The U.S. Supreme Court has not overturned its 1973 Roe v. Wade decision, but lower courts and statehouses are threatening to turn the clock back nearly 50 years on abortion rights. The fate of Missouri’s only remaining abortion provider, a Planned Parenthood clinic in St. Louis, hangs by a thread, awaiting the outcome of a recent arbitration hearing. If it is forced stop performing abortions, Missouri will become the first state without an abortion provider since Roe recognized the right to abortion in America.

The State of Missouri refused to renew the clinic’s license to perform abortions, citing safety concerns. Planned Parenthood disputes that rationale, testifying that abortion is one of the safest medical procedures. Abortions performed in the U.S. have few complications. Among women in the U.S. who have had them, fewer than 1 death in 100,000 can be attributed to the practice. An injection of penicillin is more likely to cause death than an abortion.

Prior to Roe, however, abortions were a significant contributor to maternal mortality. Before 1970, abortions upon request were effectively illegal in the U.S. Only 11 states liberalized their anti-abortion laws to include certain exceptions. Colorado led the way by allowing abortion in cases where the woman’s mental or physical health was at risk. But in other states, many women were forced to seek unsafe, illegal abortions.

Outlawing abortion did not mean the demand for it ceased. As many as 1.2 million illegal abortions are estimated to have been performed annually in the years prior to Roe. Illegal abortions, whether self-induced or performed by untrained providers, were inherently dangerous. Some women died. In the years before Roe, upwards of 17 percent of all deaths attributed to pregnancy and childbirth were caused by illegal abortion.

In 1970, four states — Alaska, Hawaii, New York, and Washington — repealed their anti-abortion statutes to allow licensed physicians to perform abortion upon request. New York was one of the only states to allow non-residents to request the procedure, making it a safe haven for women seeking to terminate their pregnancy. At the time, almost 85 percent of known abortions performed outside of a woman’s state of residence took place in New York, some traveling 2,000 miles to get there. Many women, however, didn’t have the time or the means to travel such distances.

Before Roe, the vast majority of women in the U.S. lacked local access to safe abortion services. Today, many still do. Nearly 40 percent of women of reproductive age in the U.S. live in counties without an abortion provider. 11 million live more than an hour away from the nearest clinic.

As clinic access shrinks, more and more women are going online to research self-induced abortions. The abortion drugs misoprostol and mifepristone are being sold illegally over the internet by foreign suppliers. While the highly safe and effective combination has been prescribed by physicians for early abortions for decades, women should be able to receive it, or other abortion services, from a licensed physician and not have to turn to an unknown supplier. Women should be able to confidently choose the type of abortion care that is right for them. But the closure of local abortion clinics is leaving them without many options.

If the last Missouri abortion clinic is forced to shut its doors, women in the state will have to consider other options. Planned Parenthood just opened a large facility in Illinois to handle an expected influx of patients from Missouri. Located 15 miles from the Missouri clinic, it will help ensure access for women living in or near St. Louis. But what about women in other parts of the state?

A woman’s access to reproductive health care in America should not depend on where she lives. But for a growing number of women in this country, it does. If federal courts and state legislatures continue to whittle away at abortion rights, that number will soar.

And it’s not just abortion access that is under siege; it’s also family planning services, including access to contraceptives. Title X-supported clinics deliver family planning services to 4 million low-income households every year, but the Trump administration is now preventing that from continuing. Its regulatory changes forced Planned Parenthood, which served 40 percent of Title X patients, to withdraw from the program. Other providers are following suit, leaving the Title X program in jeopardy.

In Missouri and many other places in this country, the clock is being turned back 50 years. Their reproductive health will suffer accordingly unless the escalating political assaults on reproductive rights stop.