WASHINGTON (AP) — For much of her life, Angela Crawford considered herself a fairly conservative Republican — and she voted that way. But then a wave of court rulings and Republican-led actions in states restricted abortion and later in vitro fertilization, the very procedure that had helped her conceive her daughter.

Now, Crawford, 38, is working to gather signatures in her home state of Missouri for a ballot initiative in the fall that would enshrine access to abortion and other reproductive health care. And she’s voting for Democrats.

When Roe v. Wade was overturned by the U.S. Supreme Court in 2022, Republicans insisted the ruling would mostly affect those seeking abortions to end unwanted pregnancies. But that hasn’t been the case.

Women who never intended to end their pregnancies have nearly died because they could not get emergency treatment. Miscarriage care has been delayed. Routine reproductive medical care is drying up in states with strict bans. Fertility treatments were temporarily paused in Alabama. As the fallout grows, so does the opportunity for Democrats.

“I wish everyone would realize how big this topic is,” Crawford said of reproductive rights. “People really minimized it initially, because they didn’t realize the scope.”

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Democratic candidates are increasingly running on the broader reproductive rights issues and they are seeing results.

For Biden, who is trying to overcome consistently low approval ratings and Republican Donald Trump’s loyal following in order to win reelection in November, the broader matter of reproductive health is becoming an increasingly potent issue as rights diminish in states such as Indiana, Florida and, soon, Arizona.

A Texas woman who went into premature labor, developed sepsis and nearly died because she was unable to get an abortion, and a Louisiana woman who said restrictive laws prevented her from getting miscarriage care are campaigning for Biden in North Carolina. At a Durham community center, blue and red signs with phrases such as “Stop Trump’s Abortion Ban” lined the wall.

Doctors attending the event said that helping pregnant patients has become much harder. And tasks they have never had to consider, such as printing out driving instructions to Virginia for patients unable to get an abortion in North Carolina, have become more common.

The uncertainty has also motivated Amaia Clayton, a student from Duke University, to get more politically involved.

“I mean, I’m 19. I’m in college,” she said. “Reproductive health care is very, very applicable to me right now, and it will be very applicable to me for the foreseeable future.”

In Alabama, the pause in IVF services was temporary, but it sent shock waves across the country as other states are weighing laws that could create similar results.

Voters have consistently sent strong messages of disapproval over the past two years about restricting abortion rights, and Republicans, including Trump, are struggling to find a satisfying and consistent response.

“What we continue to see are more and more extreme positions on this issue, now around contraception and IVF,” said Biden’s campaign manager, Julie Chavez Rodriguez. “And these are policies that voters have continued to reject time and time again.”

Support for abortion access drove women to the polls during the 2022 midterm elections, delivering Democrats unexpected success.

About two-thirds of Americans say abortion should generally be legal, according to polling by The Associated Press-NORC Center for Public Affairs Research. Only about one-quarter say abortion should always be legal and only about 1 in 10 say it should always be illegal.

Since the fall of Roe, several states have enacted strict abortion bans or worked to make their laws stricter. In Arizona, the state Supreme Court on Tuesday ruled that officials may enforce an 1864 law criminalizing all abortions except when a woman’s life is at stake.

When voters have been given the choice, they have approved statewide ballot initiatives to preserve or expand the right to abortion.

In a follow-up to the end of Roe, Alabama’s highest court in February ruled that frozen embryos were children, a decision that led to the temporary pause in in vitro fertilization services. Alabama also has one of the strictest abortion bans in the nation.

Democrat Marilyn Lands made it a major focal point of her campaign to flip a seat in the Alabama House in a suburban district that, while increasingly politically moderate, had long been held by the GOP. And she won. Two years earlier, she had lost her bid for that seat.

Lochrane Chase, 36, of Birmingham, Alabama, had her IVF treatments paused because of the state court’s decision. That changed how she engages with politics. She said she routinely votes for Republicans. But this time, she supported Lands.

“The IVF ruling made me realize that the Roe v. Wade decision has set such a dangerous precedent for states who now have the power to make their own rules,” Chase said.

Reproductive rights advocates are not surprised. They expected the ripple effects.

“Despite all of our knowledge -- and this has been in plain sight — we face a believability gap with the American people,” said Mini Timmaraju, president of Reproductive Freedom for All. It was the same before the fall of Roe, she said. People just did not believe it could happen.

Where abortion has been a difficult topic for some more centrist Democrats, including Biden, to talk about, the larger issue of reproductive freedom works. Not just for lawmakers, but also for voters for whom abortion isn’t top of mind.

“The beauty of using the freedom framework is that we can talk about a broader set of issues to a broader range of Americans,” Timmaraju said.

Biden has said Trump is to blame for the growing medical peril. After the new Arizona ban that is expected to take effect in the next two months, Biden’s campaign sent out an email that read: “Trump did this.”

Vice President Kamala Harris will be in Arizona on Friday addressing the issue.

Republicans are struggling with how to manage the broadening question of abortion and reproductive health after decades of pushing to overturn Roe.

Trump, whose judicial nominations as president paved the way for the Supreme Court’s conservative majority decision, has bragged about overturning Roe. But in a video statement on his social media site, he tried to punt the issue back to the states, and on Wednesday, he said the Arizona law goes too far.

“It’ll be straightened out and as you know, it’s all about states’ rights,” he said.

In Missouri last week, Republican legislators refused to codify language in the state budget that would have stated that nothing in state laws could preclude Medicaid coverage for contraceptives or IVF-related services.

State House Minority Leader Crystal Quade, a Democrat who is running for governor, said it was a small way that Republicans could have shown they were supportive of IVF.

But the Democrats’ reason for seeking the vote was also political: They wanted voters to see the track record in black and white.

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Associated Press writer Makiya Seminera in Durham, North Carolina, contributed to this report.