An American woman's constitutional right to an abortion has perhaps never been under greater threat than it is right now. Since 2010, Republican lawmakers have passed around 300 state laws that force women to overcome obstacle upon obstacle in order to get an abortion. Five states — Mississippi, Missouri, North Dakota, South Dakota, and Wyoming — only have one abortion clinic remaining. And in response to an anti-abortion group's series of videos accusing Planned Parenthood of profiting from the sale of fetal tissue, lawmakers have attempted to defund Planned Parenthood at the federal level, and some governors have succeeded in defunding the women's health organization at the state level. Women living in areas hostile to abortion are growing increasingly curious about dangerous, DIY self-induced abortions.

This year marks a crossroads for reproductive rights in America. In the next few months, the Supreme Court will make a landmark ruling on the constitutionality of a Texas law that places restrictions on abortion providers and in a separate case will determine to what extent a religious nonprofit can affect an employee's ability to access birth control. Not to mention, of course, that 2016 is an election year in which one political party is vehemently opposed to abortion, wants to defund Planned Parenthood, and would seek to nominate Supreme Court justices who share these views. About a year and a half ago, Cosmopolitan.com spoke to Nancy Northup, president and CEO of Center for Reproductive Rights; Cecile Richards, president of Planned Parenthood Federation of America and the Planned Parenthood Action Fund; and Ilyse Hogue, president of NARAL Pro-Choice America, about the climate for reproductive rights in America. Now they've come together again to explain what's at stake for American women.

Now that you've all heard the oral arguments in Whole Woman's Health v. Hellerstedt, how do you feel about the case as we wait for the decision?

Nancy Northup: At the heart, what Whole Woman's Health v. Hellerstedt is about is a woman's right to make her own decisions about her health and family, and the politicians who are using underhanded schemes to take that right away. What we heard in the courtroom was that the Texas law hurts women. It's closing clinics and forcing women to bear additional and often insurmountable costs and burdens to exercise their constitutional right to end the pregnancy. And we heard in the courtroom that the law is not medically justified. In fact, the American Medical Association and other leading medical associations have clearly stated, and have told the Supreme Court, that it's not medically justified. And what's also clear is that [the] Supreme Court for over four decades has reaffirmed the constitutional protections that make it clear that women have a right to make the important decision about her health and family. So we are confident that the right facts came out in the courtroom, that the high stakes for women came through in the courtroom, and that the Supreme Court will reaffirm what it has said for over four decades.

Cecile Richards: Unfortunately, we are seeing the impact on a daily basis of what's happening in Texas as a result of this bill. It was certainly raised in particular by having three women on the Supreme Court. Although we had a lot of support in that room, and by male justices as well, I really felt like women were in the courtroom in a way that was very, very significant, and certainly having Justice Ginsburg talk about what's happening to women who are now driving to New Mexico — and I would argue even driving to Mexico — talking about what it means to live hundreds of miles from the closest provider was really poignant. I believe that the state of Texas was completely unable to justify this very not only restrictive but dangerous kind of legislation and bill, and the impact that it had on the very women that they purport to be supporting. I think that these kinds of cases being argued before the Supreme Court have put in stark relief how important it is to have a president who will appoint judges who respect women's rights and judicial precedent.

If this Texas law is upheld, what effects will this specifically have on the broader reproductive rights landscape?

Northup: If the Texas law is upheld, 75 percent of the clinics in Texas will have closed, so it will be devastating to the women in Texas. But we are confident that the Supreme Court is going to respect the decades of law on this, because we have to make sure that the laws that were guaranteed in Roe are rights that are not in name only but rights that are actually available in fact. It is not the role of courts to just defer to and give blind deference to the legislature. It's the role of the court to make sure that the promises contained in our Constitution are protected from overreaching by the political branches of government. What's at stake here isn't even just about one case, it's really about the rule of law itself and the integrity of courts' decision and the role of the courts in protecting our constitutional rights.

They're trying to legislate a very narrow, pretty extreme ideological worldview on the American people.

