As we commemorated the 45^th anniversary of the historic Supreme Court decision Roe v Wade last year, we were contemplating what the second year under a misogynistic, virulently anti-abortion administration might bring.

What we saw in 2018 was an overtly political and anti-science Supreme Court decision that gave fake women’s health clinics free rein to lie to clients seeking reproductive health care and support. We also fought a fierce battle to keep a hyper-partisan, alleged sexual predator and anti-abortion nominee from a lifetime appointment on the Court.

With the balance of the Supreme Court now firmly tilted towards anti-abortion, anti-gender equity special interests, we mark the 46^th anniversary of Roe with the understanding that a post-Roe society is closer than ever.

The respect for bodily autonomy and reproductive freedom for all that the Roe decision was supposed to put down into law has never fully materialized. The basics of the 1973 court decision ruled that states could not arbitrarily restrict access to abortion pre-viability (~24 weeks into pregnancy). Efforts to restrict public funding for abortion, ban minors from obtaining abortions, and install bans on which medical professionals could perform abortions were not far behind, leaving many low-income, young and/or rural patients seeking abortion with too few options for a safe procedure.

Roe was followed by a 1992 Supreme Court decision, Casey v. Planned Parenthood, that gave states more leeway to restrict access to abortion as long as the restrictions did not place an “undue burden” on the patient.

With the definition of “undue burden” left up to anti-abortion lawmakers and judges, states set about making safe abortion more and more difficult to access, closing down abortion clinics across the country and doing little to address many women’s health care needs, including unplanned pregnancy, lack of access to reproductive and maternity care, and the need for abortion care.

Finally in 2016, the Supreme Court decision Whole Women’s Health v. Hellerstadt put anti-abortion state legislatures on notice that they could not arbitrarily restrict abortion access with claims for “women’s health and safety” that had no actual grounding in medical science.  That same year, however, also brought an emboldened anti-abortion movement to push more such restrictions, with the election of a president who promised to appoint Supreme Court justices who would overturn Roe.

There are currently a number of legal challenges to Roe in the federal courts pipeline. These include restrictions states have enacted that might be considered unconstitutional based on the current legal precedent of Roe. Legislating 6-, 15- or 20-week bans on abortion (like North Carolina has); banning common and safe medical procedures such as medication abortion; and mandating abortion clinics meet medically unnecessary building and provider requirements (TRAP laws) are all laws that can be challenged in federal courts. With the federal courts being populated at a rapid pace with ultra conservative, partisan and often anti-abortion judges, it’s likely one of these challenges is going to make its way to the Supreme Court. And with a Supreme Court now including five men who were chosen at least in part for their anti-abortion, anti-equality credentials, the protection of reproductive rights by Roe is in real danger of being severely weakened, if not eventually overturned.

A direct overturn of Roe, something the anti-abortion movement states is key to their ultimate goal of re-criminalizing abortion, would leave it up to the states as to how to regulate the procedure.  While some states have protections in place to keep abortion legal should Roe fall, a number of states already have statutes in place to ban abortion outright; and more states than not have anti-abortion laws on the books that make safe abortion very difficult to access.

North Carolina, a state that actually legalized some types of abortion prior to the 1973 Roe decision, currently does not have any law stating what would happen here should Roe be overturned. Since anti-abortion leadership in North Carolina passed more laws restricting access to abortion between 2011-2016 than they did in the 40 years prior, we anticipate there would be a strong effort here to ban abortion should Roe be weakened or overturned. And we expect to see a number of attacks on abortion this coming legislative session.

Safe access to abortion is more a human issue, rather than a political one. Approximately 50 percent of pregnancies in the United States are still unplanned, and 1 in 4 women in this country access abortion. People of all religious backgrounds and political ideologies access abortion care. And as the fight over the Kavanaugh nomination and recent polling has shown, the vast majority of Americans, including nearly half of Republican voters, believe abortion should remain legal in this country, no matter their personal feelings.

Abortion has become political in how it is used by elected officials and political operatives as a wedge issue, in particular to marginalize all reproductive and sexual health care as something up for debate and subject to public judgment. In addition to abortion, we’ve also seen attacks on birth control, maternity care and pre- and post-natal care as efforts continue to weaken and repeal the ACA.  And in North Carolina, anti-abortion lawmakers have opted to give money to anti-choice centers that masquerade as health clinics, rather than give uninsured women in the state more access to Medicaid or the safety net provider Planned Parenthood.

Opponents to abortion often say it is a moral issue, and we agree there are moral considerations at play. People with resources will always be able to access safe abortion no matter what happens to Roe, as they always have.

How long are we going to allow out-of-touch government officials to play politics with the lives of those most impacted by reproductive health care restrictions, who are the least likely to have access to any affordable, quality health care?  That’s what is at stake this year.