Abortion in the U.S. is on the chopping block.

Access to the medical procedure in the country has been dwindling in recent years and with the retirement announced this week of Supreme Court Justice Anthony Kennedy, women’s health advocates say it could become effectively banned nationally within the next two years.

On Sunday, President Trump told Fox News: “Maybe some day it will be to the states, you never know how that’s going to turn out. That’s a very complex question.”

Pro-choice advocates at the National Women’s Law Center, Planned Parenthood Federation of America, and the National Abortion Rights Action League (NARAL) said in a press conference on Thursday it’s likely the Supreme Court will overturn Roe v. Wade very quickly after a new conservative judge is appointed to replace Kennedy.

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Trump has said he will only consider judges who oppose Roe v. Wade, the court case that made abortion legal federally in 1973, and there are several cases moving through the courts that could address the law.

At least one of these cases is likely to be heard by the U.S. court of appeals by January 2019, said Fatima Goss-Graves, president and chief executive officer of the National Women’s Law Center.

“Justice Kennedy’s retirement sounds the alarm over the future of civil rights in this country,” she said. “Make no mistake, Kennedy’s retirement means the balance of the court will shift, setting back people’s rights — including women, people of color, immigrants, and LGBTQ individuals — for an entire generation.”

Anti-abortion groups celebrated Justice Kennedy’s plans to step down on Thursday. Americans United For Life said in a statement Kennedy was a “25-year defender of abortion” and urged Trump to appoint a judge who would overturn Roe v. Wade. “We note that the President’s list of potential nominees includes several such candidates with impeccable credentials,” the group said.

The Kennedy news came after another victory for anti-abortion activists, when the Supreme Court ruled on Wednesday crisis pregnancy centers, which discourage women from going through with abortion procedures, will not be required to supply unbiased information about abortion to clients.

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If Roe v. Wade is overturned, a number of states will immediately make abortion illegal. Four states in the U.S. — Louisiana, Mississippi, North Dakota, and South Dakota — have trigger laws that automatically ban the procedure in the state if Roe v. Wade is overturned.

Other states are considering laws that would effectively ban abortion, including fetal heartbeat bills that ban abortion when a heartbeat is detected — often by six weeks into a pregnancy, before many women know they are pregnant.

“That is a different form of banning — making abortion so difficult to access that it is effectively illegal,” NARAL Pro-Choice America President Ilyse Hogue said.

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In total, nearly 24 states will immediately ban abortion, in effect, if Roe v. Wade is overturned and another 11 are “at-risk” for losing abortion rights, according to the Center for Reproductive Rights.

Abortion is already difficult to access in most states, the activists said. More than 27 cities across the U.S. qualify as “abortion deserts,” meaning people there need to travel more than 100 miles to get an abortion. Some of those states have additional laws like 72-hour waiting periods that create additional barriers to women seeking the procedure. In Texas, 96% of counties do not have clinics that provide abortions.

Abortion access has a number of financial implications. Women who are denied the procedure are significantly more likely to experience poverty in the years following, a 2018 study from the American Journal of Public Health found. Women who were unable to have a wanted abortion had four times greater odds of having a household income below the federal poverty level and three times greater odds of being unemployed after six months, the study found. The average cost of an abortion is $508, according to reproductive rights research organization the Guttmacher Institute.

Enacting abortion restrictions on a state level has been shown to increase the price of the procedure for women due to additional child care and travel costs. Laws that require a consultation and waiting period before an abortion increase the cost of the procedure by an average of $107, a 2015 study by California State University, Long Beach showed. That same study showed an increase in physicians per 100,000 residents by 25 can decrease the cost of abortion by $78.