To mitigate the shock, perhaps, or because people believed it, one thing said in the immediate wake of the overturning of Roe v Wade was that for much of the US, not a great deal would change. Symbolically, of course, it was horrific, potentially prefiguring a larger swing by the supreme court against civil rights. Practically, however, abortion limits across large swaths of the country were already so severe, and the availability of clinics so reduced, that it raised the question of how much difference would this make anyway. In the two weeks since the justices made their decision, the answer to that question has been rising to the surface. Doctor by doctor, activist by activist, the implications of a total abortion ban in the eight states in which it was instantly triggered, and the further nine expected to follow suit within weeks, have begun to be outlined. The threat posed to women’s health is so staggering, so nonsensical, as to seem barely possible. The danger of illegal abortions; the mental and financial disaster of forcing women to have babies they don’t want; the outrage of the state controlling what you do with your body, and the implications of forced pregnancy when it’s a result of rape – all these arguments have been staples of anti-abortion politics for decades. Now that the worst has happened, however, they are joined by a bunch of considerations that are so wildly beyond reason, so fanatically punitive, that they represent a potential death sentence for any pregnant woman. The most startling of these is the failure in those states implementing a total abortion ban to make an exception for women who discover their foetus won’t live. The vast majority of abortions in the US happen inside the first 12 weeks. So called “late stage” abortions, occurring later than 16 weeks and, in even fewer cases, after 21 weeks, represent less than 5% of the total and, according to doctors, are in most cases a response to the discovery of catastrophic foetal abnormalities. In these instances, the baby will die within hours or days of birth. What an extraordinary decision by those pious members of the supreme court to force a woman to carry a baby to term so she can watch it die. It’s not rusty coat-hangers or gin and bath tubs this time. It’s doctors, on pain of prosecution, being barred from intervening when a woman is miscarrying. When the only abortion loophole exists around a threat to the mother’s life, you’d better be sure she’s about to die before you jump in to help. These are margin calls that won’t always go the woman’s way and that make every miscarriage a potentially fatal event. The same goes for every ectopic pregnancy. A deranged piece in the New York Times this week argued that ectopic pregnancies – a bunch of cells attaching to the wall of the fallopian tubes which, if not excised, will rupture and kill the woman – might be viewed in the same way as a premature baby, and the ending of the pregnancy referred to as “delivering” that baby. You can’t incubate a baby in your fallopian tube, nor can you “deliver” a baby from an ectopic pregnancy, which can be detected at five or six weeks. Misinterpreting this lethal malfunction is mad. There has been a flippant, self-soothing reflex for those of us in liberal states to say, awful as this is, they can’t do anything to women in New York or California. This may be true, although abortion providers across the country will come under much greater pressure once women are travelling farther to use them. What it has taken a moment to understand is that pregnant women in the US, irrespective of home state, may have to consider avoiding large areas of their own country in case they are denied emergency treatment while there. This puts the US on a footing with Malta, where an American woman on holiday recently suffered a partial miscarriage and had to be airlifted to Spain for her D&C (dilation and curettage). Abortion is banned in Malta. A woman who has miscarried and needs foetal tissue removed to forestall infection will be monitored but not treated. For that to happen in Malta, as in larger and larger areas of the US in the coming weeks, doctors must stand back and wait for women to start dying. Emma Brockes is a Guardian columnist