Since Donald Trump's extraordinary election victory last week, I've seen Americans react in a range of ways: celebration, street protests and crying on public transport. But one less visible reaction has been the quiet, concerned calls to health clinics by women looking to obtain IUDs.
Intrauterine devices are a long-lasting form of birth control that, according to a number of reports, many women are considering due to the election result – one that points to an escalation of the United States' never-ending, back-and-forth war over reproductive rights and services.
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It's ironic that a thrice-married sexual braggart and former Manhattan playboy, who stands accused of multiple acts of sexual misconduct, could become a president who heralds a rise in social conservatism at a national level and curtailing of these rights and services – but it's hardly the strangest thing to happen this year.
Trump does not appear to be devoutly religious or a staunch ideological opponent of abortion or birth control. He says he's a Christian, but admitted last year he never asked for forgiveness, while greed and pride seem less sins to him than personal credos. In a 1999 interview he described himself as "pro-choice in every respect".
![Donald Trump and Mike Pence have made their views on abortion very clear.](/web/20170129175905im_/http://www.smh.com.au/content/dam/images/g/s/l/q/w/e/image.related.articleLeadwide.620x349.gsqpjx.png/1479299205042.jpg)
But what he is, is a dealmaker. His stance has hardened over the years as he warmed to a presidential run and during the election campaign he pledged loyalty to the pro-life, anti-abortion movement, ensuring a reliable block of Republican voters who hold these convictions dear would turn out for him.
Most significantly, he promised to appoint pro-life judges to the US Supreme Court, who would be there not just for his term but for potentially decades to come. He also pledged to defund Planned Parenthood – a women's healthcare provider that offers abortions, among other services – and to try to outlaw late-term abortions. He chose one of the country's most determinedly anti-abortion Republican governors, Mike Pence, to be his running mate, a man who promised to confine the landmark Roe v Wade decision on abortion to the "ash-heap of history".
Since Trump's victory, observers have been desperately trying to read the swirling tea leaves to work out which of his many extraordinary and sometimes contradictory policies would come to pass, and which ones were just campaign talk (which, like locker-room talk, should apparently be ignored in Trump's America).
But on appointing pro-life judges who would overturn Roe, he has been resolute, and there is reason to think he'll remain that way. White evangelical voters came through for him on election day, according to exit polls, and now he and Pence will come through for them.
"Once mocked for his 'New York values', Trump is expected to implement arguably the most aggressive social conservative agenda in recent memory," wrote my former colleague Jonathan Swan at US publication The Hill last week. "Not even George W. Bush, a favourite of evangelicals, entered office with an ironclad promise to defund Planned Parenthood."
This agenda comes coupled with a great deal of power – or what the pro-choice group NARAL's spokesman James Owens described as "the perfect storm" for rolling back reproductive rights and services.
The Republican Party controls Congress and the Senate, plus there is a vacancy on the US Supreme Court, thanks to Republican senators' unprecedented refusal since March to hold hearings for Barack Obama's chosen nominee.
Overturning Roe would not be simple and may even prove impossible even in two terms of a Trump-Pence White House. Julie Rikelman, litigation director at the Centre for Reproductive Rights, told Vox this week that she did not think it was likely, even with a new pro-life judge, due to the weight given to precedent, the difficulty in getting a relevant case before the Supreme Court and the fact that one of the four current conservative judges, Anthony Kennedy, sided with the liberals on a recent abortion-related decision.
But in time, if one or more of the elderly liberal judges – such as 83-year-old Ruth Bader Ginsburg – dies or retires, the court would be further tipped in an anti-abortion direction. And there are other legislative moves the administration can pursue to try to curb access to abortion in the meantime, as state-based reforms by Republican legislators in the Pence mould continue to grow.
On birth control it's even complex: no one is threatening to outlaw it and several experts have warned against the current panic some women are experiencing. But there are real questions over access and affordability. Trump's pledge to repeal "Obamacare" or major parts of it is the main source of angst. Losing their health insurance altogether, or rescinding the current rule of providing birth control without a co-payment, would make accessing it far more difficult for millions of poorer women, especially more costly methods like IUDs.
Most of the actions a Trump administration could take to restrict these rights and services, if taken at all, can't happen with the stroke of a pen, they would take time and many would face challenges – in Congress, in the courts and from sections of the American public.
But the President-elect's intent – if not his personal conviction – on the issue of abortion is clear. And some women, worrying their rights and healthcare have been dealt away in his short rise to power, are considering whatever contingency plans they can while they wait to see what unfolds.
Josephine Tovey is a Fairfax Media journalist in New York.
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