The election of Donald Trump has forced American women to reckon with a future in which the “tyranny of reproduction” looms large. This fearful vision of the future is simultaneously a plunge into the past, into the world before legal abortion and prescription birth control when to have sex was to tempt fate and unwanted pregnancies could feel like fatal mistakes.

The question surrounding the impending Trump-Pence administration is not if its members will attempt to erode women’s rights and encroach on their bodily autonomy—it’s when, how, and in what order. Organizations that promote reproductive rights are preparing for the onslaught to come, sifting through the barrage of gynophobic bombast to identify the most serious risks and plan accordingly.

From overturning Roe V. Wade to upticks in clinic violence, there are a range of concerns that leading reproductive rights organizations cite as their top priorities.

The Three Branches

Trump has said that overturning Roe v. Wade would “happen automatically” if he was elected and that the legality of abortion would go back to the states. Pence, a lifelong opponent of reproductive rights, has said that a Trump-Pence administration would consign the historic ruling to the “ash heap of history.” With one Supreme Court vacancy to fill, and possibly more to come, this may not be an empty threat.

“Donald Trump has the opportunity to nominate a regressive justice who will roll back progress on reproductive freedom, and it’s possible he will get SCOTUS appointments beyond this one,” said Kaylie Hanson Long, national communications director for NARAL. “The list of names he has suggested is really scary.”

Take, for example, short list pick William Pryor of Alabama, who has described abortion as murder and Roe v. Wade as “the worst abomination of constitutional law in our history.”

While the Supreme Court vacancy represents a widely held point of concern, not all reproductive rights advocates think SCOTUS could or would overturn the decision.

“Despite what Trump said about Roe being overturned and the VP-Elect’s position on abortion, we know that the Court has upheld the right to abortion for over 40 years,” said Amanda Allen, the Senior State Legislative Counsel at the Center for Reproductive Rights. “The Constitution does not permit states to say, ‘Okay, you can just access this Constitutional right elsewhere.’”

However, even without a Supreme Court bench stacked against abortion, President Trump will have plenty of opportunities to restrict reproductive rights in the lower courts. Kierra Johnson, the Executive Director of URGE, said this is one of her gravest concerns—and one of the most overlooked.

“It’s not the sexiest topic, but the issue of judicial appointments deserves some real attention,” Johnson said. “It’s easy to forget that the President also appoints federal judges, potentially hundreds of them. These judges will have an impact long after the next election. Right now, many state level abortion restrictions are moving through the courts or are currently being blocked by a federal judge. New judges that are hostile to abortion rights could have a chilling effect on places where it is already difficult to get an abortion.”

Conservative-dominated legislatures—at the federal, state, and local levels—are also a top concern of reproductive rights organizations, who are worried about the bills lawmakers will attempt to push through under the reign of Trump.

“We are keeping an eye on the 20 week ban—It’s a bill that has come up in multiple congresses and Donald Trump is on record as supporting it,” said Hanson Long. “Of course, we know that this bill would have the effect of restricting a woman’s healthcare in some of the most complex healthcare situations imaginable.”

In addition to the legislatures and the courts, reproductive-rights advocates say that Trump’s cabinet and administrative picks—to entities like the Department of Health and Human Services, the Department of Education, and the Food and Drug Administration—will have a drastic impact on women’s lives. These appointees will be able to hack away at reproductive rights through their dominion over issues like whether telemedicine is available to people in rural areas, whether or not students have access to medically accurate sexual health education, and the labeling of medication abortions.

Tom Price, Trump’s pick to lead the HHS, raises a cacophony of alarm bells. This is a man who participated in efforts to defund Planned Parenthood, who co-sponsored an extreme “personhood” bill and the 2015 Pain-Capable Unborn Child Protection Act—a 20-week abortion ban based on junk science. He is also a fierce opponent of the Affordable Care Act and its birth-control benefit, which requires insurers to cover FDA-approved contraceptive methods.

“Tom Price poses a grave threat to women’s health in this country,” said Cecile Richards, president of  the Planned Parenthood Federation of America, in a statement. “From his plan to take no-copay birth control away from 55 million women and allow insurance companies to charge women more for the same health coverage, to his opposition to safe and legal abortion, Price could take women back decades.”

