Abortion clinic staff reported a stark increase in hate mail, harassing phone calls, trespassing, vandalism and obstruction in 2018, according to new findings by the National Abortion Federation, the professional association of abortion providers.

The organization has been tracking incidents of violence and harassment at abortion clinics since 1977. On Thursday, it released its 2018 report, coinciding with a wave of extreme anti-choice legislation that has cropped up in conservative states.

Among its findings: Picketing of clinics has skyrocketed, increasing over threefold from 2015 to 2018. And with more protesting came more confrontations between anti-abortion activists and those trying to seek health care inside the clinic’s doors.

In 2018, abortion providers reported a 78 percent increase in acts of obstruction, which is defined as attempts to interfere with a clinic’s business, or preventing people from entering or exiting an area. In one case detailed in the report, anti-abortion protesters covered a clinic’s parking lot with nails, damaging the tires of patients and clinic staff.

Under federal law, it is a crime to use force or threat of force or physical obstruction to “injure, intimidate or interfere with” someone entering a reproductive health care facility.

Abortion clinics also reported a marked increase in hate email and internet harassment, with members reporting 21,252 incidents up from 15,773 the previous year. “If one murders, they must pay with their life,” one clinic protester wrote online. “If we start doing this, abortion stops.” Harassing phone calls and hate mail sent to clinics rose as well.

At another clinic, a protester threatened staff, telling them, “I have a bullet with your name on it.” The incident is currently under investigation by law enforcement. Trespassing at clinics increased in 2018 to more than 1,135 incidents — the highest number since the organization began collecting data on it.

The Very Reverend Katherine Ragsdale, Interim President and CEO of the National Abortion Federation, said the findings echo a similarly dramatic increase in 2016 and 2017, which she noted corresponded to President Donald Trump’s rise to power.

“When violent, incendiary rhetoric takes place, you watch the violence escalate,” she said. “What makes these last couple of years different is that it used to be that kind of demonizing rhetoric came from extremists. And now it’s coming out of the mouth of the president.”

So far this year, four states have enacted so-called fetal heartbeat bills, which ban abortion around six weeks, before many women even know they are pregnant: Georgia, Ohio, Kentucky and Mississippi. Alabama’s legislation is even more extreme, banning abortion at all stages of pregnancy, except when the woman’s life is at serious risk. On Friday, Missouri’s governor signed a bill into law that would ban abortion at eight weeks, with no exceptions for rape or incest. None of the new bans have gone into effect yet, and all will likely be challenged in court.

In the wake of renewed anti-abortion fervor, abortion providers have reported feeling increasingly nervous about their safety at home and online ― fears which Ragsdale said were completely reasonable.

“When you start calling doctors murderers, it’s demonizing and dehumanizing and it sets targets on people’s backs,” she said. “It makes it somehow seem okay to extremists to inflict violence on these folks.”

