Carol Tobias' life's work came to fruition when the Supreme Court overturned Roe v. Wade last month, doing away with federal protections for abortion rights and 50 years of precedent.
But like the rest of the anti-abortion rights movement, Tobias and her organization, National Right to Life, are looking ahead to what's next: getting strict bans enacted in states with legislatures and governors friendly to the cause. In states where efforts to enact such legislation will prove difficult, the group will promote laws around "informed consent" for medically induced abortions and allowing medical personnel to opt out of any abortion procedure.
"I’m not concerned that the pro-lifers are going to sit on their hands and let everything slip away," Tobias said in a recent interview.
Yet Tobias, who has served as NRLC's president for 11 years and has spent much of the past half-century involved in the organization at both the state and national level, said in an interview after the decision came down that she would rather be playing the piano than talking about the historic moment.
Her own activism dates back to when she was a teenager growing up in North Dakota, attending anti-abortion rallies with her parents. Those who know the reserved executive say she prefers to be behind the scenes, where she helps mediate debates within the group and sets the tone for the agenda it pursues.
"She’s been a steady hand for the pro-life movement," Mike Gonidakis, president of Ohio Right to Life, one of the organization's chapters, told NBC News. "She doesn’t pound the table, so to speak. She's not always looking for the spotlight, she does her job and doesn't care who gets the credit."
"And in a day and age of flashy social media, that's not Carol Tobias and I'm complimenting her for that," he added. "Carol and her team, wisely, just do their jobs and go home."
With its 50-state chapters, NRLC touts itself as the oldest anti-abortion rights group in the U.S., having its first state subsidiary launch in the late 1960s. The group spent decades advancing model legislation to friendly legislators, shaping how the issue is discussed in the U.S. and connecting grassroots anti-abortion rights activists with the larger political movement.
Many of those laws were passed with the hope that, when challenged in court, they would ultimately cause the Supreme Court to chip away at the abortion rights protections guaranteed under Roe and force the court to reconsider the constitutionality of the decision.
The strategy worked.
"I think that whole laying the groundwork of court cases year after year after year, judges and I’m sure the Supreme Court must have, I assume, started getting tired of all the cases," she said. "But I think that was a great prelude" to the Dobbs decision.
A lot of NRLC’s work took place behind the scenes, away from public scrutiny.
"For the most part, people have no clue what happened behind the scenes that got us to that point," Michael Ciccocioppo, executive director of the Pennsylvania Pro-Life Federation, an NRLC state chapter, said in an interview. “But I can tell you in many, many cases, it was National Right to Life and its staff working behind the scenes in Washington and working with its state affiliates that have made a big difference in everything that has happened."
During Tobias' time as the organization's political director, NRLC was credited with coining the phrase "partial-birth" abortion in the mid-1990s to describe a then-new medical procedure that involved removing fetuses from the womb intact, ultimately playing a critical role in the 2003 "Partial-Birth Abortion Ban Act" signed into law by President George W. Bush. Through her past decade as president, the group authored a number of model laws that were passed in statehouses across the country, including legislation banning abortion after 20 weeks because of the possibility the fetus could experience pain — legislation that served as a precursor to the Mississippi law that ultimately served as the vehicle by which a 5-4 conservative majority on the high court overturned Roe.
In a post-Roe country, Tobias would like to see a nationwide ban but does not think it is possible until Republicans have full control over the government and a filibuster-proof Senate majority. But, she said, she's hopeful Congress passes laws preventing minors from accessing abortions across state lines should those rights be curtailed in their own states.
"Our work has just begun," Gonidakis said, adding that while Ohio has a law banning abortion at six weeks — which is when fetal cardiac activity can be detected but is often before many women know they are pregnant — his organization is seeking new legislation to entirely "end abortion in Ohio."
"We’re not spiking the football," he added. "We’re not taking a victory lap."
On its website, the organization outlines new post-Roe model legislation for states that calls for the creation of a "robust enforcement regime" penalizing those who perform abortions as well as anyone who "aids and abets an illegal abortion," which, as the legislation entails, includes someone who provides information on abortion procedures or referring someone to an abortion clinic.
The group calls for the outlawing of all abortion procedures except to save the life of the mother, though it calls for states to require physicians to report to a state agency when such a procedure was necessary — or face misdemeanor charges.
"In the spectrum of anti-choice groups, there are those that try to do the kind of public-facing attempts to veil what the real agenda is," Dina Montemarano, research director for NARAL Pro-Choice America, told NBC News. "And then you have the groups who can tell you and point you to what the real agenda is. And to me, that's what National Right to Life does."
Montemarano pointed to the abortion exception the group supports — when the woman's life is on the line — saying there’s more to that than meets the eye. Only when a person is deemed to be on the very precipice of death, and no sooner, can an abortion be performed — a standard she called "unbelievably cruel."
In the wake of Roe being overturned, abortion rights activists have pointed to reports of doctors waiting for a patients' vital signs to become alarming before treating an ectopic pregnancy, which can be fatal and has no chance of becoming viable.
"They are clearly saying here that they are pushing that 'robust enforcement regime,'" she said. "They're talking about how to ban abortion nationwide and criminalize it. Scare people out of seeking care by putting people in jail."
But while National Right to Life and other anti-abortion rights groups ready for the next wave of legislation, polling show the Supreme Court's decision to undo constitutional protections for abortion is out of step with public opinion. An NPR/PBS/Marist survey taken after the decision last month found that 56% of Americans disagree with the Supreme Court's decision to overturn Roe, compared to 40% who support the ruling. The poll found that 88% of Democrats and 53% of independents opposed the decision while 77% of Republicans said they support it.
Anti-abortion rights advocates often point to state-level polling rather than national opinion as the key driver in this debate. But a Pew Research Center survey released this week found that adults living in the 17 states where abortion is or will soon be largely prohibited, 46% say they support the Supreme Court's decision while 52% disapprove.
The political consequences of the ruling are still shaping up, with abortion rights certain to be at the forefront of the discussion in a number of key swing state races. Tobias said she had no doubt that the issue would invigorate abortion rights supporters, though she predicted it would not dominate those on her side of the issue at the polls.
"Maybe they were kind of lulled into thinking this was never going to be a problem," she said, adding some Democrats may be discouraged by what they see as a lack of action from party leaders. "So I'm sure they will have more voters, but I'm not expecting them to overwhelm the pro-lifers as the reason they vote."
Gonidakis said activists on both sides of the issue post-Roe are in "uncharted territory," making it difficult to predict where both abortion laws and the politics around abortion rights go from here. But as for his organization, he left no doubt as to what lies ahead.
"We believe in the incremental approach, one step at a time, and it's worked so far," he said. "Right to Life is the tip of the spear in advancing pro-life legislation today and going forward."