On Monday night, moments after the Senate voted overwhelmingly to end the government shutdown, Senate Majority Leader Mitch McConnell (R-KY) quietly put forward the nomination of former pharmaceutical executive Alex Azar to lead the Department of Health and Human Services. While his confirmation is likely to sail through the Senate on Wednesday, Democratic lawmakers and women’s health advocates are sounding the alarm about Azar’s statements on reproductive rights, religious rights, and the intersection of the two.

Amid the chaos of the shutdown, both the secretary’s confirmation and several other Trump administration actions related to women’s health have flown under the radar. With the Department’s move to draft rules protecting doctors who want to refuse to perform abortions, sterilizations, or assisted suicides, and the placement of hardline conservative activists in key health policy positions, some lawmakers worry the Department under Azar will “undermine years of progress” on reproductive rights.

As a former general counsel for HHS and an executive of the pharmaceutical behemoth Eli Lily, Azar has little on his record concerning reproductive rights and women’s health policy. But his written responses to questions from senators ahead of his confirmation, obtained by TPM, shed some light on his conservative views.

Sen. Patty Murray (D-WA) asked Azar to comment on the strategic plan HHS released in October that endorsed so-called fetal personhood, asserting that it was an “unconstitutional definition of persons as beginning at conception, which has no basis in science.”

Azar responded by endorsing the controversial change in HHS’ stated mission. “The mission of HHS is to enhance the health and well-being of all Americans, and this includes the unborn,” he wrote.

Murray, the top Democrat on the Senate Health, Labor, Education and Pensions committee, then asked Azar for his thoughts on the Trump administration’s recent rule—blocked for now by a federal court—that would allow for-profit, non-religious companies and organizations to refuse to include contraception in their employees’ health insurance plans. Again, Azar gave a brief answer indicating his support for the department’s move.

“It is critical that we balance individuals’ access to healthcare with the protection of conscience of those with contrary moral or religious beliefs,” he said.

Former CMS Administrator Tom Scully, who served with Azar for three years at HHS under the George W. Bush administration, says Azar is far from the hardline crusader his Democratic critics make him out to be.

“I found him to be an incredibly reasonable guy. He’s fairly conservative, and, I would assume, fairly pro-life, but I think he’s not a zealot in any direction,” Scully told TPM. “He’s a great listener. He’ll be very engaged and open-minded, not really doctrinaire or divisive.”

Most senators, including a handful of Democrats, agree.

Sen. Joe Manchin (D-WV), one of several Democrats pledging to vote for Azar, told TPM on Tuesday that even if he holds conservative views on contraception and abortion access, he believes it won’t heavily influence his work.

“I think we can move him on that,” Manchin said. “Trust me, I have enough faith that the good women who work at HHS can bring some common sense to him in his thought process.”

Still, some lawmakers and progressive advocates say Azar would join a cadre of political appointees already at HHS whose backgrounds in the anti-abortion movement are already having a major impact on administrative policy.

Abstinence education activist Valerie Huber, for instance, was recently put in charge of Title X family planning programs. Charmaine Yoest, the former head of the anti-abortion organization Americans United for Life, is one of HHS’ top spokespeople. Craig Bowman, who worked for several years suing the Obama administration over the contraception mandate on behalf of the conservative Alliance Defending Freedom, is now HHS’ general counsel. His resume also lists as a qualification three years as a “full-time pro-life volunteer.” Roger Severino, an anti-abortion attorney and alumnus of the conservative Heritage Foundation, runs the department’s Office of Civil Rights.

Under these officials, HHS has moved aggressively to not only roll back the Obama administration’s policies on everything from insurance coverage of contraception to equal access to health care for transgender patients, but also to bring a conservative religious bent to the department’s work across the board.

An agency memo leaked last October expressed a desire to funnel family planning funding away from programs that offer contraceptives and toward those that promote “fertility awareness” methods.

HHS’s Office of Refugee Resettlement has been sued for blocking an underage immigrant girl from having an abortion, and attempting to dissuade others in the agency’s care from having the procedure.

Last week, as the government was on the cusp of a shutdown, HHS announced the creation of a “Conscience and Religious Freedom Division” within its Civil Rights office that would work to protect health care providers who cite religious reasons for refusing to care for certain patients or perform certain procedures.

“For too long, governments big and small have treated conscience claims with hostility instead of protection, but change is coming,” vowed Severino.

Moments before the Senate held a procedural vote to advance Azar’s nomination, Sen. Ron Wyden (D-OR) warned that the soon-to-be-confirmed secretary would continue the administration’s “anti-women’s health agenda.”

“Health care is a right in America, but discrimination is not,” Wyden said. “The way Mr. Azar describes the position he’s nominated to fill, it sounds like he understands that. He said in his confirmation hearing: ‘If I get this job, my job is to enhance and protect the health and wellbeing of all Americans. But Mr. Azar has not committed to reversing these anti-woman, anti-LGBTQ, discriminatory policies.”