To sex workers, navigating the world without medical access to abortions or reproductive care is nothing new. But the overturning of Roe V. Wade puts their livelihoods further at risk.

• Sex workers have long found ways to get abortions despite limited access to traditional healthcare.
• Their use of unconventional medicine for unwanted pregnancies offers a window into a post-Roe world.

The healthcare realities of sex workers offer a glimpse of life with limited access to abortion.

A Supreme Court draft was leaked on May 2 indicating the potential overturning of the landmark abortion decision Roe v. Wade. But sex workers – from pornographers to escorts – say they've long lived in a post-Roe world, often resorting to unconventional methods of abortion due to a lack of healthcare access and to remain under the radar of law enforcement.

Sex work doesn't typically come with standard medical insurance. Instead, workers turn to other means for their reproductive health, networking through their own community to get access to everything from gynecological exams and primary care to safe abortions.

"We practice safe sex, some will say a lot better than 'civilians' (our term for regular people), however, accidents happen," Milo Skye, an escort based in Tennessee, told Insider.

If Roe is overturned in June, 13 states — including Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, South Dakota, Tennessee, Utah, Texas, Oklahoma, and Wyoming — with so-called trigger laws will immediately outlaw all or nearly all abortions.

In those states — and 10 others that may restrict abortion rights — patients could soon look to more unconventional remedies that sex workers have long relied on.

Cristine Sardina, director of a pro-sex worker organization Desiree Alliance, told Insider that as a result of living outside the margins of traditional healthcare, some workers have become experts in "herbal remedies and menstrual extractions."

Menstrual extraction is a procedure that requires the use of a plastic tube, a needle-less syringe, a cannula, and a collection jar that pulls out uterine contents — such as period blood — through the cervix, Mic reported in 2016. The process has been used since 1971 — several years before the Roe v. Wade decision.

Paul D. Blumenthal, professor of obstetrics and gynecology, argued in a piece for The Atlantic that the extraction technique is not complicated and that trained non-medical professionals could perform them with assistance.

But there is the possibility of infection. "You're introducing something into the uterus," gynecologist Dr. Donnica Moore told Insider of the technique in 2019. "Things are supposed to go out, not come in. Anytime that happens, we worry about infection."

But Sardina believes solutions like this will only become more common if access continues to dwindle. "It will also create clandestine markets that can hurt us such as black market birth control, botched and inept medical procedures, [or] criminalization," she said.

Sharing information and providing mutual aid to those in need of abortion could soon become even riskier, said Kate D'Adamo, sex worker rights advocate and partner at Reframe Health and Justice, a consulting collective that supports social justice organizations and movements.

Private citizens in states like Texas and Oklahoma are encouraged to report others for illegal abortions — pushing information on safe abortions further underground by criminalizing those who help.

For instance, Texas lawmakers enacted the country's restricted abortion law in 2021: a so-called "heartbeat" bill that bars abortion after six weeks of pregnancy, which is usually before individuals recognize they're pregnant. Senate bill 8 also encourages private citizens to enforce the law by allowing them to sue providers and patients suspected of getting an abortion — as well as people who help in the process — for up to $10,000 in damages.

Other states are also hoping to push forward with restrictive measures as well. Oklahoma approved a ban on abortion similar to Texas and Florida reduced the procedure's availability down from the 24th-week of pregnancy to the 15th week of pregnancy.

"Sex workers are deeply familiar with the long shadow of criminalization and how it will impact information sharing, basic harm reduction, community and mutual aid, and a range of other things we do to survive," D'Adamo said.

Currently, sex workers rely on their own communities and organizations to privately connect them to safe reproductive care including abortions, but some online resources are also available.

The BIPOC Adult Industry Collective is one of many organizations that support sex workers through education, wellness, and financial assistance. Sinnamon Love, a Black feminist pornographer and the founder of the BIPOC Adult Industry Collective, told Insider that the collective is working to expand its budget for people in the industry looking to travel out of state for abortion care.

While limitations on reproductive and healthcare set by the government are not new to individuals in the sex trade, many are prepared for their work to get much more difficult if the court does decide to overturn the landmark abortion law. Unintended pregnancies – one of the many risks of the trade – could impact a sex worker's income and livelihood, Love told Insider.

"To leave this decision to states means sex workers in red states are in jeopardy of increased policing when working and when accessing medical and mental health care," Love said. "So much of the struggle sex workers like myself face is steeped in combating the idea that we can't possibly know what is good for us and that someone needs to save us from ourselves."