Carolyn Egan has seen people cross the Canada-US border for abortions – going north to south.

In the years before Canada’s supreme court legalised abortion in 1988, it was common for Canadians who needed abortions to travel to the US. “We had a network of people who could make referrals and help them get there [to the US]. If it’s necessary, that probably would happen again – but the other way,” said Egan, spokesperson for the Abortion Rights Coalition of Canada.

If, as a leaked draft decision indicates, the US supreme court votes to overturn Roe v Wade, many Americans in need of surgical abortion could be forced to travel not just across state lines but, once again, across international borders – both along the northern border to Canada and the southern one to Mexico.

On Tuesday, Canada’s minister of families, Karina Gould, reaffirmed that Americans can access abortion services in Canada. “If they, people, come here and need access, certainly, you know, that’s a service that would be provided,” she told CBC News.

An estimated 26 states are likely to ban abortion if Roe v Wade is overturned, according to the Guttmacher Institute, an American sexual and reproductive health rights research organization. That includes Michigan, which sits across the water from southern Ontario, where there are plenty of abortion clinics. “If a state like Michigan banned abortion, certainly there would be interest in coming across the border,” Egan said.

Michigan has a 1931 ban that could automatically kick in when Roe v Wade ends. Michigan residents could also travel to Illinois or Pennsylvania, as those states are unlikely to outlaw the procedure, according to Guttmacher data, and many Americans would be expected to travel internally between states.

Those travelling internationally won’t find it free – people without immigration status in Canada are charged about C$500 (US$388) for a surgical abortion, Egan said – but Americans do not need a health card to access clinics in Canada. Wait times vary, from one to two weeks in Ontario to several weeks or months in the Atlantic provinces.

Crossing the border will probably only be possible for those who can afford to do. Abortion advocates in the US have underscored that after Roe v Wade falls it will be wealthier white women who have the means – including travelling – to access abortion, while people on lower incomes and those who face socioeconomic barriers including African American, Latino and Indigenous women and transgender people may struggle more.

“You have to have the financial resources” to travel between states or internationally, Meghan Doherty, director of global policy and advocacy at Action Canada for Sexual Health and Rights, said. “There will be a limited number of people who will be able to do that.” She added that not everyone has dependable childcare, the ability to take time off work or a valid passport.

The cheapest option early in pregnancy will probably continue to be abortion pills, obtainable either through the mail or via telehealth services.

But after working for more than 10 years at clinics in Ireland while abortion was illegal, Doherty says she has no doubt that people will cross borders. “Over 5,000 women a year travelled to the UK, so we know that abortion restrictions don’t stop women from accessing abortion – it just places more burden on them.”

South of the US border, Mexican advocates are preparing for an increase in Americans visiting to access abortion services. In 2021, Mexico’s supreme court ruled it was unconstitutional to criminalise abortion, although access still varies by state.

The advocacy group Las Libres is part of a network that helps people on both sides of the border access abortion pills. Vero Cruz, advocacy coordinator with Las Libres, said Americans can technically obtain surgical abortions in public clinics in certain Mexican states for free, though she doesn’t know of anyone who has done so yet. Cruz said surgical abortions were available in Sinaloa, Coahuila and Baja California, but only up to 12 weeks of pregnancy.

“The women who are crossing into Mexico are coming to Monterrey, Tijuana and other cities to have abortions using medication,” she said. The abortion pills are free, too. “It’s completely free, it costs nothing.” She said both private and public clinics in border cities in Mexico were planning for an American influx; both Tijuana and Coahuila recently set up services, she said.

Egan said Americans in Canada will be warmly received, too. “For a cabinet minister to say that Americans would be welcome here, gives the sense that the government is considering the possibility, and making it clear they would not be interfering in that.”

Many Canadians are upset about the looming end of Roe v Wade, she said. “There’s tremendous upset, distress and anger that Americans would be in the situation of having to face this kind of thing. So my sense is people will do everything they can to make access easier.”