Fifty years ago, on Jan. 22, 1973, the U.S. Supreme Court in a case known as Roe v. Wade granted the right to an abortion.

It was a decision that allowed autonomy over pregnancy, but triggered decades of political turmoil — protests across the country, promises from politicians on both sides and cases of violence, including the deadly bombing of a Birmingham abortion clinic in 1998.

But just 212 days before what would have been the 50th anniversary of Roe v. Wade, the U.S. Supreme Court in another case (Dobbs v. Jackson Women’s Health Organization) overturned the landmark Roe v Wade case. The new ruling returned the authority to grant a right to an abortion – and subsequently other reproductive rights – to the states.

In Alabama, where the state legislature ranked most conservative in the country in one study released late last year, that means abortion has been illegal, without exception for rape or incest, for over six months.

When Roe v. Wade was overturned in June, Alabama’s federal injunction on the Human Life Protection Act, which only allows abortion in cases where the patient’s health is danger, was lifted within hours of the decision.

Thus, Alabamians saw a drastic shift in abortions in the state, dropping from thousands each year to “fewer than 10″ each month. And with that shift came threats of prosecution that have remained unclear since, such as whether it’s illegal to help an Alabamian travel to get an abortion, which Attorney General Steve Marshall’s office still has not commented on.

More recently, Marshall said pregnant people in Alabama could be prosecuted for taking abortion pills, despite wording in the Human Life Protection Act that puts the onus on providers. Since then, Marshall’s deputy communications director told the Washington Post that “the Attorney General’s beef is with illegal providers, not women,” while Marshall has continued to protest access to medicated abortions at the federal level.

June’s ruling forced certain clinics to close and others to pause their services amid legal confusion. Now, reproductive care in Alabama, a state with a maternal mortality rate of 36.4 per 100,000 and an infant mortality rate of 7.6 deaths per 1,000 live births, has shifted even further.

Here’s where the state stands on issues related to reproductive care and abortion:

What’s legal and illegal now?

All abortion procedures, except when a patient’s health is seriously threatened, are illegal in Alabama. But since federal laws trump state laws, Alabama has less control over medication abortions, which are approved by the U.S. Food and Drug Administration.

Alabama is one of several states that has hotly contested the Biden administration’s promise to expand access to medication abortions — a type of termination that accounted for 56.3% of pregnancies in Alabama in 2021 and 44% in 2020.

In January, the FDA finalized a rule that could broaden access to medication abortions, allowing brick-and-mortar and mail-order pharmacies to dispense mifepristone and misoprostol, which the FDA first approved for pregnancy terminations in 2000. Pregnant people could also receive prescriptions via telehealth and receive them in the mail, which the U.S. Department of Justice said is still legal even in states where abortion is banned, so long as the sender does not have intent for the drugs to be used unlawfully.

“There are manifold ways in which recipients in every state may use these drugs, including to produce an abortion, without violating state law,” wrote Christopher Schroeder, assistant attorney general for the Office of Legal Counsel. “Therefore, the mere mailing of such drugs to a particular jurisdiction is an insufficient basis for concluding that the sender intends them to be used unlawfully.”

Alabama Attorney General Steve Marshall said in January that pregnant people who use medication abortions could be prosecuted, though his deputy communications director said the attorney general’s “beef” is with providers. Alabama law does not allow for the prosecution of pregnant people who receive an abortion, though Marshall cited chemical endangerment laws.

Since his comments, Marshall joined attorneys general from states across the U.S. to write the FDA, petitioning that they reverse the decision to expand medication abortion access.

The Medical Association of the State of Alabama released a memo responding to questions about Alabama’s law, which can be found at the bottom of this article. It specifies that Alabama’s law does not affect IVF or contraceptive medications. According to the memo, termination of ectopic pregnancies is not considered an abortion in Alabama’s ban.

What were reproductive care and abortion like in Alabama before Roe v. Wade was overturned?

In 2020, Alabama’s five clinics provided 5,713 abortions, with 82% occurring at 10 weeks or earlier. In 2021, 6,489 abortions were performed in the state. In total, 8,294 pregnancies were terminated for Alabamians in 2021, with 6,813, or 82%, occurring at 10 weeks or earlier.

Black Alabamians accounted for 67.3% of pregnancy terminations in 2021, while white women made up 28.2%. Only 33.5% of pregnancies were ended by someone who had not previously given birth, meaning 5,508 of the pregnancies that ended were by people who already had at least one child. In 2020, more than 5,000 already had one child.

Abortions rose after the leaked draft decision, prior to abortion becoming illegal in the state. More than 500 terminations of pregnancy occurred in June 2022, but fell to less than 10 each month, according to a report from the Society of Family Planning.

Alabama is part of the south central part of the U.S., which saw a 96% decrease in abortions overall from April to August, according to the report.

Alabama is still in the middle of a struggle with maternal and infant mortality. Black babies in the state are more than twice as likely to die compared to white babies, at rates of 12.1 and 5.8 deaths per 1,000 live births, respectively. In terms of maternal mortality, Alabama ranked third worst in the U.S.

Nationally, Black women die at 2.9 times the rate of white women after giving birth.

In August, the state released its second Maternal Mortality Review Committee report, which stated that “45 new mothers in those two years died of preventable causes. Of those deaths, 95.6% had “some” or a “good” chance of a different outcome.”

