To reduce the impact that Republican lawmakers can have on abortion, President Obama is using protection. With the stroke of a pen last week, he finalized a rule that will prohibit states from withholding federal funding from clinics just because they offer abortions.
But while advocates of women's health and reproductive rights celebrated Obama’s move, most still fear how abortion clinics will weather a Trump administration.
“We are deeply concerned that there will be nothing stopping the new Congress from disproving the new rule," said Audrey Sandusky, communications director for the National Family Planning and Reproductive Health Association. "They only need a simple majority to block it, and we believe this regulation is one that Congress will."
The rule takes effect Jan. 20, two days before President-elect Donald Trump officially takes office. It comes in the wake of legislation at the state and federal levels to defund clinics that provide abortions.
The federal government is legally barred from funding abortions, so congressional Republicans have instead repeatedly threatened to pull Title X funds from clinics that offer them. The problem, advocates say, is that those clinics are often women's main resource for birth control and cancer screenings. About a dozen Republican-dominated states successfully passed such laws -- though many of them are either on hold or have been ruled unconstitutional by courts.
Studies show that eliminating funding from abortion providers has a negative effect on women's health and leads to an increase in unplanned pregnancies. Currently, 32 states prohibit spending government funds on abortions.
“We’ve made really great progress in the past couple of years with a decline in teen pregnancies and unintended birth rates," said Sandusky. "When women have access to family planning education, communities thrive."
With Republicans in control of Congress, the White House and a historically large number of states come January, most expect an uptick in bills to cut funding for abortion clinics and to restrict women's access to the procedure. Already in Ohio, a 20-week abortion ban -- which has been struck down in a couple of states -- was signed into law this month. Trump has also vowed to appoint conservative U.S. Supreme Court justices who would overturn Roe v. Wade.
While no one in Congress has signaled whether they will keep Obama's new rule, House Speaker Paul Ryan said last month that "our position has not changed," in regards to Planned Parenthood funding.
Since the election, Planned Parenthood has received a surge in donations. But it only performs roughly a third of the abortions in the United States. That worries providers like Laura Churchill, deputy director of Greene County Public Health in upstate New York.
“We need Planned Parenthood, but we have to get this focus off just looking at them," she said. "We’re Title X recipients too, we just do the business and lay low."
Even clinics that don't offer abortions are already feeling a post-election pinch.
The Greene County Public Health Department, for example, is the region's major provider of women’s health services. Unlike Planned Parenthood, it hasn't received any donations since Trump's victory but has seen more demand for its services.
“We’ve had an increase in women wanting long-acting reversible contraceptives," said Churchill. "We’ve been able to accommodate them, but we’re running through them."
As women worry that a Trump presidency will make birth control harder to get or more expensive, many states have noted an increased demand for long-acting reversible contraceptives like IUDs.
Title X grantees vary widely from place to place. In some areas, Planned Parenthood affiliates are the main source of reproductive health services. In others, it’s a federally qualified health center or county health department.
Title X funds account for about 22 percent of financial support for women's health clinics. The rest comes from a mix of Medicaid money, private grants and out-of-pocket fees. If Congress decides to override Obama’s rule -- and subsequently cut Title X funding -- it would be devastating for many health-care providers.
"New York would try to supplement that money, but I don't how long they would be able to do so," said Churchill.
Even if Congress and the Trump administration keep the status quo, which is unlikely, Sandusky from the National Family Planning and Reproductive Health Association notes that the Title X program is “woefully underfunded.” It’s the sixth straight year that funding has remained flat.