Seated on red plastic bleachers in the Montgomery County Community College gymnasium in Blue Bell, Pennsylvania, Alexis McGill Johnson, the president and CEO of Planned Parenthood and the Planned Parenthood Action Fund, was fired up. Sporting a black T-shirt emblazoned with a rainbow-colored “1973”—a nod to the passage of Roe v. Wade—Johnson said the organization’s “playbook really hasn’t changed” since the Supreme Court overturned the landmark case, gutting federal protections for abortion with its ruling in Dobbs v. Jackson Women’s Health Organization. “What surprises me is the playbook on the other side. What we’ve seen there is they are doubling down on things that are deeply unpopular, which shows you the lengths that they will go in order to control our bodies.”

Bluntly, she added of antiabortion politicians and activists: “They double down on crazy.”

A little over an hour before the start of a rally for Pennsylvania US Senate candidate John Fetterman, volunteers and Planned Parenthood staffers dotted the gymnasium. But outside, the line of attendees for the “Women for Fetterman” event was overwhelming; nearly 3,000 people showed up. (“I am John Fetterwoman,” the candidate later joked from the stage.) The message of the day was clear: Abortion is on the ballot in November. “That’s why we are here, just to energize folks and to let them know that their vote matters, their volunteerism matters, their participation matters, their voice matters, and now is the time to exercise it,” Johnson said.

The last time I spoke in person with Johnson was at a dimly lit restaurant in Lower Manhattan in early 2020. It was on the eve of the pandemic, just days before COVID would shut down the city, and on the heels of the Supreme Court’s oral arguments in June Medical Services LLC v. Russo. The case ended up being one of Ruth Bader Ginsburg’s last. At issue was the constitutionality of admitting-privilege requirements for doctors providing abortions. The fall of Roe seemed like nothing more than a pipe dream of the religious right and overzealous Republicans. I never would’ve imagined that the next time we’d see each other would be at a political rally for a candidate running against TV’s celebrity doctor Mehmet Oz.

Yet the Fetterman–Oz race and the political dynamics in Pennsylvania are a microcosm of the broader fight over reproductive rights playing out in post-Roe America. If Fetterman wins the Senate seat—vacated by Republican Pat Toomey—and Democrats don’t lose any seats, he could be the 51st vote to scrap the filibuster and codify protections Roe provided—two things he has pledged to do if sent to Washington. In contrast, in May, Oz told the audience at a campaign event that abortion—at any stage in a pregnancy—is “murder.” (Oz, who describes himself as “strongly pro-life,” later clarified that he doesn’t support criminalizing abortion.) Meanwhile, the Republican-controlled Pennsylvania legislature has had its attempts to ban abortion stymied by Democratic governor Tom Wolf. But with Wolf termed out, the next governor will determine the fate of reproductive rights in the commonwealth, thrusting the spotlight onto the race between Democrat Josh Shapiro and far-right Republican Doug Mastriano, who has expressed support in the past for banning abortion without exceptions. The threat of an abortion ban in Pennsylvania, Shapiro told me over the summer, “is concrete and real.” And nationally, Senator Lindsey Graham said Tuesday that a federal abortion ban will be put to a vote if Republicans seize control of Congress in November.

That Democrats are making abortion a key issue in this election cycle represents something of a sea change for the party. But it is clear that candidates up and down the ballot are no longer shying away from the issue or the stakes of the 2022 election. On Sunday, Fetterman, who is still recovering from a May stroke, followed a string of speakers—Planned Parenthood of Southeastern Pennsylvania CEO Dayle Steinberg; Dr. Val Arkoosh, chair of the Montgomery County Board of Commissioners; Pennsylvania House Democratic leader Joanna McClinton; congresswomen Madeleine Dean and Mary Gay Scanlon; and Johnson—all of whom pounded the abortion drum. In his remarks, which clocked in at just under 10 minutes, Fetterman focused on the issue. “Should this decision be made by Dr. Oz?” Fetterman asked, met by an emphatic “no” from the crowd. He continued: “It should be left to a woman and a real doctor.”

Despite headwinds, there is a hope among Democrats that the fall of Roe will change the political calculus. In a purple state like Pennsylvania—where Donald Trump won in 2016 and Joe Biden won in 2020—the politics of the issue are acute. In an interview on Saturday, Fetterman’s wife said she felt a shift in the race when the Dobbs ruling came down. “There was fear.… It wasn’t just women that were terrified,” Gisele Barreto Fetterman said. “It has energized, I think, a group of people who maybe voted or casually voted, but now they are knocking on doors. Now they are making phone calls. And I think it also has brought in a crowd that never really thought politics was for them, or really impacted them, to see this as this big reality check that has immense consequences, and it impacts every single one of us.”

