In places where the laws are restrictive — as they are in countries like Brazil or El Salvador — those barriers mount. In the United States, a patchwork of state-level restrictions perpetuate the falsehood that medication abortion must be taken in a clinical setting to be safe. Nineteen states currently require a clinician to be physically present during a medication abortion, thus prohibiting the use of telemedicine. If Roe v. Wade is overturned and state-level laws further restrict access, medication abortion will most likely become significantly less accessible.

As with surgical abortions, when abortion laws are restrictive, women turn underground. They buy drugs of uncertain provenance, or resort to combining the drugs with herbal teas or other unsafe methods — all common occurrences in Brazil. While obtaining good-quality abortion pills online is possible in America at this time, increased legal restrictions will force many women to turn to less reliable retailers.

Then, even when women can afford to obtain high-quality pills, there is no guarantee that they’ll have access to accurate information about how to use them effectively, causing additional stress and decreasing the likelihood that the abortion will work. In India, the information that accompanies abortion pills is often inaccurate. Abortion pills bought online in the United States typically come without instructions about how to use them, and what to expect as an abortion proceeds. (The International Women’s Health Coalition’s fact sheet on self-managing an abortion is the most popular download on our website — a strong indication of the desire for accurate information from all corners of the globe.)

Most distressingly, in an environment that is hostile to reproductive rights, women can land in jail for provoking their own miscarriage, as has happened to at least 25 women in El Salvador. In the United States, some states — including New York — have laws directly criminalizing self-induced abortion. In Indiana in 2015, when Vice President Mike Pence was governor, Purvi Patel was sentenced to 20 years in prison after her miscarriage was suspected of having been induced with medication. Her conviction was overturned on appeal, but the prosecution was an ominous sign of where aggressive enforcement could lead.

Abortion pills and community self-help networks have saved women’s and girls’ lives and safeguarded their health around the world. They are a critical tool and will be used, no matter the legal regimen governing abortion. But abortion pills will not solve all the problems of a post-Roe world, especially for those who cannot afford or have access to them. For them, the coat hanger may yet make a terrifying comeback.

Françoise Girard is the president of the International Women’s Health Coalition and a longtime advocate and expert on women’s health, human rights, sexuality and H.I.V. and AIDS.