Cutting Off Funding

The prime directive of the anti-abortion movement is, of course, to eliminate abortion. Evidence shows that easy access to free birth control dramatically reduces abortion rates. And yet, the politicians most vociferously endeavoring to restrict abortion are also working to pulverize pathways to affordable birth control. Trump and his ilk want to “repeal and replace” the ACA, and Pence has made defunding Planned Parenthood, by cutting off Title X family planning funding, a personal crusade. These actions would not only throttle access to contraception and abortion, but also to other critical services that help prevent negative health outcomes, such as as cervical cancer, HIV and other STIs, infertility, and preterm and low-birth-weights.

“When women lose access to affordable, reliable reproductive-health care, they not only experience higher rates of unintended pregnancies and sexually transmitted infections, but they lose the ability to make to make informed decisions about their reproductive lives,” said Katey Zeh, the board chair of the Religious Coalition for Reproductive Choice. “Creating a family is sacred work that requires thoughtful decision-making.”

Dismantling the ACA, cutting Title X funding, and codifying the Hyde Amendment, which blocks federal Medicaid funding for abortion services (except in extreme cases), will have a disproportionate effect on members of marginalized populations, who don’t have hundreds of dollars on hand to shell out for reproductive-health services. In the case of abortion, these measures would render it inaccessible to all but the most privileged women—those who can afford the procedure, cover necessary travel expenses and logistics, take time off work, and/or secure childcare. Thus the burden of enduring unwanted pregnancies and supporting unplanned-for children will overwhelmingly land onto those who are already the most vulnerable.

“When politicians deny coverage of abortion care, the harm falls hardest on those who can’t go to another state to get the care they need—such as families with low incomes, people of color, immigrant women, and youth,” said Jessica González-Rojas, executive director of the National Latina Institute for Reproductive Health. “Latinas and other women of color are more likely to experience unintended pregnancy, and less likely to be able to pay for an abortion out of pocket, since systemic barriers, such as the wage gap, hinder Latinas’ ability to be in charge of their reproductive decisions.”

Without Title X funding, many clinics will have to close. This will make it harder for women to get contraception, and if they get pregnant, harder to get an abortion. Renee Bracey Sherman, Senior Public Affairs Manager of the National Network of Abortion Funds (NNAF), said that clinic closures cause increased wait times at remaining clinics, which can push patients later into their pregnancies. This means fewer clinics can see them, as well as more complex procedures and increased costs.

“As abortion access continues to be eroded, people are finding ways to self-induce their abortions,” she said. “There’s no such thing as no abortion. There’s simply safe, and unsafe abortion, or legal and criminal abortion. And we’re at the point in which states are making abortion extremely inaccessible, then criminalizing people for attempting to get health care.”

A Climate of Hostility

The criminalization of pregnant women is a worrying trend that’s been gaining ground in states over the past few years, and reproductive-rights groups anticipate this trend will accelerate under Trump’s rule.

“In several states, women, particularly women of color, have been arrested for or on suspicion of self-inducing their abortions, or after a miscarriage,” Bracey Sherman said. “No one should feel unsafe or risk arrest simply for seeking an abortion. It’s clear that under a Trump administration, he will stop at nothing to inflict the cruelest punishment on people seeking abortions, just as he promised while running.”

While Trump retreated from his statement that women who get illegal abortions should be punished, his and Pence’s anti-abortion rhetoric puts American women at risk by exacerbating the stigma that already pervades reproductive healthcare and by setting a national tone that will embolden politicians who seek to strip away women’s rights.

“Having people at all levels of government who are anti-choice may give a lot of people in state legislatures even more permission to introduce incredibly extreme anti-choice bills,” said Hanson Long, of NARAL. “And if you assume that there are anti-choice justices at different levels, there may be a better chance that even the most extreme anti-choice bills could stay on the books.”

The permissiveness and extreme rhetoric is also likely to embolden abortion opponents, who may channel that acceptance of extremism into violence against women and providers.

“We do constant surveying and have seen that the harassment and threats towards clinics have increased in the past two years,” said Ellie Smeal, president of the Feminist Majority Foundation. “The extremism of the positions these politicians have put forth is fostering a climate of violence, as is the attitude that women don’t count.”

These are just a few in the ever-lengthening catalog of risks that the Trump-Pence administration threatens to inflict on women and their families, but members of the reproductive-rights community, as well as millions of women who did not vote for Trump and his regressive, incoherent vision of what America should be, refuse to go back.