Having grown up in Brazil, Gisele recalled seeing firsthand the impact of a near-total ban on abortion. “The number of abortions never changed in Brazil,” she said. “It was just the death that we saw. And that would be the same thing that would happen. Abortions are not going to decrease, but we’re going to lose more lives.”

As she has traveled through the commonwealth on the campaign trail with her husband, Gisele said, women have regularly brought up abortion. “Some women pull me aside, and some say it loudly, and some whisper about their fear and their concerns about what the future looks like for them in the state,” she said. “Everyone loves someone who’s had an abortion. And a woman pulled me aside and said, ‘I’m not a murderer.’ Like, it was heartbreaking, but this is the weight that women are carrying in the state.… I can’t think of something scarier than having an uncertain future. And that’s what we’re seeing right now in Pennsylvania.”

As the crowd ballooned at the Fetterman rally—despite the rain and the Philadelphia Eagles opener—it became stunningly clear that for many there, abortion was a key motivator. Meghan O’Brien and Angela Sontheimer drove two hours from Gettysburg to Blue Bell to see Fetterman. In July, just after the Dobbs ruling, O’Brien and Sontheimer made a pact with, as they characterized it, their “old lady book club” to protest outside Mastriano’s office every Friday. “Freedom of choice is obviously very important to us,” Sontheimer said. What began as just a small group of about half a dozen women has grown to dozens. “We are totally behind Fetterman. Oz is such a joke…We’re all about protecting women’s rights, human rights, and we believe that Fetterman is going to do it,” O’Brien said.

Dr. Mark Lopatin, a retired rheumatologist, fears the potential ripple effects of abortion bans like those supported by Oz and Mastriano. “Now, in my mind, the risk of banning abortions is greater than the risk of abortions being allowed,” he said. Notably, Lopatin was apolitical until around 2000, when he was named in a civil malpractice lawsuit and spurred into political action—mainly around tort reform. After voting for Republicans for two decades, Lopatin, who says he’s driven by a candidate’s “integrity,” is backing Fetterman. “Are they saying things for their own personal gain? Are they saying things, whatever, to be elected?” Lopatin said of his criteria for candidates. “Are they saying things they genuinely feel are gonna be beneficial to Pennsylvanians?”

Lorraine Mory used to be a single-issue voter, and that issue was abortion. “If a candidate was for abortion, I was against him or her,” she said. But now, as the country grapples with the fallout from the Dobbs ruling, she considers herself pro-choice. She explained that it was a series of books by Sara Donati, namely The Gilded Hour, and listening to the experiences of her daughter Jessica Klemens, an ob-gyn who provides abortion care, that changed her view. “In my opinion now, congressmen and senators and governors have no right to get into the middle of a medical decision between the doctor and a patient. They need to stay out of it. It’s not any of their business,” Mory said. “I think they’re not looking at the whole picture. They’re just seeing abortion as black or white—it’s either right or wrong, period—rather than looking at the fact that sometimes it’s medically necessary.”

After decades of backing Republicans, Mory plans to cast her vote for Fetterman this fall, along with her daughter. Despite identifying as a lifelong Democrat, Klemens, too, has had something of a political evolution. “For me, as a physician, I don’t think I’ve ever been this outwardly political,” she said. But as she’s watched her colleagues in other states where draconian abortion bans and restrictions have gone into effect, a fear has settled in. “We have minutes, not hours, to intervene if someone is hemorrhaging,” she explained, referring to scenarios wherein a physician needs to perform an abortion to save the life of the mother. But in practice, post-Roe decisions such as these have become even harder for doctors to make in abortion-restrictive states.

As Klemens noted, even when an abortion ban includes exceptions regarding the life of the mother, there can be a gray area that doctors are forced to navigate with little, if any, guidance as to when exactly they can intervene. “Lawyers don’t know when that is,” she said. “A politician surely doesn’t know when that is.” Klemens is uncertain about staying in Pennsylvania if Mastriano and Oz win, assuming abortion is banned. “I have two small kids and a husband. I don’t know that I want to take the chance of being charged with crimes,” she said. “But I want to take care of women in Pennsylvania. I don’t want to abandon them either. So it’s really a moral struggle.”