Richards: I think it's also important to broaden this because obviously this case is about abortion access, but the impact of the kinds of laws that are being passed are so far beyond even that. Of course in Texas, even prior to this case being brought, we had 82 health centers shut down — not only centers that provided safe and legal abortion access, but provided basic family planning access, and of course the research is already in that is demonstrating what happens to women as a result, which is fewer women being able to access all forms of birth control, a rise in unintended pregnancy rates. Anything that wasn't able to get passed through Congress — whether it's the defunding of Planned Parenthood, whether it's a further restriction on abortion access, denial of birth control access — we're now seeing it state by state by state in states like Indiana, Wisconsin, Ohio, even Florida, where the legislature just passed a bill that would end access for thousands of women to basic preventative care. It's basically the dangerous road we are going down with some politicians who are putting their own political agenda ahead of basic access to health care for women.

Ilyse Hogue: We often agree with each other, but I will add a couple of thoughts. One is that there is a very well-coordinated, well-funded movement that drives all of these state-by-state restrictions. Part of why they've kind of been able to amp up their success rate at the state levels since 2010 is because they have been really successful at taking over state legislatures by not actually showing their true agenda on restricting not just abortion access, but women's empowerment. So when we think about the kind of state laws that we've seen be introduced for decades by this movement [and have been passed at] unprecedented rates since 2010, they fall into three categories: One is the TRAP [Targeted Regulation of Abortion Provider] laws. TRAP laws are defined by being deceptive, right? The second category is outright abortion bans. We're seeing these all over the country; the 20-week ban that's been debated at national Congress — and which was defeated in the Albuquerque referendum, the only time it's been put directly to the people — all the way down to the heartbeat bans at six weeks, which is before many women know that they're pregnant. And then the third category of bills is what we call the stigma bills. These are the mandatory waiting periods, these are the forced ultrasounds, these are the biased counseling scripts that have no bearing on the medical procedure at all but are basically saying, "Look, if we can't stop you outright from having an abortion because we think it's wrong, we're going to try to do everything within our power to make you feel bad about it." We talk a lot about how abortion is a medical procedure, but actually if you look at what the other side is doing, they're trying to legislate a very narrow, pretty extreme ideological worldview on the American people.

Every Republican presidential candidate has said that he would like to see Roe v. Wade overturned, a view that is not in line with what a majority of Americans believe. How did such a minority viewpoint gain so much popularity among the Republican leadership, and why do you think there's such a large disconnect?

Hogue: What we're seeing is actually Republican candidates play to a smaller and more ideologically driven base on the Republican side, and so their strategy has been, and I suspect will continue to be, to pander to that extreme moral view in the primary and then erase their record as quickly as possible in the general [election] because they know they're on the wrong side of the American electorate when they are forced to articulate the views that satisfy their base in the general election. We saw this on display abundantly in 2014, where you had everyone from [Wisconsin Gov.] Scott Walker to [Colorado Sen.] Cory Gardner trying to erase their anti-choice views, and they did so successfully. Our strategy is make them own their positions, to hold them to every vote they have taken, every statement they have said, and make sure that those voters who actually prize autonomy think it's absolutely the wrong priorities for an elected official to be focusing on rolling back reproductive rights and restricting personal freedoms at the expense of so many other issues that our country has to deal with.

We're all fighting for the day in which partisan politics is no longer something that is used to attack women's access to health care.

Richards: I think that we look back at four years ago and the presidential election, President Obama was reelected with the largest gender gap ever in the history of Gallup polling, and it was quite stunning because the issue of Roe v. Wade, the issue of access to Planned Parenthood, were widely discussed both in presidential debates and in paid advertising, and it was demonstrated without a doubt [to be] deeply damaging to Gov. Romney when he took these positions. There was a lot of rethinking and head-scratching after the election, and there was a commitment by the Republican party to recast their views about women and their support for women, and in fact just the opposite has happened. We're seeing now a total race to the bottom on women's access to health care, and on Roe, and on Planned Parenthood specifically, and I think it is going to be enormously damaging to [Republicans] when we get to the November election. I think that's why we see even Donald Trump trying to hedge his point of view, because when 1 in 5 women in the country have been to Planned Parenthood, they don't like hearing that one of the top priorities of a presidential candidate is to get rid of their access to care.

