Jamie Chung for TIME A patient at Red River clinic awaits consultation with a doctor

Cover Photograph by Jamie Chung for TIME

In January 1973, the Supreme Court made access to abortion a federally protected right. As I write in this week’s TIME cover story, that seemingly decisive victory 40 years ago kicked off a war that the pro-choice movement has been losing ever since. In many parts of the country today, obtaining an abortion is more difficult than at any point since the 1970s.

There are fewer doctors willing to perform the procedure and fewer abortion clinics open for business. Pro-choice activists have been outflanked by their prolife counterparts, who have successfully lobbied for state-based regulations that limit access. Scores of states now require women to undergo counseling, waiting periods or ultrasounds prior to obtaining abortions. Minors across the country must often get permission from their parents if they want to terminate pregnancies. And pro-life state legislators are passing laws that require clinics to comply with arcane requirements—such as a hallway having to be more than five feet wide— that make it difficult for them to stay open.

(Viewpoint: Pro-life and Feminism Aren’t Mutually Exclusive)

The pro-life cause has been winning the abortion war, in part, because it has pursued an organized and well-executed strategy. But public opinion is also increasingly on their side. Thanks to prenatal ultrasound and advanced neonatology, Americans now understand what a fetus looks like and that babies born as early as 24 weeks can now survive. Although three-quarters of Americans believe abortion should be legal in some or all cases, most support state laws regulating the procedure and fewer and fewer are identifying themselves as “pro-choice” in public opinion surveys.

The prochoice establishment has also been hampered by a generational divide within the cause. Young abortion rights activists today complain that the leaders of feminist organizations, who were in their 20s and 30s when Roe was decided, aren’t eager to pass the torch to a new generation whose activism is more nimble and Internet-based. But the most pressing challenge for prochoice activists may simply be that abortion is legal. In a dynamic democracy like America, defending the status quo is always harder than fighting to change it.

MORE: Read TIME’s cover story, “What Choice?” By Kate Pickert