Will Alabama’s lawmakers address abortion and reproductive health care in this year’s session?

It’s not clear yet whether Alabama’s state legislature will address abortion further. In June, Decatur Republican Rep. Terri Collins, who sponsored the Human Life Protection Act in 2019, said she was not aware of particular efforts in the legislature related to reproductive health and that she was “just celebrating.”

When asked if exceptions to the law could be made before the session, Collins reiterated that the session “begins in March.”

So far, only two bills have been pre-filed for the upcoming session, neither of which pertain to reproductive health.

In July and November, AL.com emailed lawmakers who had worked on abortion-related bills to ask if they would be working on legislation “relating to abortion, reproductive health, birth control, family services, etc.” At the time of this article, no lawmakers have issued an official statement in response to the inquiry.

Alabama House Minority Leader Anthony Daniels wrote a letter to Marshall asking for clarification on the state’s ban. Previously, Daniels requested a special legislative session to address the 2019 ban, which was denied by Gov. Kay Ivey.

“As reiterated later in this letter, absent clarification, doctors are experiencing a chilling effect and are deterred from providing medically necessary care to mothers out of fear of being prosecuted for homicide,” Daniels’ letter read. “There are many instances which this law does not provide clear guidance on, in which a fetus is nonviable or a mother is miscarrying which may require an abortion – are abortions permissible in such instances?”

At the federal level, Republican U.S. Rep. Jerry Carl of Alabama said he is co-sponsoring anti-abortion legislation.

New U.S. Senator from Alabama Katie Britt was vocal about her anti-abortion stance throughout her campaign, and reiterated her stance in a video message on Twitter as the March for Life took place in Washington, D.C. last week.

What other resources are available for pregnant people?

Uninsured pregnant people in Alabama may be eligible for Medicaid coverage, which the state has extended from 60 days postpartum to 12 months.

Organizations focusing on maternal health continue to advocate for the extension to become permanent. Of women who died within a year of giving birth, two-thirds were enrolled in Medicaid. Additionally, 50% of total live births in the state are covered by Medicaid.

Robin Marty, the operations director at the West Alabama Women’s Center, said it still takes between six and eight weeks for pregnant patients to be enrolled in Medicaid.

Like all Alabama clinics, the West Alabama Women’s Center no longer provides abortions. Marty said the clinic sees pregnant patients coming in unsure of next steps.

“They know that it’s going to be impossible for them to do anything other than stay pregnant, and they don’t have options. They don’t have a next step, and so we provide them with the confirmation that they need in order to be able to try to get on to Medicaid, but it’s still taking six to eight weeks even after that for them to get approved,” she said.

Marty added that the clinic provides prenatal care, but cannot help deliver babies. She added that even after being enrolled in Medicaid, some patients opt to continue receiving care from the clinic up until delivery because they worry about the continuity of their care.

“They’re just like, ‘I know that I can get care consistently until that point and I’ll just roll the dice once it’s time to deliver.’” Marty said. “And that’s the most horrible thing that I’ve ever heard: ‘I’ve given up on finding a doctor that is going to be able to take me through the entirety of my pregnancy.’”

Marty is also working to get the Alabama Resource Directory for Women, Children and Families online. It’s a physical book, constituting nearly 100 double-sided pages, that clinics were required to give out during the waiting period for abortions.

But the document, which lists “agencies that offer assistance, adoption agencies, development of the unborn child, methods and risks of abortion and childbirth, father’s obligations, and alternatives to abortion,” is not available online. It’s a physical copy, mailed to patients after they expressed that they wanted an abortion before it became illegal.

The Alabama Department of Public Health, who publishes the book, did not comment on reasons for keeping the document from being put online. Multiple employees said that the document is currently being updated. The law requiring the distribution of materials was passed in 2002.

Anti-abortion leaders have repeatedly pointed to churches as alternatives to care and lauded the possibility of adoption. In June, Collins said the state had been working on ways to address health disparities relating to birth, but thus far, has not offered clarification on what those ways are.

The American College of Obstetricians and Gynecologist issued a brief warning pregnant people against using “crisis pregnancy centers,” which are sprinkled throughout Alabama.

“CPC is a term used to refer to certain facilities that represent themselves as legitimate reproductive health care clinics providing care for pregnant people but actually aim to dissuade people from accessing certain types of reproductive health care, including abortion care and even contraceptive options,” the brief read. “Staff members at these unregulated and often nonmedical facilities have no legal obligation to provide pregnant people with accurate information and are not subject to HIPAA or required by law to maintain client confidentiality.”

For pregnant folks who aren’t sure where to begin, here are some of the available resources:

Health care centers that no longer provide abortions, but do provide health care services for pregnant people:

People who were newly pregnant when Roe v. Wade was overturned are now in the later stages of their pregnancies. Other states are starting to deal with some of the results of abortion restrictions.

“We’re at about that time where the crisis is really going to show its results. I’m just terrified of what it’s going to look like in all honesty,” Marty said. “It’s coming in the next couple of months; that’s when it’s really going to start.”

Sarah Swetlik is a gender and politics reporter at AL.com. She is supported through a partnership with Report for America. Contribute to support the team here.