Dalia Vidunas could never forget New Hampshire’s first-ever abortion clinic. It wasn’t buried within a suburban plaza or tossed away in an outlying town. It was in Concord, the state’s capital, right off the city’s Main Street.

Even then, years after the landmark Roe v. Wade Supreme Court decision had upended the national conversation around abortion, the topic was precarious.

“Nobody talked about abortion services,” Vidunas recalled before a crowd of abortion rights activists at the Grappone Center on Thursday. “Nobody said ‘Oh I had an abortion.’ It was all under the radar.”

Today, Vidunas is running that clinic – now Equality Health Center – and a lot has changed, she says. Attitudes are more permissive. Funding efforts are in greater supply. And practitioners are less timid about what they do.

Now, she says, “I get to shout from the rooftops: ‘We provide abortion services’.”

She added: “I think that is one of the great things that we have really been able to do. To provide things on Main Street and provide things not quietly, but in your face.”

To the abortion rights supporters in the room, gathered to celebrate the anniversary of the 1973 Roe decision, Vidunas’s was a success story, the result of evolving attitudes and expanding footholds for reproductive care. But 46 years after the Roe decision, a series of changes in Washington have set off brewing storm clouds for abortion rights supporters.

A series of proposed rule changes have put national organizations like Planned Parenthood on the defensive. And a pair of Supreme Court nominations by President Donald Trump have tilted the high court to its first conservative majority in decades, putting the entire underlying Roe decision to an uncertain fate.

Attendees of Thursday’s event, hosted by the American Civil Liberties Union of New Hampshire, didn’t shy away from reality.

“I think the reality is we’ve taken huge steps backwards,” said Meagan Gallagher, CEO of Planned Parenthood of New England, who gave the keynote speech. “Abortion access is going to be bicoastal, and then Montana, Illinois, Michigan, and that’s abortion access if Roe v. Wade is overturned.”

New Hampshire anti-abortion supporters, meanwhile, are watching Washington, but with their own caveats.

“Having Roe v. Wade overturned would be wonderful, but it won’t affect New Hampshire right now; it would just go back to the states,” said Jennifer Robidoux, president of New Hampshire Right to Life. “And New Hampshire does not have restrictions on abortions.”

New Hampshire Right to Life’s position is clear, she said. “We would want to put restrictions on abortions and make it unthinkable and illegal.”

Getting there, though, would require a heavy lift: pushing a bill that would limit or outright ban the practice through the Legislature. Robidoux is the first to admit the long odds.

At stake is a court decision that advocates on both sides say is more complicated than it seems. For reproductive health advocates, the legacy and impact of Roe dovetails with major reforms in the ’60s and ’70s, including the introduction of the birth control pill and family planning centers.

But Gallagher cautioned that Roe was never a silver bullet. The decision didn’t directly turn on women’s rights. And it couldn’t stop limitations set up by individual states, which have made acquiring abortions distant and inconvenient for many.

“Roe said that Americans have a constitutional right to an abortion. But do they?” Gallagher said. “In many ways what was true before Roe remains true now. If you have the resources to get an abortion, you can get one. If you don’t, that constitutional right doesn’t mean much.”

It’s unclear what actions the new Supreme Court could take. But Gallagher said it was “probable” that abortion protections could be weakened under the new court, and “possible” Roe could be overturned entirely.

“The reality is that most of us in this room can’t do much about that,” she said. “But if Roe is overturned, states will determine if and how people can access abortion services.”

New Hampshire would be immune from the immediate effects of reversal of Roe, Gallagher contended. Presently there are few restrictions against abortion in the Granite State, a contrast to states with dormant anti-abortion laws that could be quickly reactivated.

And the state is seen by abortion rights activists as relatively safe, with an independent-minded electorate. Last year, despite a Republican-dominated Legislature, allies of Planned Parenthood were able to hold off a series of attempted limitations to the state’s abortion laws.

But activists say they’re wary of a tidal shift in the State House should the Supreme Court remove its backstop. At that point, advocates say, the stakes in Concord for all parties would skyrocket.

For now, little major action is being taken on either side. Though Gallagher has called for a sweeping bill to codify Roe in New Hampshire law, similar to legislation that passed New York this month, no New Hampshire Democrat has filed that bill this year. And though Robidoux says the state should outlaw the practice altogether or pursue strict safeguards, no Republican filed a bill for that either.

For now, Gallagher said, the response is clear: digging in, and fighting complacency.

“We have to be unapologetic about women’s rights over their bodies,” she said. “And we need to not be afraid to talk about it.”

Robidoux admitted a longer path.

“We here at New Hampshire Right to Life, we know that we have hill to go up,” she said. “It’s a big hill. But we’re ready for the fight.”