At the 45th anniversary of their biggest victory, supporters of abortion rights see Republicans who control Congress, the presidency and North Carolina’s legislature working to undo their efforts.

Abortion opponents have found an ally in the Trump administration, which has worked through judicial appointments and executive action to restrict access to the procedure despite the landmark Roe v. Wade ruling on Jan. 22, 1973, that laws prohibiting abortion were unconstitutional.

The administration’s efforts are cause for celebration for the thousands who marched in the March for Life in Washington on Friday and heard a live video address from President Donald Trump. North Carolina Right to Life activists held a march of their own in Raleigh on Jan. 13.

“As someone who has fought in the trenches for the pro-life movement for decades, I have never been more encouraged,” U.S. Rep. Robert Pittenger, a Republican congressman from Charlotte, said in an email statement. “Part of making America great again is restoring the freedom and dignity of every life.”

Abortion could be an important issue in what is shaping up to be one of North Carolina’s most competitive Republican primary elections this May. Pittenger has touted his anti-abortion credentials as he tries to fend off a challenge from a Baptist minister, Mark Harris, in a rematch to represent the district that runs east from Charlotte to Robeson County. Harris has criticized Pittenger’s vote in favor of an omnibus spending bill that kept funding for Planned Parenthood intact.

Abortion rights groups, facing a hostile administration, are supporting grassroots campaigns at the state level, but in North Carolina, there’s little support for expanding abortion access among Republicans who have enough votes in the legislature to override Democratic Gov. Roy Cooper’s vetoes.

“The fact that we are going backwards is just very disconcerting to me because women have a role to play, we need them to have control of their lives so that they contribute to their families and their society and run for office,” said state Sen. Terry Van Duyn, a Democrat from Asheville.

New conscience protections

The federal Department of Health and Human Services announced Thursday the creation of a Conscience and Religious Freedom Division in its Office for Civil Rights. The division is meant to protect health care workers who refuse to perform medical services such as abortions that contradict their moral or religious beliefs.

On Friday, the department’s Office for Civil Rights announced a rule to enforce “conscience protections” in the health care system. The department also rescinded 2016 guidance that had restricted states from disqualifying abortion providers from their Medicaid programs.

“It’s about time that the government started protecting the conscience rights of Americans rather than attacking them,” said Tami Fitzgerald, executive director of the North Carolina Values Coalition.

But Tara Romano, executive director of NARAL Pro-Choice North Carolina, worries allowing religious exemptions could primarily affect patients in emergency situations in which abortion is medically necessary.

“Generally people who are opposed to abortion might not work at a place like Planned Parenthood or abortion clinics,” she said. “We’re thinking this is going to be playing out in hospitals, or places where somebody might come in for an emergency, and it might be that abortion is what is needed for that person’s health and safety.”

North Carolina’s congressional delegation has been active in supporting legislation regulating abortion and abortion providers. On Friday, the House approved a bill titled the Born Alive Abortion Survivors Protection Act, cosponsored by several North Carolina Republicans, which requires health care practitioners to “exercise the same degree of care as reasonably provided to any other child born alive at the same gestational age” for a child born alive during an abortion.

The Senate, where Democrats in the minority can block many proposals, has not considered the bill. Nor has the Senate taken up a House-passed bill, supported by Trump, to ban most abortions after 20 weeks.

Despite once declaring himself as “pro-choice in every respect,” Trump has worked to restrict abortion. Just days after his inauguration last year, he reinstated the “Mexico City” policy, first enacted in the Reagan era, which prohibits international organizations that receive government funding from performing or promoting abortion as a method of family planning.

Congress and Trump also rolled back an Obama-era regulation in April that prevented states from withholding federal funds from abortion providers. And his appointment of Neil Gorsuch and promise to appoint pro-life judges to the Supreme Court could have far-reaching consequences in determining the future of Roe v. Wade.

“I think the feeling in the pro-life movement is ecstatic right now,” Fitzgerald said. “We have a president who fully embraces the value and the dignity of human life, especially human life in the womb.”

Waiting period in NC

With Republicans in charge at the federal level, some abortion rights activists are focusing their lobbying efforts on state governments.

On Jan. 11, the State Innovation Exchange, a strategy group for liberal state legislators, launched its Reproductive Freedom Leadership Council, a coalition of more than 200 state legislators – including nine from North Carolina.

“With the arrival of an incredibly hostile federal administration to all things reproductive rights, I think that has been an impetus for states to step up and recognize that they have a stronger role to play,” said Kelly Baden, director of reproductive rights at the State Innovation Exchange. “If Roe were overturned tomorrow, that means it would revert back to state law, and there are many states that still have the criminalization of abortion on their books.”

According to the group, 401 state-level restrictions on abortion have been enacted since 2011.

North Carolina restrictions currently in place, according to the left-leaning Guttmacher Institute, include a 72-hour waiting period before receiving an abortion.

“That’s insulting,” said Van Duyn, who joined the Reproductive Freedom Council. “To suggest to a woman who has made that difficult decision, that she needs to go home and think about it for another three days, especially when you have women for whom that’s an economic hardship as well, that’s just, it’s an abuse of power.”

State Rep. Graig Meyer, a Democrat from Durham and Orange counties who also signed onto the council, said he’s tired of playing defense on the issue of abortion.

“In North Carolina, we generally only talk about reproductive health care when there’s a bill on the table to restrict abortion access,” he said. “And I’ve been inspired by women who have spoken very openly about the importance of this. It has made me believe that we need more voices to be willing to speak up on the side of health care access.”

North Carolina’s legislature is unlikely to support the council’s goals with its current ideological balance, which some members of the council hope will change after the 2018 elections.

But Fitzgerald isn’t worried about the council’s impact, even nationally.

“I think it’s a weak attempt to counter the gains the pro-life movement is having right now,” she said. “I don’t expect it to have much success given the fact that people now realize with the invention of the 3D ultrasound that babies as early as 12 weeks have a heartbeat, at eight weeks they have hands and toes and fingers – people can now see with their own eyes that unborn babies are humans and that they should have human rights.”