The Planned Parenthood president, Alexis McGill Johnson, was stuck on the tarmac in Washington DC, and not happy about it. She’d raced to catch a flight and now she was sitting in the stale air of a plane grounded by stormy weather. Then, the woman next to her asked a question common among strangers: “What do you do?”

“I work for Planned Parenthood,” Johnson said, and the woman asked, “Did they ever find a president?” Well, actually, they did, Johnson replied.

That sparked a two-hour conversation, spanning the other woman’s profession in aerospace and engineering. The woman was, in Johnson’s words, “a total badass”. Johnson was thrilled to bring the story of her plane ride home to her two girls, seven and 10, little New Yorkers who gobble up all things air and space, and also to tell them about a brilliant woman at the top of a profession.

Johnson thanked the woman.

She replied: “I wouldn’t be such a badass if it weren’t for the abortion I had at 22, so thank you.”

This is the essence of Planned Parenthood. With more than 600 health clinics spread across the US, Planned Parenthood provides millions of tests for sexually transmitted infections, millions of birth control and informational appointments and hundreds of thousands of cancer screenings per year.

But it is known for a service that represents just 4% of its overall work: abortion. It is the service on which the organization has staked its advocacy, because, Johnson believes, when politicians come for abortion rights, they really come for so much more. And in the Trump era there is little doubt: social conservatives are coming for abortion rights with a mission to take them away.

“The conversation is framed around abortion,” Johnson said. That framing sometimes leads people to think, “They may come for that, but they’re not going to touch your contraception … And then they force people out of Title 10,” a federal program to help poor women with family planning services, “But they’re not going to touch your IVF. And it’s like, no, actually, the bigger picture is about control, right?”

This is not theoretical.

Demonstrators participate in a rally for Planned Parenthood at the capitol in Austin, Texas, on 5 April 2017. Photograph: Jay Janner/AP

In December, the US Senate confirmed Sarah Pitlyk to a lifetime seat on a federal district court in Missouri. She has spent most of her career lobbying against the rights of couples who seek help in conceiving children, including through in vitro fertilization. The Trump administration has appointed appeals court judges, the highest level most cases will reach, at double the pace of the Obama administration.

Last year, a wave of severe abortion bans swept across midwestern and southern states, from Ohio, where abortion was banned at six weeks, to Alabama, where it was banned outright. Those measures went into law, but not into effect, because they are unconstitutional. Abortion is still legal in all 50 US states.

In this particular era of gloom, we’ve been testing a model of what it means to engage our supporters … and turn them out around our issues Alexis McGill Johnson

But in Ohio, another even more extreme measure was proposed. It was an outright ban from conception and would require doctors who terminate ectopic pregnancies, which form in the fallopian tubes and are never viable, to try to “re-implant” an embryo. Such as procedure does not exist in medical science. A penalty of “abortion murder” was proposed for doctors who did not try to accomplish the impossible.

Meanwhile, health officials in Missouri are trying to shut down the state’s last abortion clinic, which happens to be a Planned Parenthood affiliate. A man who had shared anti-abortion memes, comparing the procedure to the Holocaust, tried to firebomb a Delaware location.

Add to all of this a new conservative US supreme court bench which appears poised to restrict abortion nationally with a case from Louisiana and the potential re-election of Donald Trump, whose administration is working to restrict abortion nationally and internationally.

Johnson’s view of all this is pragmatic, even optimistic, but remains focused on systemic issues. A wholesale victory, across the White House and Congress, still requires more work.

“Even if we get a pro-choice White House Senate and we hold the House as pro-choice as it is, it means that we still have to do work state by state, knowing that the courts are not going to be our stopgap,” Johnson said. “We still have to undo all of the damage.”

Planned Parenthood is not standing on the sidelines. The organization just made its largest ever commitment to electoral work, pledging to put $45m into the 2020 race. This will not go unchallenged. The anti-abortion group Susan B Anthony List announced it would spend $52m to re-elect Trump.

Alexis McGill Johnson at her office. ‘There’s so many structural issues that we collectively … are grappling with.’ Photograph: Ali Smith/The Guardian

“In this particular era of gloom, we’ve been testing a model of what it means to engage our supporters, engage our voters, and turn them out around our issues,” said Johnson. “We didn’t start on 1 January 2020,” she said. “We’ve actually been building for quite some time around these issues.”

She sees the fight as one that started not in 2016, with the election of President Trump, but in 2010, the year the Tea Party rose up against the Obama administration.

“I can go back a decade and kind of lay out the groundwork of what we saw in 2010 when the landscape shifted,” she said. Those changes, “laid the groundwork for a number of [abortion] bans,” said Johnson.

That year, the US supreme court decided in Citizens United versus the Federal Election Committee, that corporations could spend unlimited amounts of money in political campaigns, because money is speech. It became apparent to Johnson, courts would not be the antidote to either money in politics or gerrymandering, the dark art of drawing political boundaries for partisan gain. This was also the year Johnson started on the board of the Planned Parenthood Action Fund, the organization’s political arm.

You have legislatures feeling emboldened and empowered to introduce legislation to limit access to reproductive health care Alexis McGill Johnson

“There’s so many structural issues that we collectively – other movements, including reproductive rights – are grappling with,” she said. “The structural piece is something that we’re keenly aware of.”

This is why Johnson believes that even if politicians supportive of reproductive rights win the US Congress and the White House – a wholesale sweep – the victory would be a qualified one.

“There may be a conception that people have – a misconception – that these are issues where legislators are only focusing on maybe in the Bible Belt,” she said. But with 47 states introducing more than 300 anti-abortion bills nationally, “you have legislatures feeling emboldened and empowered to introduce legislation to limit access to reproductive health care. There is a kind of national cover that they are getting,” she said.

At the same time as all this is happening, Johnson represents a shift of leadership within Planned Parenthood, and one that rattled some supporters. Johnson became acting CEO in July after Dr Leana Wen was forced out, a short and rocky tenure in a critical election year.

“I’ve had a tremendous opportunity to be able to fly around the country and meet and sit with so many of our staff… and engage with many of our patients as well,” she said. “Just like sitting on the plane next to people [to hear] about how Planned Parenthood was there, and I know that is both the nexus of the wonderful experience that they’ve had, and how hard multiple staff worked to make that experience what it is.”

In all the “doom and gloom”, it’s those conversations that keep her optimistic.

“I feel incredibly good about going into this year.”