The writer is an obstetrician/gynaecologist in Wisconsin

Roe vs Wade was overturned last Friday. Those of us who provide abortion care, in my case for the women of Wisconsin, had been bracing themselves for it for a while, especially after the Scotus leak in May. But the actual ruling was still a brutal punch in the gut. It has changed everything.

Twenty-six of America’s 50 states either outlawed abortion immediately or are facing legislative and judicial challenges, leaving millions of women without essential healthcare. The majority of them belong to vulnerable, under-represented populations, many of whom were already struggling to get by with limited resources in the wake of the pandemic. Health disparities in the US, even now among the worst in developed nations, are certain to widen as a result.

The impact on an individual level is different. As an obstetrician/gynaecologist, it is my duty to provide compassionate, evidence-based care across a woman’s life, including management of high-risk pregnancies. My patients present with complicated stories — mental health concerns, financial challenges, conflicting beliefs and life experiences. These often deeply personal scenarios require them to exercise their right to bodily autonomy as they make decisions for themselves and those in their lives.

This is particularly heartbreaking when women are faced with unanticipated conditions within a desired pregnancy. Developmental and genetic diagnoses incompatible with life, maternal health complications, pre-viable premature rupture of membranes and ectopic pregnancy (to name a few). All of these require a compassionate discussion covering risks, benefits and alternatives, including termination.

Abortion care has already been severely limited in Wisconsin over the past 10 years. Until last Friday, we had just four clinics that provided abortion care, serving the state’s nearly 3mn women. Now we have none. Every physician I know has been forced to stop offering abortion care due to reversion to an 1849 law that criminalised termination, making it a felony — without exceptions for rape or incest. This law was written one year after Wisconsin became a state and over 70 years before US women earned the right to vote. It is unclear whether it is enforceable but, because most of us provide care in other settings, we can’t afford to put our practices, and our lives, at risk.

What will those who are pregnant do? The ones who can will travel to nearby states, including Illinois and Minnesota, where abortion care is still available. Some will turn to self-management for their termination, ordering mifepristone and misoprostol online or co-ordinating a “menstrual extraction” procedure with a supporter. Others, probably those who have fewer resources to begin with, will be forced to continue their undesired pregnancies, often perpetuating cycles of poverty and abuse.

Many of my medical colleagues will now start travelling to our border states to help with the anticipated influx of patients. I will provide telehealth abortions for Minnesotans and fill in as needed at a clinic five hours away from my home. For those “haven” states, whose clinics will absorb large increases in patient volume while facing a historic staffing shortage, the problems are entirely different and extremely pressing.

We anticipate a rapidly evolving landscape in the weeks and months ahead, requiring a nimble and resilient population of dedicated healthcare providers to ensure that women have access to compassionate, quality information and resources. We will do our best. We have been doing all we can, but we can only do so much. Ultimately, our ability to take care of our patients is in the hands of politicians. The direction that we take from here — including on other constitutionally protected rights such as access to contraception — now lies in the hands of the voters.