changing views on pregnancy.
"I would hope that having legal protection for the unborn in the state, they would say, 'Hey, you know what? I can do this, people can help me,'" she said.
But proponents of abortion rights said requiring patients to travel hundreds of miles to seek care takes away the ability to make a choice.
"It can cause people a lot of suffering and a lot of unnecessary fear, having to travel outside of the state," Wallett said. "The end result is ... unnecessarily poor outcomes."
Nearly century-old law
Roe v. Wade, decided by the Supreme Court in 1973, held that the U.S. Constitution gives people a right to privacy that includes a person's right to choose an abortion.
In the nearly five decades since, that decision has protected abortion prior to a fetus being able to live on its own outside its mother's body. Called the point of viability, it is typically after the 24th week of pregnancy, or about six months.
But Roe is effectively up for reconsideration with a case out of Mississippi, known as Dobbs v. Jackson Women's Health, that bans most abortions after 15 weeks of pregnancy. If the conservative-led Supreme Court does anything other than explicitly affirm Roe, experts say it will effectively end.
The 1973 decision guarantees people in Michigan access to abortion. Marnon is among those who have been advocating for that to change.
"We're hoping to see a complete repeal of Roe v. Wade," she said.
It's impossible to know what the court will do, but during oral arguments early last month, justices signaled a willingness to consider at least a partial repeal.
If Roe v. Wade is overturned, Michigan would most likely return to a law that has been on the books since 1931, known as Act 328. It makes it a felony to perform an abortion. At the time it was written, abortions were a significant cause of maternal deaths. One researcher in 1931 estimated that 15,000 women a year were dying across the country because of abortion.
Michigan Attorney General Dana Nessel has said enforcing Michigan's abortion laws would "drive women to back alleys again."
"I will never prosecute a woman or her doctor for making the difficult decision to terminate a pregnancy," said Nessel in 2019, suggesting that doing so would be "sending women to be butchered."
Gov. Gretchen Whitmer has repeatedly said she wants to see the Legislature repeal the state's law. The Jan. 3-7 News-WDIV poll found that 66% of likely Michigan voters also want that law repealed, but that's unlikely. Democrats have introduced bills to repeal it, but the state's Republican-controlled Legislature opposes them and has taken no action.
Act 328 would likely mean more pregnancies would be carried to term. But it likely wouldn't halt all abortions. More than 29,000 abortions were reported in Michigan in 2020, the most since 2003.
Individuals who can afford to travel could seek abortions. There are groups that help people with travel costs for abortions, including many that have stepped up as Texas has imposed more restrictive laws. But if Roe is overturned, those groups may be spread thin as people from around the country suddenly need assistance.
It could lead some women to other options, including giving birth, but also to dangerous choices that might put the mother's life at risk, medical experts say.
"Allowing the lawmakers of Mississippi or any other state to substitute their own views in place of a physician's expert medical judgment puts patients at risk, and is antithetical to public health and sound medical practice," Gerald Harmon, president of the American Medical Association, wrote in October. The AMA joined several professional groups in an amicus brief asking the Supreme Court to decide against the Mississippi law.
But women need to consider all of those affected when seeking an abortion, Marnon argues.
"Women have control over what they do or do not do with their bodies," she said. "Once they get pregnant, now that's taking control over the body of another human being, because their unborn child is a different body."
Who has abortions?
The average woman who has an abortion in the U.S. is in her 20s, according to 2019 data from the Centers for Disease Control and Prevention, and most have at least one child already. No single racial group has the majority of abortions, but Black women receive 38% of all abortions, while White women had 33%.
Those factors — age, race, and whether someone is already a mother — often put people at a disadvantage already, said Elizabeth Nash, state policy analyst with the Guttmacher Institute.
Those working jobs that pay poorly or don't offer time off are further challenged. For those who are already mothers, finding child care could be an additional hurdle.
"Low-income individuals, Black or brown people, younger people, LGBTQ individuals, all often have fewer resources to get to Illinois or Pennsylvania or even further to access abortion," Nash said. "Who can travel, if new laws come up or old ones change? The people who have more money, who are able to navigate the health care system, who already have the resources to do so."
Existing restrictions on abortions, including laws in Michigan that require a woman to wait 24 hours, read state-mandated literature and pay for the procedure out of pocket, already burden people, experts said.
Marnon, whose group is behind many restrictions, argued they help women fully understand the decisions they are making.
Removing abortion from the state entirely provides a whole new set of barriers, Wallett said. She noted 1 in 4 women will have an abortion at some point in her life.
What happens to patient care?
If Roe is overturned, Wallett said she worries that her patients "will have to lead lives they don't want, that would be forced upon them."
Wallett said Act 328 leaves some uncertainty in how it could be implemented, particularly given how medicine has changed in the 91 years since it was enacted. But Marnon said she felt the law makes clear that abortions would have to stop in the state.
Guttmacher estimates that in 2017, Michigan had 30 facilities providing abortions. If it's overturned, some might have to close. Others could remain open to provide birth control, sexually transmitted infection testing and other services, but some doctors could choose to leave the state.
"It's going to make care of all kinds harder to get," Wallett said.
It's likely pregnancy resource centers will try to fill in the gaps. Pregnancy resource centers often push women away from abortions, offering services such as free diapers and other baby supplies. Those items can come with a caveat, though, including requirements on attending parenting classes or watching videos with religious views that do not match a woman's own.
Marnon said those centers can serve as a valuable resource. Right to Life is working with some of them to be prepared for new visitors if Roe is overturned.
What comes next
The decision from the Supreme Court could come as soon as April. Even if the decision doesn't outright overturn Roe v. Wade, it's possible future bans established by other states also could end up before the high court.
"There are many, many cases moving through the legal system, and any one of them could overturn the law as we know it," Nash said.
Activists are working at the state level to try to ensure abortion protections in the future. In Michigan last week, a new group submitted ballot initiative language that would "explicitly affirm Michiganders' fundamental right to reproductive freedom."
Reproductive Freedom for All, which is made up of the American Civil Liberties Union of Michigan, Planned Parenthood Advocates of Michigan and Michigan Voices, is leading the charge, anticipating that Roe will be overturned. It seeks to amend the Michigan Constitution.
That would include the right to make decisions about pregnancy, including prenatal care, childbirth, abortion and infertility care.
Other states have introduced similar ballot initiatives, but the effort in Michigan is unique in seeking to amend the state's constitution, Nash said.
"I think we're going to see more citizen-led efforts, both in states where legislatures have been hostile to abortion and also in states where there hasn't been much action to protect abortion rights," she said. "When people understand what's at stake, they're going to want to be active however they can."
