By the evening of 6 November, despite protestations of mass voter fraud, it was becoming clear that Donald Trump’s time at the White House would end. January 2021 will bring to a close one of the harshest administrations on reproductive rights in recent history; what has been less clear in the weeks since the election is what exactly the Biden administration will do to defend and extend these rights.

As an issue, abortion has long motivated the bases of both parties, and the stance of a candidate can turn out large numbers of single-issue voters. Despite the ongoing assault on reproductive rights, however, the Democratic Party has been much less vocal on the topic recently, barely giving it a mention at their National Convention in August. The death of Supreme Justice Ruth Bader Ginsburg and the nomination of Amy Coney Barrett looked set to place the issue front and centre six weeks out from the election, but by polling day it had faded back into the background.

What went unmentioned in the state-by-state coverage of the race was that six of those fifty-two states have only one abortion clinic each. Any focus on voting patterns at county level meant viewers were almost definitely looking at an area without a clinic: only 10% of counties in the US have one. And the relative win for reproductive rights at the presidential level was not mirrored in the Senate, which the Republicans retained as the number of anti-choice women representatives tripled.

The bedrock of abortion access in the United States rests on Roe v Wade, a landmark 1973 Supreme Court ruling which decided that a state law prohibiting abortions was unconstitutional, effectively legalising abortion across the country. However, in the decades since, anti-choice legislators in almost all states have constructed a lattice of abortion law. The regulations range from long waiting periods and mandatory counselling before an abortion to banning the use of public funding to provide abortions for those on Medicaid. These laws don’t stop abortion, but they create barriers to access that most profoundly affect people who are already at a socioeconomic disadvantage.

Many hope that in Joe Biden, an incumbent who’s promised to codify the 1973 ruling to make it ‘the law of the land’, the reproductive rights movement has gained a powerful ally. (That’s despite his inconsistent history on the issue, including his vote to allow states to overturn Roe v Wade in 1982.) But Roe v Wade is the floor, not the ceiling. Kamala Harris, with her strong pro-choice record, may push Biden further still, but most battles will still need to be fought at state level – and those on the frontlines are facing a fight both inside and outside the clinic.

Covid-19 has required clinic staff to quickly adjust to new health and safety measures while facing worsening working conditions. Many clinics have relied on workers’ deep belief in their mission to push them to continue, despite mass burnout and a lack of parental leave benefits or support. Large numbers of staff have been made redundant, too, while senior managers’ salaries have gone untouched.

Ongoing complaints of systemic racism coupled with the sacking of 28% of staff two months into the pandemic prompted workers at Planned Parenthood Greater New York to successfully call for the immediate removal of their CEO. Their victory can be attributed, in part, to the strength of their workplace organising and their unanimous vote to unionise ten months prior. But organising strength is uncommon in their industry: one survey from ReproJobs—an organisation which campaigns for positive workplaces in the reproductive rights sector—found that only 12% of those surveyed had a recognised union in their workplace.

This figure is not particularly surprising, since only about 11% of American workers overall are in unions – but the hostility outwardly progressive nonprofits show towards unionisation is. In most cases, examples of union busting have come to light at Planned Parenthood affiliates due to the high profile of the organisation. Planned Parenthood has an annual revenue of $1.3 billion, much of which comes from federal funding and donations, and employs over 60,000 people; senior management can expect to earn in the mid six figures. But to date, only five of Planned Parenthood’s 56 affiliates are unionised – leaving workers and the communities they serve at risk.

In Texas, known for its draconian laws on reproductive rights, officials effectively outlawed abortion in the early months of the pandemic by deeming it a non-essential medical procedure. Rather than work to ensure access to other vital reproductive health services, the managers of Planned Parenthood in Austin took that moment as an opportunity to undermine attempts at workplace organising: in April, the day before its family planning clinic was finally due to start seeing clients online, the clinic’s entire junior staff was laid off. The decision was framed as a business necessity in light of Covid-19, but former workers believe the lay-offs were targeted at those attempting to organise.

‘There are so many questions that are left unanswered,’ one former worker told Tribune. ‘So many questions that it makes Covid-19 seem like a perfect scapegoat for an ulterior agenda. Questions that we asked while being laid off and after the fact via email were rebuffed.’ In hope of getting some answers, the National Labor Relations Board in Texas is currently investigating the case.

Planned Parenthood Austin had retained 90% of their public funding – far more than any other centre in Texas. The funding helps the clinic provide vital services at an accessible cost: for example, an IUD that could cost over $1,000 elsewhere costs from $15 to nothing at that centre. But the consequence of the junior staff layoffs is that there are now simply not enough workers to ensure that those most in need in the city can access reproductive healthcare.

‘Before Covid we were seeing sixty people a day,’ another staff member said over Zoom. ‘We then got to a point where we were seeing fifteen a day. And I came into work and couldn’t stop crying as I cancelled all the appointments, knowing that they just wouldn’t be seen elsewhere.’

Fighting these battles can be devastating for workers, whose firm belief in reproductive rights often leads them to accept subpar working conditions, and to avoid criticism of their workplaces: the relentless assault on reproductive health organisations from the Right means that any labour-based critiques can then be weaponised and used in bad faith. But as an anonymous representative from ReproJobs told Tribune via email, addressing these issues is crucial to bringing about a much-needed improvement to workers’ lives, and in that, to enabling them to better advocate for those they see in their daily work.

‘If we don’t do the deep work and hold ourselves accountable to a higher standard,’ the representative asks, ‘how can we expect the elected officials we’re trying to push to do so as well? If we don’t humble and challenge ourselves, we’ll never have the ability to push our legislators towards a better vision.’

If there are any gains to be made for reproductive rights in the coming years, they will begin with the workers in clinics all across the United States – not with the politicians on Capitol Hill.