As the US Supreme Court prepared to hand down its decision on Friday, Emily Freeman was racing against the clock at a clinic in Missouri.
Uncertain of when a ruling on the country's abortion rights might occur, the obstetrician and gynaecologist scrambled to help a patient who had travelled for nearly four hours to undergo a medical procedure that would be completely banned in the state by the end of the day.
"I'm not sure how we pulled it off … there was a lot of effort with a lot of folks to make it happen for her," she says.
Dr Freeman and her colleagues had been waiting "with bated breath" every day for Roe v Wade to fall since a leaked draft opinion in May showed the US Supreme Court was poised to overturn the landmark 1973 decision enshrining access to abortion in the country.
"Since Friday, I have felt a wide range of emotions, but I think the overarching feeling I have is just sadness — mostly for my patients that I've cared for in the past, and then additionally the patients that I can't care for now," she says
Missouri, which already had some of the strictest abortion laws in America, was one of 13 US states with "trigger laws" in place in the event Roe v Wade was overturned.
"Thanks to decades of conservative leaders, Missouri has become one of the most pro-life states in the nation, and our administration has always fought for the life of every unborn child," Missouri Governor Mike Parson declared on Friday after filing the necessary paperwork for the law to kick in.
Soon after, the sole remaining abortion clinic in the state notified Missouri's Department of Health and Senior Services that its abortion services were being immediately ceased.
A similar scenario is playing out across the US, with the right to an abortion set to slowly disappear in a large swathe of states in the south and mid-west.
With the constitutional right to abortion gone, healthcare providers, clinics and millions of women and pregnant people around the country are now grappling with a new reality.
For some Americans, such as those in the anti-abortion movement, this is the realisation of a decades-long ambition.
But for others, including those that believe abortion should be legal, there are concerns the country is winding back the clock to a time when abortion was carried out in the shadows, often resulting in serious health complications and sometimes death.
America before Roe v Wade
Before the Supreme Court decision on Roe v Wade in 1973, abortions were prohibited in more than half of US states and only allowed in special circumstances in 13 others.
But women and pregnant people were still undergoing procedures. An estimated 200,000 to 1.2 million illegal abortions were performed a year in the US throughout the 1950s and 1960s, according to the Guttmacher Institute.
Historians say there was a vibrant word-of-mouth network that enabled pregnant people to find safe providers. Access depended on a person's financial situation, their location and their ability to travel, among other things.
Another method women turned to was self-induced abortions, giving rise to horror stories of ingested poisons, household instruments and perilous falls down stairs.
"A variety of horrific things were done to self-induce abortion [back then]," says Flinders University's senior lecturer in US history Prudence Flowers.
"The kind of horrors of the backyard abortion meant that most hospitals had septic abortion wards for women coming in who had abortions that had gone wrong."
Census bureau data shows that only about one in five American women today were old enough to have had to make decisions about pregnancies during this time.
Historians, legal experts and health practitioners point to modern medicine and a changed pharmaceutical landscape as examples of how the other four in five are unlikely to experience a future that mimics the past.
But the decision to overturn Roe v Wade will still have a number of implications for women and pregnant people, perhaps on a greater scale than ever before.
What to expect now abortion rights have been toppled
America is not necessarily going back to pre-1973 era, but research shows that in countries where abortion is outright banned or restricted, women are more likely to suffer negative health outcomes.
Advances in the nation's pharmaceutical industry, however, have made it easier for women to self-administer abortions, with pills now used by half of Americans seeking to terminate their pregnancy.
Medication abortion, which became legal in the US in 2000 after mifepristone was approved by the FDA, involves taking two different drugs to stop the development of a pregnancy.
It can be taken up until 10 weeks, with the process usually causing contractions similar to a miscarriage.
Medication abortion is a cheaper, less invasive alternative to surgical abortion in the early stages of pregnancy. Pregnant Americans can access abortion pills online or via the telephone, or travel to buy them elsewhere.
Outlets like Just the Pill have reported huge increases in people asking for abortion pills. Before Roe, the organisation would typically receive about 20-25 requests a day. As of Wednesday, it had over 260 requests just from Friday.
Yet some states have begun to restrict access to these pills or outright ban them, as Texas has done by introducing a law to prohibit sending abortion pills through the mail.
It is unclear how state governments plan to enforce these laws.
What is certain amid a changing legal landscape is that American women are facing greater surveillance and criminalisation, observers say.
"It's not just now about unsafe abortions and access to non-mainstream treatments, but also this more widespread surveillance by the government … in terms of tracking devices," Swinburne University law school's Georgina Dimopoulos, a privacy expert and law lecturer, says.
"Should [women] be worried about what they're telling other people [and] what information and data they're inputting into apps?"
Period-tracking apps, online search histories and text messages could all be used as evidence in a hypothetical criminal case, according to activists.
State bans also incentivise bounty hunters to report abortion providers. In Texas, for instance, a private citizen who sues a healthcare worker or abortion provider is rewarded with $US10,000 and their legal fees are covered by the state.
The current situation in Texas, however, is currently unclear due to a tangled web of abortion laws in the state being in the courts.
Ultimately, the US Supreme Court's ruling goes much further than tackling the issue of abortion in America, it also disrupts decades of understanding of privacy.
First, legal experts argue, there is the issue of informational privacy, given the uncertainty over how data from apps and Google searches could be used against those seeking an abortion.
But it also raises concerns over "decisional privacy", which is a privacy that protects an individual's ability to make decisions about their bodies "without unwarranted interference from the state and from others," Dr Dimopoulos says.
"… It's a huge step backwards for rights and for privacy and for our understanding of the value of privacy in our society," she says.
Some states offer a glimpse into a post-Roe future
As America adjusts to a rapidly shifting reality, some states are already offering a glimpse into a post-Roe world.
Parts of the US have been moving to restrict abortion for a number of years, resulting in the closure of one-quarter of US abortion clinics between 2011 and 2016. As of early 2022, there were five states with only one clinic.
These measures have led to homegrown networks forming to help people operating in restrictive states, whether by providing access to abortion pills or advice on where to safely get an abortion.
Even so, estimates suggest about one-quarter of people who would have had an abortion under Roe will be forced to continue with a pregnancy post-Roe.
Observers say this will likely entrench existing inequalities for poor Americans who will not have the capacity and resources to travel interstate or access abortion pills online.
"We know who is often criminalised in the States and it's black people. And with abortion, it has always been poor people as well," says author and post-research fellow at La Trobe University Erica Millar.
At Dr Freeman's medical practice in Missouri, phones have been ringing off the hook since Friday.
Some women and pregnant people call with questions, others share their anxiety over the future and what this decision means for them.
"The office that I work in saw a huge influx of phone calls for patients … desiring permanent sterilisation or long-acting reversible contraception such as IUDs and so on," Dr Freeman says.
She says the repercussions of this decision will be unlike anything she has experienced in her medical career.
It also raises a number of questions, not only for patients but for healthcare workers like herself too.
Some physicians may now find themselves caught in an ethical bind, unable to fulfil their professional duty to provide care to their pregnant patients because of state laws that prohibit it.
Alabama-based physician Leah Torres has described how even under Roe v Wade, medical providers who treat pregnancy-related issues in conservative states "exist in a constant state of fear of performing any procedure that can be classified as an abortion".
Ultimately, for both providers and patients, where they work and live will play an outsized role in their ability to administer or access abortions.
