Just minutes after the US Supreme Court overturned Roe vs Wade, Eric Schmitt, the attorney-general of Missouri, proclaimed that his state would be the first to ban abortion after the landmark ruling on Friday.

In reality, such bans automatically took effect in multiple states after the ruling, thanks to laws previously passed by their state legislatures that were meant to come into effect if Roe were ever knocked down.

Doctors, campaigners and politicians on both sides of the US abortion debate have been planning for this moment for years. In 13 states, lawmakers have passed so-called “trigger bans”, laws to outlaw abortion should Roe ever be overturned. Another 13 are likely to pass their own bans in the coming weeks.

Many abortion providers in states where the law was due to change had already stopped seeing patients in recent days or begun planning to move across state borders. In other places where they expect the law to change within weeks, providers face a dash to put into place contingency plans for patients who have been lining up in recent weeks to receive treatment.

“We saw our last patient in Missouri last week,” Dr Colleen McNicholas, the chief medical officer of Planned Parenthood in the St Louis region, said hours after the Supreme Court ruling.

“I have fielded calls from colleagues across the state hoping to get their patients onto Illinois schedules in the coming days,” she added. “And this is just in the moments after the decision.”

In three states — Louisiana, Kentucky and South Dakota — the trigger bans were designed to go into place automatically without any further intervention from state officials. Another three — Arkansas, Wyoming and Mississippi — require a final sign-off from a governor or attorney-general for their bans to be enforceable.

Even before Arkansas’ attorney-general gave the go-ahead on Friday afternoon, the state’s Planned Parenthood group announced it would no longer provide abortions.

The impact was felt quickly in Texas, which had a trigger law in place to ban abortion after Roe was overturned. Many clinics across the state immediately suspended abortion services to avoid potential prosecution. The Houston Women’s Clinic, in downtown Houston, one of the city’s largest abortion providers, was closed on Friday and had a sign hanging outside its facility saying it “is no longer able to provide abortion care”.

Other states, such as North Dakota, have a 30-day grace period for their laws to go into effect, giving doctors and patients some time to adjust.

The Red River Women’s Clinic in Fargo, North Dakota, has been planning for some time to move 15 minutes across the border to Minnesota. But Tammi Kromenaker, the clinic’s director, said she did not know whether it would be able to open its new site soon enough to prevent an interruption to services.

“We’re so thankful and grateful that Minnesota is five minutes away, and it will take less than 15 minutes to get to our new clinic,” she said. “But it is not just a matter of turning the lights on — an enormous amount of work will go in to make it available and enable us to see patients.”

For now, the clinic is continuing to schedule patients for their appointments, uncertain of when exactly the clock will start ticking on the 30-day countdown. Kromenaker said she had scheduled an abortion just minutes after the ruling for a patient who seemed unaware that the ruling had happened.

It is not just Minnesota that is gearing up for an influx of abortion patients from states where it is now or about to be banned. Providers in and around Illinois, which borders both Missouri and Kentucky, say they are expecting a surge of demand in the coming weeks.

“We anticipate more than 14,000 additional patients from the Midwest and the South will turn to this care [in Illinois],” said Yamelsie Rodriguez, president of Planned Parenthood in St Louis.

“Since Texas banned abortion in September, our health centre in Fairview Heights, [Illinois], has already seen more than 100 per cent increase in the patients that we’re taking care of.”

Abortion advocates have for years operated funds in states with strict restrictions on the procedure to help pay for patients to receive treatment. But many of those funds say demand has been so high in recent weeks they have struggled to keep up.

One such group, Fund Texas Choice, said that where it used to pay for a friend or family member to travel with patients for an abortion, it is now only able to do so for those under the age of 18.

“These bans will go into force, whether it takes hours or days,” said Elizabeth Nash, principal policy associate at the Guttmacher Institute, which advocates for abortion rights. “There is a question over when they will be enforced, though many providers have already stopped accepting appointments.”

Even in some states where the path ahead is still uncertain, some providers were adjusting quickly to the new legal landscape on Friday morning.

Alabama does not have a trigger law in place, but in 2019 Kay Ivey, the Republican governor, attempted to enact a sweeping bill that would have banned almost all abortions. That effort was blocked by a federal judge.

Many abortion advocates and providers in the state are expecting a similar bill to be passed quickly. Robin Marty, the operations director at the West Alabama Women’s Center, said her centre stopped providing abortions the minute the ruling was passed down.

“Even if they are on the patient bed, any charts they come and seize afterwards, they can check and see if we did an illegal abortion,” she told local news website al.com.

Additional reporting by Justin Jacobs in Houston



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