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People rally in support of abortion rights at the state Capitol in Sacramento, Calif., on May 21, 2019.Rich Pedroncelli/The Associated Press

Although Roe v. Wade remains the law of the land, women can no longer get a legal abortion in two states, Oklahoma and South Dakota. In at least one other, Missouri, they can no longer make an appointment. And in a fourth state, Wisconsin, clinics will not schedule abortions for after the end of the Supreme Court’s term in late June.

Before May 2, when a draft Supreme Court opinion that would overturn Roe was leaked, there had been at least one abortion clinic in every state. But in some states, health care providers aren’t waiting for the actual decision to be issued to start operating as if Roe were overturned.

“It’s already happening,” said Caitlin Myers, a professor of economics at Middlebury College who studies abortion accessibility. She is leading a national survey of abortion clinics and supplied data on her recent findings, which was verified by The New York Times.

The changes in the last few weeks suggest how quickly an overturning of Roe could reduce abortion access across the South and Midwest, which would be a hard-fought victory for the anti-abortion movement. Roe guarantees a constitutional right to abortion until the point of fetal viability, around 23 weeks, and without it, around half of states are expected to ban the procedure. Many of those states already had limited access – six had a single clinic, and three had two – and various restrictions that made abortions harder to get. Now it is changing from hard to impossible, at least without crossing state lines.

In Oklahoma, clinics have stopped operating because the state passed a new ban, even though it clearly conflicts with Roe. “We haven’t had abortion for 2 1/2 weeks,” said Susan Braselton, a clinic escort and a board member of the Roe Fund in Oklahoma, which helps patients finance abortions.

“From the moment life begins at conception is when we have a responsibility as human beings to do everything we can to protect that baby’s life and the life of the mother,” Gov. Kevin Stitt of Oklahoma said in a statement upon signing the ban last month. “If other states want to pass different laws, that is their right, but in Oklahoma we will always stand up for life.”

The only clinic in South Dakota, Planned Parenthood in Sioux Falls, which also served patients from North Dakota and Minnesota, performed its last abortion Monday, even though the state has not yet banned it. Abortions at the clinic were already sporadic. A Minnesota doctor flew in around once a month to provide them.

And in some other states, legal abortion has become much more scarce. In Idaho there were four clinics, but Planned Parenthood in Boise closed June 1. At another, Compassionate Abortion Care in Boise, the only doctor is set to take a summer vacation, and staff members are telling patients that abortion may not be legal by the time he returns. A third is offering only medication abortion.

At Planned Parenthood clinics across the country, phone recordings tell callers that abortion remains legal and accessible, but some have stopped scheduling abortions.

A banner at the top of the website for Planned Parenthood of Wisconsin says: “Our doors are open. Planned Parenthood of Wisconsin will continue to help patients get the care they need – including safe and legal abortion. No matter what.” But the organization there decided to stop offering any new appointments for abortion after June 25, anticipating that the court might release its opinion two days later, on its last scheduled decision day. Wisconsin still has an 1849 law on the books criminalizing abortion.

Dr. Allie Linton, the organization’s associate medical director, said the decision was in part because of worries that it would be hard to contact patients if their appointments needed to be cancelled. She also said the group’s leaders were “cognizant of the significant trauma that might come for patients and staff if we are in the middle of a procedure or the middle of a procedure day, and have to tell patients we cannot provide care.”

The Wisconsin clinics have avoided scheduling procedures on days this month when the Supreme Court is expected to issue opinions. Many members of the staff plan to spend the week of June 27 training at new clinics in Illinois, anticipating they may need to relocate so that Wisconsin patients can travel there to obtain care.

At Planned Parenthood Great Northwest, which operates clinics in Hawaii, Alaska, Washington, Idaho, Indiana and Kentucky, five clinics closed last month as the organization started shuffling resources. Idaho, Indiana and Kentucky are expected to ban most abortions if Roe is overturned, so the organization is trying to expand telemedicine abortion in the remaining states and to help patients get to out-of-state providers.

As clinics schedule new patients, they are warning them that the legal status of abortion may be in flux. “Our patient navigators, when they are scheduling, they give patients a heads up and say, ‘Hey, just so you know, there may be a legal change,’” said Katie Rodihan, a spokesperson for the clinics.

Danika Severino Wynn, the vice president for abortion access at the Planned Parenthood Federation of America, said in a statement that local affiliates were independently deciding what to do as the court’s decision nears.

“Planned Parenthood affiliates in these states that are extremely hostile to abortion access are being forced to make the difficult decision whether or not to suspend providing abortion services following the court’s decision, due to their state’s legal landscape,” she said.

Even in states that intend to ban abortions, many would allow the procedure to save the life of the mother or for pregnancies caused by rape or incest. But with clinics closing in states with bans, women eligible for such care may still need to travel to receive it.

Other clinics in states that are expected to ban abortion are fully open, like Red River Women’s Clinic in Fargo, North Dakota. The state has a trigger ban that would make abortion illegal 30 days after a court decision. “We will continue to provide abortion in our state as long as it is legal,” said Tammi Kromenaker, the clinic director. If Roe is overturned, she plans to open a new clinic across the river, in Moorhead, Minnesota, to continue to serve women in the region.

Already, clinic closures are leading to long wait lists at open clinics, which has caused some patients to travel far to receive care. Last week, the Red River clinic admitted three patients who had driven four hours from the Twin Cities, because they could be seen sooner that way.

The legal limbo has also been confusing for patients, said Dr. Erin King, executive director of the Hope Clinic for Women in Granite City, Illinois.

“Every time a restriction is enacted in a state, there’s mass confusion about how to comply and what it means,” she said. “After the leak, we had patients calling to ask if abortion was still legal.

“Trying to get information out – as providers and organizations who work directly with patients, that’s a huge part of the role.”

She said that – for now – the message they give patients is: “Abortion is legal in this country. It may be very difficult to access in some states, but it is legal.”

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