Read more stories commemorating the 42nd anniversary of Roe v. Wade here.

Over the past few years, the three abortion clinics I run across the South have been struggling. Sometimes the struggle is about waiting to see whether a judge or a court will allow our doors to stay open, as states pass laws—such as those requiring doctors to get hospital admitting privileges—specifically to shut us down. Sometimes it is financial, as states approve legislation designed to bankrupt us, often requiring unnecessary supplies or staff, building renovations, and hours and hours of useless paperwork.

Roe v. Wade turns 42 this year. How did this we end up in this mess?

Last Friday, as I read an article in the Clarion Ledger about one such struggling facility I oversee—the Jackson Women’s Health Organization, the last clinic of its kind in Mississippi—a quote jumped out at me that may go a long way toward answering this question. Marjorie Dannenfelser, president of the anti-abortion lobbying group the Susan B. Anthony List, had made a statement the day before referring to the 2015 congressional session. “Now begins the hard work of getting our return on investment. … We’re off to an encouraging start,” Dannenfelser had told an assembled news conference.

Dannenfelser’s mention of “investment” had articulated what I’d known, but had been too distracted by the constant barrage of new rules and regulations to acknowledge: The anti-abortionists have been planning for the future, while we have been stuck responding to their maneuvers in the present.

In the decades since Roe, anti-choicers have tried many tactics, each designed to shut off access one clinic at a time. In the 1980s, protesters traveled by the hundreds to different facilities across the country, blocking entrances and intimidating people seeking abortions. But the clinic operators defiantly waited them out, finding creative ways to get patients in the doors. The clinics made appointments at odd times of the day, picked up patients from secret meeting points to “smuggle” them in, and trained clinic escorts to walk patients safely through the throngs of protesters.

Then, the 1990s brought a rash of violence against clinic workers. The 1993 murder of Dr. David Gunn in Pensacola, Florida, inspired me to volunteer at a local clinic as an escort, and two years later I was hired at the same clinic as the full-time office manager. One could almost feel the great wave of alarm spreading across the country’s abortion providers. But another thing also spread among us: determination. Yes, some doctors and staff quit working out of fear. What I remember most, though, were the heels that dug in and the resolves that stiffened. And the anti-choicers, I am willing to bet, saw that too: The way to shutting down clinics was clearly not through violence. Many of us who see our patients every day were—and are—able to overcome our concern for ourselves to protect their access to abortion. Besides, the murders made the supposedly “pro-life” side look really, really bad.

The leaders of the anti-choice movement, I believe, realized they would have to lie low for a while, regroup, and re-strategize. Although plenty of individuals still harass patients at clinics, they focused their fight in far-removed high-rise office buildings and subdued state courtrooms. They honed in on and mastered the deceptive rhetoric of caring about “women’s safety,” rebranding themselves and trying to distance the movement from the previous decades of villainizing and shaming people who sought abortions. And it worked.

When I first began running a clinic, in 1999, in Birmingham, Alabama, we had been subject to some legal wranglings since Roe: The state had passed a mandatory parental notification law in the late ’80s, as well as one banning abortion past 24 weeks. But for most women in Alabama, getting the money together for the procedure was the main obstacle to obtaining an abortion. We made same-day appointments. We were able to focus intensely on providing a safe and comfortable environment for our patients. They would receive actual input from a trained counselor, not pages of propaganda dictated by the state’s anti-choice legislators designed only to inflict guilt and fear.

In just the 16 years since, as study after study proves abortion to be much safer than giving birth, the anti-abortion laws have multiplied. Alabama now has on its books, to name a few: state-mandated and -scripted counseling, a 48-hour waiting period, a law requiring all clinics to adhere to surgical ambulatory center requirements, and finally a law that allows a court to appoint a lawyer for the zygote, embryo, or fetus of any minor asking to receive an abortion without parental consent.

I predict it won’t stop there. Those trying to prevent access to reproductive health care are committed to the cause of dictating the bodies and decisions of others through increasingly innovative means. In a recent article written about Dannenfelser in the New Yorker, she described the vigor she feels:

“When I was really strongly pro-choice, I didn’t go to bed thinking, Oh, my gosh, women can’t be free unless they have abortion; what am I going to do tomorrow?” she says. “Now I’m going to sleep thinking, Oh, my gosh, thirty-eight hundred children are going to die tomorrow. What am I going to do to actually save some of them?” She calls this phenomenon “the intensity gap”—a simple way of understanding why her side hasn’t lost this war, and may yet win it.

Many pro-choice advocates do experience the kind of visceral fear on others’ behalf that Dannenfelser felt she’d lacked. And many of them are those on the front lines; the clinics that provide abortions, and the people who need them, are the casualties of this war. We are mired in the laws that Republicans and anti-choicers so carefully crafted and passed, their “investment” beginning to pay off. Meanwhile, those supposedly on our own side—especially majority white, upper-middle-class politicians—have too frequently taken the “right” imbued by Roe for granted. Each time a law restricting abortion was allowed to pass, far too few elected leaders on the left kicked and screamed their way across every public medium they could find. Our officials, trusted to protect abortion access, have plodded around our capitol and our country tepidly arguing on our behalf. How do we imbue passion and dedication to people so far removed from the real-world effects of these laws?

I’m convinced now that in some situations, things must get worse before they get better. I’m convinced that things will get worse for abortion access in this country. Then, perhaps, these same middle-class white people may be affected by all these laws. And then, maybe then, the wide-ranging hard work, dedication and intensity needed to save abortion access in this country will begin.