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This week’s leak of a draft opinion that would overturn Roe vs. Wade came as more than half of U.S. states are poised to outlaw abortion if the Supreme Court does strike down the 1973 decision. In those states, many in the South and Midwest, it already feels like the landmark decision is being overturned bit by bit as restrictive new laws have been taking effect.

“This is a region of the country where it’s not just an abortion desert — it’s a healthcare desert,” said Rebecca Tong, co-executive director of Trust Women, which runs clinics in Kansas and Oklahoma. “Many of these states did not expand Medicaid. These states have terrible maternal and infant mortality. It’s two separate countries.”

At least 26 states are expected to ban abortion if Roe vs. Wade falls, 13 of them “trigger” states like Oklahoma, with bans set to take effect as soon as the justices rule against Roe. But state lawmakers have not been waiting on the nation’s highest court to pass stricter abortion laws.

On Tuesday, Oklahoma’s Republican Gov. Kevin Stitt signed a law banning abortion after fetal cardiac activity is detected at about six weeks of pregnancy. The so-called heartbeat law will in effect expand the country’s largest “abortion desert.” It was modeled on a similar law Texas enacted last fall, the most sweeping restriction on abortion since Roe vs. Wade.

Last month, Stitt also signed a bill making it a felony to perform an abortion, punishable by up to 10 years in prison. It’s due to take effect in late August and is likely to face legal challenges.

“I want Oklahoma to be the most pro-life state in the country,” Stitt tweeted Tuesday after signing the new ban.

Trust Women clinics in Oklahoma City and Wichita, Kan., were already handling twice as many patients in recent months because of the Texas ban, Tong said. Now the Oklahoma City clinic is preparing to comply with the new state laws, and the Wichita clinic is expanding ahead of an anticipated increase in patients from Oklahoma.

“We plan to provide abortion care up to the legal limit,” Tong said.

“We are incredibly aware of the need,” she added, “mainly because our phones do not stop ringing.”