We support Republicans, Democrats, independents, anyone who supports women's access to reproductive health care. It just happens to be right now that the Republican leadership in the presidential campaign has taken these extreme positions. I think we're all fighting for the day in which partisan politics is no longer something that is used to attack women's access to health care.

NARAL launched a campaign called "Ask About Abortion" to highlight the lack of discussion about abortion in the Democratic debates. Why do you think abortion has been left out in these debates, and how do you feel that that omission has affected a larger conversation about reproductive rights in the country?

Hogue: One of the interesting things that I've heard as we've run this campaign is that both candidates are pro-choice, and if you actually look at their voting records, that's absolutely true. Now, we believe that the ability to have an honest conversation that moves toward confronting the access crisis in this country has to come from more than just votes. When we leave abortion out of the debates, a couple things happen. One, people don't think that this is a real priority. Two, particularly in the primary that we're facing, as we've already acknowledged where all the pro-choice candidates are on one side and all the anti-choice candidates are on the other, we lose the ability to frame the debate on our terms, right? We saw that with Fox News' town hall when they asked the question about a very small incident of abortion in a very anti-choice frame. It was not about the access crisis in our country, it was not about candidates' plans for what to do about making sure that every woman has access to her constitutional rights. It was about a very small number of cases of later-term abortion, which we can discuss, but it's not real life for most people and the 1 in 3 who do choose to have an abortion in our country. So we want to make sure that we're lifting this up during the primary, because when we do, we're actually debating on our terms, and that is so important to have the conversation in the general election.

The final thing I will say is, some people have said, "But they're both pro-choice, so why don't we spend time on issues that they have differences on?" What my answer to that is, well, they both say they want to regulate Wall Street and they both say they want to expand health care, but we actually demand to know how, right? We want to hear the very concrete steps that these candidates would take to make sure that every woman has access to her constitutional rights and basic health care.

Is there an end in sight to lawmakers threatening to defund Planned Parenthood, or do you think that these attacks based on these videos will continue?

Richards: Look, they've been trying to defund us for years. I would point out that not only has Planned Parenthood been exonerated by a Houston grand jury, but a Republican district attorney in Houston in fact indicted the two perpetrators of this, so if there was any wrongdoing, it's been by the folks who perpetrated this scam against us and other abortion providers. And they are known anti-abortion activists. They are not folks interested in women's health. And that's because, Nancy and Ilyse have said as well, this is about a nationally orchestrated effort to end access to legal abortion in this country. I do think it has pushed us all into a place in which the American people are going to make a very important decision next November about whether in fact we are going to go back to the 1950s, when women didn't have access to legal abortion in this country and young healthy women died routinely in emergency rooms all across America, when birth control was hard to get and expensive to pay for, and when young people couldn't get access to sex education in their schools.

I spent a few hours in front of one of the House committees that was supposedly investigating these matters, even though the chairman admitted himself there's absolutely no evidence of Planned Parenthood's wrongdoing. And really, the result of that was we gained half a million new supporters. Folks saw what Congress was doing and how little empathy they had for women and women's access to health care, and so I feel like this is coming back around against the folks who are trying to deny women's access to health care in a way that is just unacceptable to the broad public. I think actually, all it has done is helped fuel an understanding across the country of what is at stake in this election, both at the Supreme Court, in Congress, in state legislatures, and for everyday Americans simply trying to access health care and live their lives.

Northup: I would just say that what links the deceptive videos and the deceptive sham Texas law is the willingness of certain opponents [of] reproductive health and rights to use deceptive and dishonest means to pursue their agenda. And they use deceptive and dishonest means because they know that the public is on our side. They know the Constitution is on our side. So they turned to underhanded tactics that do more to show why they're trying to go underground to pursue their agenda than to have a policy debate in the broad light of day.

