The dystopian American reality one month after the Roe v Wade reversal

Severe new restrictions upend reproductive care across whole regions of the US. Patients report delays for procedures that were once common and routine, as doctors fear vague new laws with criminal penalties. A 10-year-old rape victim was forced to travel out of state to terminate a pregnancy. And activists promise more draconian restrictions to come.

In the month since the supreme court bombshell that ended the right to abortion, this picture is the new American reality, as states across the south and midwest embrace their new ability to ban abortion – at times without exception. The consequences have been both chaotic and predictable.

“Everything is super in flux right now,” said Elizabeth Nash of the Guttmacher Institute, a reproductive rights research organization.

“We’re looking at probably about 15 million women living in a state with an abortion ban right now. That number we expect to increase, because more states are looking to ban abortion – and we could see as much as half of the country without abortion access very soon.”

At its most basic level, the upheaval caused by the supreme court’s decision in Dobbs v Jackson Women’s Health Organization has endangered patients, doctors and lawyers said. Dobbs ended federal abortion protections nearly 50 years after the landmark decision Roe v Wade, and returned regulation of abortion to states.

Bans at six weeks gestation or earlier, before most women know they are pregnant, are in force in 12 states as of Thursday. The bans have forced patients seeking abortions, and who have the time and money, to travel hundreds of miles from home. At times, that travel has also placed friends, family and abortion rights organizations in legal jeopardy, as states have criminalized helping people obtain abortions. Other patients have seen routine care for miscarriages and ectopic pregnancies delayed, as doctors fear criminal sanctions should they accidentally violate bans.

“Truly frustrating and harrowing in my view, the state of Texas [being] intentionally ambiguous about when hospitals can provide care,” said David Donatti, a staff attorney at the American Civil Liberties Union (ACLU) of Texas. Patients face “prolonged pain and suffering for pregnancies that are not viable, because the chilling effect of what the state of Texas has done is so powerful”, he said.

More broadly, however, the court’s late June decision has shifted what was once a fight over national abortion policy to multiple fights in individual states, and even local governments. In Louisiana, the legality of abortion has changed almost daily, as a court case about three new abortion bans progresses. On the local level, some progressive cities such as Austin, Texas, intend to bar police from investigating abortion-related cases, even as the state bans the procedure.

Meanwhile, small towns and some conservative prosecutors have vowed enforcement. In Benton county, Arkansas, the local prosecutor warned abortion would be investigated “like any other potential crime”.

In those states where abortion remains legal, patients have suddenly found clinic appointments full. In Kansas, the nearest state to Arkansas, Missouri, Oklahoma and Texas (all of which have banned abortion), clinics are at capacity.

“We just don’t have enough appointments to meet the need,” said Emily Wales, the president and CEO of Planned Parenthood Great Plains, which once operated clinics in Arkansas, Missouri and Oklahoma, as well as Kansas. “That’s something we’re trying to make clear to Kansans as well.” The nearest clinics with appointments may now be in Illinois, Colorado, Nebraska and New Mexico, she said.

A still untold number of patients will carry unwanted or dangerous pregnancies to term, a situation likely to worsen as more states bring bans online in the coming weeks.

North Dakota, Idaho and Wyoming are all expected to begin enforcing bans this summer. Indiana has called a special session to restrict abortion. A more severe criminal ban, providing punishments of 99 years in prison and $100,000 in fines, is also expected in Texas, where abortion is already banned.

The court’s decision has also rippled into politics, as Americans absorb the shock of rescinding a nearly 50-year-old precedent.

Kansas is representative of one such political battle. On 2 August, voters there will cast ballots on the first abortion-related referendum in the country, in what is likely to be a tight and closely watched campaign. Its neighboring states have, one by one, banned abortion: when the supreme court allowed Texas to ban abortion at six weeks gestation in 2021, clinics in Oklahoma began to care for Texas patients; then Oklahoma passed a similar six-week ban, forcing patients to Missouri and Kansas; when the court ruled in Dobbs, Missouri banned abortion, too. That has left Kansas as a legal haven for abortion.

It may not remain that way. Lawmakers have placed a statewide constitutional amendment vote on the primary ballot, which would give the Republican-dominated state legislature more latitude to restrict abortion in a state where lawmakers have already shown interest in banning it.

However, Kansas could also be a bellwether of how overturning Roe v Wade has changed the political landscape. New polling suggests the court’s decision may have galvanized supporters of abortion rights – an issue that previously motivated its opponents more strongly than supporters. About 85% of Americans support legal abortion under at least some circumstances. Historically, however, they have been less well organized than anti-abortion groups.

Now, there has been a “dramatic increase in moderate Republicans, apolitical folks” who have found themselves interested in the Kansas referendum , said Ashley All from Kansas for Constitutional Freedom, a group that supports abortion rights. She said the court’s decision “was a wake-up call for people who thought their constitutional rights were protected at the federal level – and that is not the case now”.

Kansas won’t be the only place where the new political reality is tested. There are a record number of states with ballot initiatives on abortion rights this fall. Voters in Kentucky and Montana will be asked to vote on anti-abortion ballot measures, while voters in California and Vermont will be asked to protect abortion rights. Campaigners in Michigan, too, are working to secure a ballot initiative to protect abortion rights.

Notably, local campaigners said Kansas’s abortion rights vote has also energized the LGBTQ+ community. The rights to gay marriage, same-sex intimacy and contraception were all called into question in the Dobbs decision in a concurring opinion by Justice Clarence Thomas, who argued the court should “reconsider” cases granting those rights.

“They’re showing up and showing out,” Martha Pint, co-president of the League of Women Voters in Kansas. “This right to reproductive choice – they honestly feel their rights will be next.”

While there does appear to be bipartisan support in Congress for enshrining protections for gay marriage in statute – even as Senate Republicans are expected to block protections for abortion and contraception – any hopes that abortion bans would increase support among Republicans for social safety net programs have so far been dashed. Instead, anti-abortion groups have focused on closing remaining legal routes to abortion.

“When all is said and done, about half of the states [could ban] abortion,” said Nash. “Meaning 34 million women of reproductive age would live without access.”