Women and advocacy groups are preparing for the most serious assault on reproductive rights in decades after Hillary Clinton, the first female nominee of a major party, lost the presidential election to Donald Trump.

Trump’s election, in tandem with an undivided Congress under Republican control, 33 GOP governors and an open seat on the supreme court with the possibility of more appointments, has cast serious uncertainty about the future of abortion in the US, advocates say.

“It’s really bad – bad as we’ve ever seen it,” said Donna Crane, the vice-president of policy for Naral, a pro-choice advocacy group.

Like many of his policy views, Trump’s stance on women’s reproductive rights has shifted throughout his campaign, including three contradictory positions on abortion in three hours. In an interview on Sunday with CBS’s 60 Minutes, Trump reiterated his vow to appoint conservative and pro-life supreme court justices, which could gradually restrict abortion access and even lead to overturning Roe v Wade, the 43-year-old ruling that legalized abortion in the US. (Trump, who appears to have an incongruous understanding of how the supreme court operates, had previously suggested this would happen “automatically”.)

The prospect of overturning Roe v Wade has set off alarm bells among women’s health advocates, who are already fighting to hold the line against an avalanche of regulations meant to restrict access to abortions at the state level. But experts saying dismantling the precedent would be much more difficult than Trump seems to think it will be.

“Roe has withstood the test of time, over 40 years,” said Kelly Baden, interim senior director of US policy and advocacy at the Center for Reproductive Rights, noting that US supreme court justices take precedents seriously even when they disagree with them. “It has survived anti-choice administrations, including ones that have pushed to appoint anti-choice justices to the supreme court.”

He has no idea what that actually means, as far as how real people live their lives Amy Hagstrom Miller, Whole Women’s Health

In the interview, Trump said that if Roe v Wade is overturned, then women would “have to go to another state”. Asked if that was acceptable, he replied: “Well, we’ll see what happens. It’s got a long way to go.”

This was a time Trump would remember well. New York was one of the first states to legalize abortion in 1970, three years before Roe v Wade was decided. Women from other states who could afford to travel were able to receive the procedure. But low-income women and women of color were disproportionately affected.

“This comment tells us that he has no idea what that actually means, as far as how real people live their lives,” said Amy Hagstrom Miller, the CEO of Whole Woman’s Health, which was the lead plaintiff in a supreme court case that struck down a Texas law that would have closed all but 10 of the state’s abortion clinics.



Women in New York protest Donald Trump’s victory. Photograph: Erik M/Pacific/Barcroft Images

“Women in the Rio Grande Valley couldn’t even make it 200 miles to get to a clinic, now he’s suggesting they would have to travel out of state?”

Women attempting to perform their own abortions was also more common and sometimes deadly, and the practice continues today among women with limited access to clinics.

Trump has also promised to sign a ban on abortion after 20 weeks’ gestation – or several weeks before viability – into law. The bill is based on the scientifically unproven argument that after 20 weeks, fetuses can feel pain, and it bans abortion before many women learn about severe fetal anomalies.

Hagstrom Miller said that above all she’s concerned about the culture a Trump presidency might normalize.

“The violent, hateful language he uses about women and people of color terrifies me,” she said. “I’ve seen this in my work: when that kind of language and rhetoric lands on the wrong ears it can be an invitation for violence.”

Four states – Louisiana, Mississippi, North Dakota and South Dakota – have laws that would automatically ban abortion if the supreme court overturned Roe. Eleven states would retain their “pre-Roe bans”, all of which would take effect after the ruling. Just seven states have laws in place that would preserve the right of women to access an abortion if Roe was struck down.

While Trump’s views may be harder to pin down, vice-president elect Mike Pence is ardently anti-abortion. Photograph: Spencer Platt/Getty Images

That Trump would prioritize undermining Roe v Wade is concerning, advocates say, and a clear indication of how he plans to appease Republicans in Congress and the cultural conservatives who ended up supporting his candidacy over Clinton’s.

“Roe exists as long as five justices say it does,” Naral’s Crane said. “When five justices no longer agree, it’s Katy bar the door.”

Though Trump’s view on women’s health is hard to pin down, there is no wavering for Mike Pence, the vice-president elect who is ardently anti-abortion. The Indiana governor was the architect of the first bill that blocked federal funds from going to Planned Parenthood, a women’s health organization that provides contraception, medical services and abortions at hundreds of clinics across the country.

The silver lining is that we have a really powerful organizing tool for 2020 Destiny Lopez, All Above All

During the course of his campaign, Trump has long threatened to dismantle the Affordable Care Act (ACA), which provides access to free birth control and annual well-woman examinations. In recent days, however, he has suggested he might not repeal it entirely. He has also threatened to defund Planned Parenthood, which provides women’s health services at hundreds of clinics across the country and to codify the Hyde Amendment, a 40-year provision that prevents federal funds from being used to pay for abortions.

In reaction to Trump’s agenda, a “Women’s march on Washington” scheduled for the day after the inauguration, already has more than 90,000 people who say they will attend. On social media, many women are encouraging other women to switch to longer-lasting birth control methods, especially intrauterine devices, commonly known as IUDs, while it is still covered under the ACA.

Trump has threatened to dismantle the Affordable Care Act, which provides access to free birth control. Photograph: Spencer Platt/Getty Images

Diane Horvath-Cosper, a reproductive health advocacy fellow at Physicians for Reproductive Health, said doctors across the US have reported an uptick in patients concerned about losing free access to birth control under a Trump administration.

“I really would hate to see a situation where people are so afraid of losing their coverage that they make a health care decision they would not make otherwise,” Horvath-Cosper said.

Perhaps hardest to accept is just how different the battles might have been if Clinton had won the election. In a historic first, the Democrats approved a platform at the Democratic national convention in Philadelphia that explicitly called for elected officials to overturn the Hyde amendment. On that front, advocates will now be fighting to keep Hyde from being codified, which would make it much harder to abolish.

“The silver lining is that we have a really powerful organizing tool for 2020,” said Destiny Lopez, the co-director of All Above All, a network of reproductive rights advocates that is leading the push to repeal Hyde.

She added: “The election really brought a daunting challenge to our doorstep but we women – low income people, people of color, immigrants – we are used to fighting against impossible odds.”