A sweeping abortion ban went into effect in Indiana on Thursday, containing only extremely narrow exceptions for medical emergencies, rape and incest and making it the latest state to largely outlaw the procedure in the US.

The ban is being challenged in court by the ACLU and several abortion care providers, with hearings set to start on 19 September.

Indiana lawmakers passed the legislation during a special legislative session in early August, with a six-week pause before it came into effect. Then, Indiana was the first in the nation to bring in a new law banning abortion after Roe fell. Before that, anti-abortion activists had relied on so-called “trigger laws”, written pre-Roe, to ban the procedure once the supreme court decision came down.

But earlier this week West Virginia followed and also passed a sweeping ban.

“We will always have more work to do because we need to make it unimaginable to end an unborn baby’s life,” the Republican state senator Liz Brown said when she backed the bill six weeks ago.

The law effectively wipes out abortion access for 1.5 million Indianans of reproductive age, and will have far-reaching consequences as Indiana had become a safe haven for those seeking abortion in other nearby states.

Now, residents in places like Ohio, Wisconsin and Kentucky, which have total or near-total abortion bans in place, will have to travel hundreds of miles to neighboring Illinois for the procedure. Meanwhile, other midwestern states, like Michigan, will put abortion rights directly to the public in a ballot in November.

The Indiana law – known as SB 1 – is an all-encompassing abortion ban with some extreme restrictions. It limits abortions to cases where there is serious risk to the health or life of the pregnant person, and in the case of a lethal fetal anomaly up to 20 weeks post-fertilization.

Similar abortion restrictions in other states have already put the lives of pregnant people at risk, which is of huge concern in a state like Indiana, which has some of the worst maternal and infant mortality rates in the US.

The Indiana law allows abortions in the case of rape or incest – but only up to 10 weeks of pregnancy. Indiana threw rape and incest exceptions into the spotlight on an international stage early this year, after a 10-year-old girl travelled to the state from Ohio after being raped. Dr Caitlin Bernard, the girl’s OB-GYN, spoke out about the case after the 10-year-old was denied an abortion in her home state due to a trigger law in Ohio that does not include exceptions for rape.

The ban puts a limit on where abortions can be performed, specifically banning abortion clinics from performing the procedure. Instead, abortions must be performed in hospitals or surgical centers owned by hospitals. That has left hospitals scurrying to set up special units and work out their options – previously hospitals performed only a tiny fraction of abortions happening in state.