Objective
To examine changes in travel distance and abortion incidence if Roe v. Wade were reversed or if abortion were further restricted.

Study Design
We used a national database of abortion facilities to calculate travel distances from the population centroids of United States counties to the nearest publicly-identifiable abortion facility. We then estimated these travel distances under two hypothetical post-Roe scenarios. In the first, abortion becomes illegal in 8 states with preemptive “trigger bans.” In the second, abortion becomes illegal in an additional 13 states classified as at high risk of outlawing abortions under most circumstances. Using previously-published estimates of the short-run causal effects of increases in travel distances on abortion rates in Texas, we estimate changes in abortion incidence under each scenario.

Results
If Roe were reversed and all high-risk states banned abortion, 39% of the national population of women aged 15-44 would experience increases in travel distances ranging from less than 1 mile to 791 miles. If these women respond similarly to travel distances as Texas women, county-level abortion rates would fall by amounts ranging from less than 1% to more than 40%. Aggregating across all affected regions, the average resident is expected to experience a 249 mile increase in travel distance, and the abortion rate is predicted to fall by 32.8% (95% confidence interval 25.9 to 39.6%) in the year following a Roe reversal.

Conclusion
In the year following a reversal, increases in travel distances are predicted to prevent 93,546 to 143,561 women from accessing abortion care.

Implications
A reversal or weakening of Roe is likely to increase spatial disparities in abortion access. This could translate to a reduction in abortion rates and an increase in unwanted births and self-managed abortions.