Organizations dedicated to women’s health and reproductive rights say they are ready to fight President-elect Donald Trump in order to preserve and protect women’s rights. Trump poses several dangers to women’s health, advocates say: the promised repeal of the Affordable Care Act, the appointment of one or more Supreme Court Justices, and the threat of defunding Planned Parenthood, making it harder for women to seek care.

Trump will be sworn in on January 20th, 2017, and for women’s health advocates, this is the calm before the storm. It’s not clear whether the president-elect’s actions will match his rhetoric. All we can see, for now, are his cabinet picks, and their histories with women’s rights. It is not a rosy picture.

Women’s reproductive health has taken a hit this year. Our soon-to-be vice president, Mike Pence, signed a bill in Indiana that would prohibit an abortion because of the race, gender, or disability of the fetus. The bill additionally holds doctors legally liable for performing an abortion under said circumstances, and requires the fetuses to essentially be given a funeral through burial or cremation. The Indiana law was blocked by a federal judge. But Indiana isn’t alone — similar legislations have surfaced in states like Texas and Ohio. In many places, rules are being imposed to make abortion more difficult to obtain, if not outright impossible.

Pence has vowed to send Roe v. Wade “to the ash heap of history”

While these laws may not ban abortion wholesale, they place financial and logistical burdens on women. Both the president-elect and the vice-president-elect have views that suggest women’s reproductive health advocates are right to be worried. In his political career, Pence introduced legislation to defund Planned Parenthood and has vowed to send Roe v. Wade “to the ash heap of history.” Before winning the presidency, Trump explicitly said there “has to be some form of punishment” for women who seek illegal abortions. But threatening to punish women for abortions is an unpopular opinion, and Trump backtracked rapidly on this statement. Instead, he said, it should be the doctors who performed them who are held responsible.

The biggest threat to women’s health is Trump’s animosity toward the Affordable Care Act. His crusade to repeal the ACA, colloquially known as Obamacare, energized voters. But before the ACA — which demands pregnancy and maternity be covered under the 10 essential health benefit categories — insurance policies were able to charge women more for care because of their gender; plans often excluded crucial maternity coverage. In addition to helping with preventative health care, like cervical cancer screenings or mammograms, the ACA also stops insurers from denying coverage on preexisting conditions. Young adults are allowed to remain on their parents insurance until age 26, and it helps women obtain birth control with no co-pay.

The peril for women goes beyond the potential loss of the ACA. Trump will appoint at least one, if not more, Supreme Court justice. He continues to stack his cabinet with members whose past actions suggest hostility toward women and reproductive rights. The future president has vowed to defund Planned Parenthood — a sentiment echoed by his vice president — a blow for anyone wanting to safely seek and receive reproductive health care. Though Planned Parenthood is synonymous for “abortion” in some conservative circles, the bulk of its mission is low-cost care for poor women; its 650 health centers across the country help 2.5 million people. Defunding it penalizes these patients, who might not otherwise be able to afford health care.

Planned Parenthood has been around for 100 years; it’s always known opposition. Planned Parenthood's director of political communications, Erica Sackin, tells The Verge that the organization’s focus right now is holding its ground — making sure that access to care isn’t rolled back for people who need it. “Look, the bottom line is no matter what, Planned Parenthood is here,” Sackin says. “And then, of course, that we're gonna fight like hell to make sure that our doors stay open and that people continue to have access to and rights to access reproductive health care.”

“we're gonna fight like hell to make sure that our doors stay open.”

But Sackin says she’s seen fear in communities nationwide. She points to an uptick in appointments for birth control, and IUDs specifically. Thanks to the ACA, 55 million women have access to birth control right now without a co-pay, she says. Now people are worried they’ll lose their health care. “For some of them, that could mean the choice between buying groceries every month or paying for birth control,” Sackin says. “It can really add up.”

Reproductive health care, like all health care, is expensive — making it less accessible for those in poverty. That’s why the National Network of Abortion Funds, NNAF, exists. The organization encompasses abortion funds and assistance in more than 38 states and is dedicated to helping overcome the financial and logistical barriers to getting abortions. Like Planned Parenthood, NNAF hasn’t changed its goals of focusing on organization and growth post-election. Executive director Yamani Hernandez says the organization’s plans are even more urgent, and then it will “pursue those goals relentlessly.”

“It actually makes it more important that we get more people involved,” Hernandez says of the election results. “We have seen a surge even in just days and weeks after the election of some people who weren't necessarily active with us, or in the movement at all, have become fearful of what it means to be hearing a president elect talk about making abortion illegal or overturning Roe.”

The threat to Roe v. Wade may not be imminent, but Trump’s appointment of the next Supreme Court justice is important. In an interview with 60 Minutes in November, Trump said that the judge will be pro-life.

“If [Roe v. Wade] ever were overturned, it would go back to the states,” Trump said in the interview, adding “Yeah, well, [women will] perhaps have to go — they’ll have to go to another state.”

In fact, women are already traveling for abortions. If women live in states with only one clinic, or the laws are especially restrictive, it adds an extra layer of both logistical and financial burden. Women traveling far from home to get an abortion may need to account for time off work, overnight stays, or childcare for their families. States also have different laws about abortion. Some require counseling or an ultrasound prior to the procedure, while others have different standards about how far the pregnancy is.

