A sprawling grassroots infrastructure has already grown in the cracks created by such challenges, even with Roe still the law of the land. More than 90 local organizations known as abortion funds raise money to pay for procedures and related expenses. Practical-support groups offer rides to medical facilities, along with housing, child care, and translation services. Clinic escorts guide patients past throngs of angry protesters. Doctors and other abortion providers travel hundreds of miles to work in underserved areas that are openly hostile to abortion.

This improvised safety net doesn’t catch everyone, though. Below the grass roots is the underground: a small network of community providers who connect with abortion seekers by word of mouth. This network, too, is growing. Its ranks include midwives, herbalists, doulas, and educators. When necessary, they are often willing to work around the law…

A post-Roe world will not resemble a pre-Roe world. Women already have different options. In Blumenthal’s view, the future doesn’t lie in Planned Parenthood (which in addition to education and advocacy offers abortion services through a network of clinics). “I think the future lies in more self-managed care and alternative distribution schemes,” he told me. Pharmaceuticals are a big part of that future—the work-around of first resort and one that’s hard for authorities to stop. Blumenthal’s confidence in the safety of medication abortion, including when it is self-managed, is the medical consensus, supported by the WHO, the FDA, and numerous studies.

In circumstances where pharmaceuticals may not be appropriate, he believes that laypeople can be instructed to wield manual vacuum-aspiration devices, including the Del-Em, with little risk of infection. Technicians without medical degrees, he added, have been using such tools safely for decades in South and Southeast Asia. “This is not a complicated procedure,” Blumenthal said. Vacuum aspiration outside a clinical setting is not “self-managed” the way pills can be—it requires assistance. Although specific studies are few, they suggest that outcomes involving trained nonphysicians are comparable to those involving physicians (and in either case, the risks are very low).