Is there anything that makes you optimistic for reproductive rights?

Hogue: I'm hugely optimistic. Ever since Roe v. Wade, our opponents have actually run a long-term strategy to do away with our constitutional right to abortion. And by proxy, [to do away with] the sort of equality and empowerment that women need in making our own family-planning decisions — because [abortion is] so closely linked with our destiny. But I think in the last five years, their overreach and their willingness to actually lay their cards on the table has really been a clarion call and illustrated for most Americans what's at stake. What's at stake is this ideological worldview where we go back to a day where abortions were in the back alley, contraception was contraband, and women were forced to marry just to even get a credit card or their name on a mortgage.

On the other side of that ideological worldview are the majority of people, who believe not only in legal access to abortion, but that when women have control over our own reproductive destinies, we can more fully participate in society at large, and that benefits everyone. That's why we're seeing more men come to the fight, that's why we're seeing more people speak up about their own abortion stories, and that's why we're seeing more people make reproductive rights and reproductive freedom and reproductive health issues central to every election decision, every legislative decision.

I don't want to gloss over the fact that there is very real impact every single day. Women are being denied basic health care that we need to get along in life, and that's real, and that's bad. To the extent that the sort of increase in energy and momentum can be parlayed into voting and lobbying your state legislature and talking in cultural outlets like Cosmo about how we really feel about access to abortion and reproductive health, that's one less day that women will suffer at the hands of the minority in this country. It makes me optimistic that we're on the right track, and I'm just anxious to get it done as soon as possible so the fewest number of people actually suffer in the interim.

Northup: I'm optimistic because of the tremendous support that we have seen throughout American society for this moment that we've come to at the Supreme Court with this landmark case in the Texas clinic shutdown law. There were 45 "friend of the court" briefs that were filed from a broad array of voices — from business to medicine to women who in their own names talked to the court about their own abortion experiences. For years, the movement that has been fighting these targeted regulations of abortion providers, TRAP laws, have had a tough time because [the laws have] been sailing under the radar screen. Well, now, it is clear to the nation that there is an access-to-abortion crisis. We're going to win this case, and as a movement, we're going to go forward to make sure that there is equity in access. We're going to be fighting it on the state level, and we're going to be fighting it on the national level. We're going to make sure that there are legislative guarantees as well as constitutional guarantees for one to be able to access abortion services, and for insurance, private and public, to cover that. The Women's Health Protection Act is an anti-TRAP law that has been introduced in the Congress. The EACH Woman Act is an insurance coverage law to make abortion affordable for all women, on public or private insurance, that has been introduced in the Congress.

Richards: The things that make me hopeful are that we're actually providing better health care to more people than ever before. We're in a 40-year low for teen pregnancy in the U.S., and it's not because young people aren't interested in sex. We're getting them better birth control, we're getting [them] better sex education, even if they have to go to Planned Parenthood online to get it. Ten years ago, we were fighting to get birth control even covered in insurance plans, and today, under the Affordable Care Act, 55 million women have access to no-cost birth control. It is a radical change, and it's only going to continue to get better. We just had a $50 IUD approved by the FDA. You just can't un-invent a $50 IUD, so no matter the political environment, we just make progress in terms of health care and medicine.

But the cautionary note here is that it's not real equity yet. I think if there is a stake in the ground I would put for the next five years, it is achieving true reproductive equity in the U.S. to make sure that your ability to access abortion services that are safe and legal, or to access birth control or LGBT services, doesn't depend on your zip code or your income or your immigration status or your race or your geography. But I feel like we are on the right path. And again, I think November is gonna be a critical point of demarcation where this country can, and I believe will, stand affirmatively for the progress that we've only begun to make.

This interview has been lightly edited and condensed.

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Prachi Gupta Prachi Gupta is an award-winning journalist based in New York.

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