Texas could serve as a cautionary tale for what’s to come

“We're not new to those struggles,” Hernandez says. “It's just making it even worse and harder, which is disturbing. It's unjust.”

In the current political climate, Texas could serve as a cautionary tale for what’s to come. The state legislature has been particularly hostile to Planned Parenthood and family planning clinics. It’s an example of how devastating the effect of losing basic health care can be, says Erica Sackin. Even under the best of circumstances, pregnancy comes with medical risks of diabetes, high blood pressure, infection, and complications. It takes a toll on a woman’s body that is best prepared for with planned medical care.

In 2011, Texas lawmakers slashed family planning funds by 66 percent, resulting in the closure of 82 clinics statewide. An analysis published this year by The New England Journal of Medicine tracked an increase in birth rates of women — a statistic they linked to the decrease in family planning options.

“You saw negative health outcomes really skyrocket,” Sackin says. “We want to make sure that that doesn't happen in other parts of the country.”

Texas didn’t stop by cutting funds. On December 19th, new regulations kick in that will require fetal tissue of any developmental stage to be cremated or buried. The burden will fall on health care facilities to take care of remains. But even the clinics don’t really know yet what these new rules will mean for miscarriages.

The Verge spoke with medical offices, clinics, and health care centers across Texas that had different responses about how miscarriages, for example, would be handled. Most declined to comment on their practices completely. Some were adamant that women who experienced miscarriages at home would not have to worry about providing a funeral for remains, but weren’t sure about whether the law would apply to miscarriages that require surgery to prevent infection. About half of women who have miscarriages undergo these procedures. One office simply said the clinic would take care of remains from miscarriages without burdening the woman. Three clinics that provide abortion services specifically told The Verge they’re still figuring out how to proceed and will have a better idea after the 19th.

Trump is surrounding himself with people who have been indifferent toward women’s rights

This law will likely raise the price of abortions, says Clinic Access Support Network executive director Angie Hayes. The Clinic Access Support Network is a Houston-based fund in The National Network of Abortion Funds. It currently assists with funding about six procedures a year for “extreme situations,” with a cost of approximately $1,000 each.

“It currently won't affect us except to make abortions more expensive and therefore more difficult to obtain,” Hayes told The Verge via email.

The measure also elevates the stigma that already surrounds abortion. The Center for Reproductive Rights, in a statement following the finalization of this rule, called the regulation unconstitutional — a “politically motivated new rule is designed to restrict a woman’s right to access safe and legal abortion by increasing both the cost of reproductive healthcare services and the shame and stigma surrounding abortion and pregnancy loss.”

It’s possible to make abortion less stigmatized, but the only way to do that is to talk about it, says NNAF’s Hernandez. NNAF in particular has worked to give women spaces online to share their stories in an effort to help others “cultivate empathy around people's abortions,” Hernandez says. “All of us know someone and love someone who's had an abortion and should be compassionate to that fact and not judgmental,” she says.

But concern remains that the Trump administration will not demonstrate any level of compassion for women in these situations. Trump is choosing to surround himself with people, beyond Pence, who have historically been indifferent toward women’s rights. Secretary of Health and Human Services Tom Price is stoutly anti-choice, voted to defund Planned Parenthood, and has cosponsored legislation that works against contraceptives like an IUD or morning after pill, or that would make nearly all cases of abortion illegal. He’s made ridiculous claims that “there’s not one” woman without access to contraception already. Trump’s chief strategist and senior counselor is alt-right figure Steve Bannon is the former executive chairman of Breitbart News, a site notorious for running stories such as “Birth Control Makes Women Unattractive and Crazy,” and “There’s No Hiring Bias Against Women in Tech, They Just Suck at Interviews.” Bannon was also charged with domestic abuse in 1996; charges were dropped after his ex-wife failed to appear in court. The new attorney general, Jeff Sessions, told The Weekly Standard that he wouldn’t “characterize” Trump’s comments of grabbing women “by the pussy” as sexual assault.

“For anybody that is able to reproduce, it's just a very sad state of affairs,” Hernandez says. “The people who live and work in this country don't have the support of their federal administration.”

“it's just a very sad state of affairs.”

Even in this transitional period, state legislatures continue to make moves that place limits on women’s abilities to make decisions about their own health care. On December 6th, Ohio lawmakers passed a bill banning abortions after a fetal heartbeat can be detected. A heartbeat can be detected as early as six weeks, according to several health care clinics The Verge spoke with. Many women don’t realize they’re pregnant until sometime after a six-week period. The law flies in the face of Roe v. Wade, which grants women the right to abortion until the point at which a fetus can survive outside the womb, which is typically the 24th week of a pregnancy. In order to stop the bill from becoming law, Governor John Kasich must veto it within 10 days.

While the political situation seems dire, ordinary people are stepping up to help. According to both Hernandez and Sackin, both organizations have received a swell of support in the form of donations in volunteers. In November alone, Hernandez says the NNAF has “tripled the number of donations that we normally get at this time.” Sackin says the increase in support confirms what they’ve always know: that the majority of the country supports Planned Parenthood or reproductive health care access. For the president to uphold the promises he pledged in his victory speech, Sackin says, that includes those who rely on Planned Parenthood.

“If [Donald Trump] says he wants to be the president for all Americans, that means being the president … of those 1 in 3 women who will have an abortion in this country,” Sackin says.