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Donald Trump has not yet taken office, but his presidential upset has already had a dramatic impact on women’s health.
Since the election, birth control appointments at Planned Parenthood have spiked, especially appointments for intrauterine devices — fully covered by the Affordable Care Act, for now.
Abortion providers are reassuring patients that, at least for the time-being, their doors are open. But battle lines are already being drawn.
Outside abortion clinics across the country, protesters are emboldened. Kim Chiz, executive director of the Allentown Women's Center in Bethlehem, Pennsylvania, told NBC News that demonstrators brandishing Trump-Pence signs have been "shoving them at the cars and the windows of our staff, patients and volunteers, saying, 'We’re winners, you’re losers, you’re going to be shut down in three years.’"
Trump has repeatedly said he would appoint justices who would overturn Roe v. Wade, the landmark Supreme Court ruling that guaranteed a federal right to abortion. But that scenario would likely take years to play out. Replacing Justice Antonin Scalia, as Trump is expected to do upon taking office, probably won't change the balance of power on the issue — though another vacancy under the Trump administration could.
Abortion and contraception were rarely discussed during the campaign — at least compared to previous elections. There were two notable exceptions. In an interview with MSNBC's Chris Matthews, Trump said there should be punishment for women who undergo abortions if the procedure was outlawed — a remark he later retracted.
And at the third presidential debate, Trump responded to a question about abortion rights with a graphic description of a later abortion.
Anti-abortion rights activists were initially leery of Trump, who used to call himself pro-choice, but his strong numbers with evangelical voters show they came around. Among voters less focused on abortion, Trump may have benefited from the ambiguity of his past positions.
"People keep saying to me, we don’t know how Trump’s going to govern. But we know what he’s said, what anti-choice advocates have said in the media and in email to their own supporters and we know how Mike Pence has governed," said Destiny Lopez, co-Director of All* Above All, which fights to repeal federal funding bans on abortion. During the campaign, Trump vowed to make permanent the Hyde Amendment, a budget rider which prohibits most federal abortion funding.
Many opponents of abortion rights now feel they can trust the president-elect, according to Carol Tobias, president of the National Right to Life Committee (NRLC). "He has stayed steady and firm, with no wavering whatsoever through this campaign," she said.
That starts with judicial appointments. Abortion rights advocates decried the announcement that Sen. Jeff Sessions of Alabama would be nominated for attorney general, since the Justice Department enforces federal laws like the Freedom of Access to Clinics Act, which stiffened penalties for blocking clinic entrances in protest.
"The last person women and families need in this job is someone who has repeatedly given a pass to individuals who commit acts of violence against abortion clinics, doesn't take sexual assault seriously, and was determined to be too racist by a GOP-led Senate to become a federal judge," said Ilyse Hogue, president of NARAL Pro-Choice America, in a statement.
Sessions could also choose to investigate and possibly prosecute Planned Parenthood. That’s the hope of Operation Rescue, a radical anti-abortion group whose founder, Troy Newman, met with Trump as part of his outreach to right-wing groups that initially preferred his primary opponents.
“Operation Rescue stands ready to assist the new Attorney General with any potential prosecutions of Planned Parenthood and other abortion businesses for a multitude of felonies committed over the past several years under the protection of the Obama Administration,” the group said.
Despite a campaign by anti-abortion forces who claim Planned Parenthood violated fetal tissue donation laws, a House committee investigation, a grand jury in Texas and official inquiries in about a dozen states have so far led to no charges against the organization.
Though much was made of Trump's primary-era praise for Planned Parenthood, Trump has also vowed to defund the group because it provides abortions.
Planned Parenthood's federal funding does not go to abortion, but rather comes through Medicaid reimbursements and the Title X program, which funds contraception and testing for sexually transmitted diseases.
Tobias said she looked forward to Trump's lower court appointments. "The federal courts have been pretty tough on laws passed by state legislatures" that restrict abortion, she said. "If the judges change, I would certainly hope that the outcome of some of those court cases change and that many of our state laws would be upheld."
Victories for anti-abortion activists likely depend on whether Senate leader Mitch McConnell eliminates the filibuster for legislation, thus requiring a simple majority rather than 60 votes to pass a bill. One of the NRLC's legislative priorities, a ban on abortion after 20 weeks, passed the House but was unable to overcome a Democratic filibuster.
"The Senate becomes the new and only firewall left between Donald Trump and every terrible idea that he’s ever had when it comes to reproductive freedom," said Donna Crane, vice president for policy at NARAL Pro-Choice America. "We will be working very closely with the Senate. We believe we have the votes to stop some of his attacks."
Other moves would not require the Senate. For example, Trump would not have to repeal the Affordable Care Act to undo a requirement that all plans cover contraception unless an employer has a religious objection.
"The HHS mandate should be repealed by executive action. And the whole statute needs to be repealed," Clark Forsythe, acting president and senior counsel for Americans United for Life, told NBC News.
If there's a silver lining for supporters of abortion rights, Crane said, "I have never seen anything like the energy that I’ve seen this week meeting with supporters. People are packing rooms."