Neil Gorsuch (pictured), US president Donald Trump’s nominee for the vacancy on the country’s Supreme Court, is a consistently conservative judge who would enter the court at a critical moment for reproductive rights.

Though Gorsuch, a federal judge on the 10th US Circuit Court of Appeals, has never ruled on an abortion rights case, his record shows him to be hostile to women’s healthcare and willing to give broad leeway to institutions that want to discriminate against them.

Women will be affected by every decision that comes out of the next iteration of the Supreme Court, of course, whether the cases deal with voting rights, labour issues, immigrant rights, civil liberties, criminal justice or any other area of law. Because women make less money than men, shoulder the bulk of home and family responsibilities, and have less access to traditional spheres of power, they are in fact particularly dependent on legal protections, and they will likely be disproportionately impacted by any harm that comes from the court’s decisions.

Nowhere is that clearer than in the field of public health. Anti-abortion advocates believe Trump and his pick will to overturn the 1973 landmark Supreme Court decision in Roe v. Wade, a strong, if imperfect, safeguard of abortion rights. A from the Center for Reproductive Rights in New York found that 22 states would be likely to roll back abortion rights immediately if Roe were overturned.

Some of these states already have anti-abortion laws on the books that predate Roe (that means they’re currently unenforceable but would become effective if Roe fell) or laws passed specifically to go into effect in the event that Roe gets axed.

Still, overturning Roe would probably require a state legislature willing to pass a blatantly unconstitutional ban, years of court battles, and five justices willing to undo clear Supreme Court precedent on an issue that hasn’t seen a broad shift in public opinion. More Americans than ever before.

That means there are other, less drastic battles for women’s healthcare access that will probably come up first. The anti-abortion set has its eyes on Roe, but conservative state legislatures are reliable incubators of laws that incrementally roll back rights and access to reproductive healthcare.

These laws make the Supreme Court docket a whack-a-mole of restrictions that seek to make it more inconvenient, expensive and degrading to get a constitutionally protected healthcare procedure. Gorsuch may end up ruling on laws that ban abortions after a certain pre-viability gestation threshold, force abortion providers to get admitting privileges at nearby hospitals, or require abortion clinics to abide by . Several states already have percolating through the courts.

“More Americans currently support Roe versus Wade than ever before”

Justice Stephen Breyer’s June 2016 opinion in Whole Woman’s Health v. Hellerstedt, a Supreme Court decision that struck down two Texas regulations on abortion providers, made a clear statement that these laws restricted women’s access to abortion care , as anti-abortion advocates claimed they did. Without Supreme Court justice Antonin Scalia, who died last February, the decision came down with a 5–3 split.

It’s notable that another anti-abortion vote wouldn’t have changed the outcome of this case, which many hailed as the most significant abortion case set before the Supreme Court in decades. This is reason to hope for evidence-based decisions on women’s healthcare in the future court, no matter how Gorsuch ends up acting on abortion cases.

Gorsuch is also likely to face cases that put contraceptive access and insurance coverage on the chopping block. Whether or not Republicans follow through on their promise to repeal the Affordable Care Act (ACA), they are likely to continue trying to make birth control and abortion care more expensive and difficult to get. Just last week, they passed a House of Representatives bill that would from covering abortion in their plans.

Gorsuch came down on the side of religious beliefs in the notorious case of , in which the craft chain’s owners won the right to deny their employees contraception coverage despite the ACA’s mandate. In the 10th Circuit’s ruling, Gorsuch attributed to the company the capacity for spiritual reverie. The ACA forced Hobby Lobby to “violate their religious faith” by covering birth control, which “their religion teaches to be gravely wrong”. Gorsuch described birth control drugs and devices as having the effect of “destroying a fertilized human egg” – a claim that is , even in most cases of .

Dissenting view

Gorsuch also joined a dissenting opinion when , another challenge to the ACA’s contraceptive mandate, came before the 10th Circuit. The dissent called the mandate a burden to the plaintiffs’ free exercise of religion. In a 1996 brief in a case about physician-assisted suicide, Gorsuch wrote that requiring public hospitals to provide abortions was an instance of “the courts [feeling] free to override the conscience of health care providers”.

In other words, Gorsuch believes that doctors, corporations, and individuals should be able to discriminate against women, preventing them from accessing necessary healthcare, on account of any personal whim they claim to the court.

More recently, Gorsuch , and likely reverse, a 10th Circuit panel decision blocking , a charity that provides free or subsidised family planning services to people on low incomes. The movement to defund Planned Parenthood by preventing patients from using Medicaid dollars on non-abortion services there has been based on false claims of illegal fetal tissue sales. Gorsuch gave credence to Utah governor Gary Herbert’s claims of such trafficking, which he proffered without any supporting evidence, instead of dismissing them as a political manoeuvre, as a majority of his fellow justices did.

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“Don’t get pregnant at the moment.” That was a Brazilian medical worker’s Ěýto women late last year as the country struggled to contain the ongoing Zika virus epidemic, which has spread throughout South and Central America, Mexico and the Caribbean.

The dengue fever­–like disease only causes symptoms in one out of every five cases, but it is thought to cause microcephaly – a rare birth defect marked by an abnormally small head and stunted brain development – in fetuses of infected mothers.

Even health officials in Jamaica, which hasn’t yet seen its first case of Zika but expects the virus to arrive soon, have recommended that women there postpone pregnancy plans for .

But pregnancy isn’t always a matter of planning. In 2002, only 51 per cent of US pregnancies were intended; the Department of Health and Human Services has set a goal to raise that rate to a mere .

That’s in a country where, for all the recent political efforts to stymie access to family planning services, contraception is widely accessible and affordable when compared with many of the nations where Zika is taking root.

So it’s likely that women will continue to get pregnant in the nations that are advising against it, even as the Zika virus spreads.

First case

The rate of children born with microcephaly has increased 20-fold in Brazil since the first Zika case was reported last year, and parents are protesting that the state has given them , or none at all. As many as Brazilians may have contracted the virus. What are pregnant women infected with Zika supposed to do?

Though as many as obtain underground abortions in Brazil every year, the procedure is currently illegal except in cases of rape, threat to the mother’s life, or fetal brain deformity. Late last year, women a law proposed by politician Eduardo Cunha, who seeks to impose further restrictions on reproductive health care.

A sonogram could detect microcephaly in a Zika-infected fetus, and that may qualify as a brain defect severe enough to warrant a legal abortion in Brazil. But in a country that imprisons women for getting illegal abortions and limits medical conversations about the practice, an abortion provider might be nearly impossible to find in time.

Some of the other countries currently battling a Zika epidemic make it even harder for women to terminate their pregnancies. El Salvador, for example, has some of the world’s most punishing anti-abortion laws, sentencing women and their doctors to for attempting an abortion.

There are no exceptions to the abortion ban; even women who have miscarriages, late-term stillbirths or premature births are often reported to the police for abortion investigations. An estimated 11 per cent of Salvadorean women who obtain an illegal abortion die from the procedure.

Abortion bans

Haiti, Honduras and Suriname – have reported Zika infections – also ban abortion , as does the Dominican Republic and Nicaragua, which will likely see Zika cases soon due to their proximity to Zika-afflicted nations. Most of the other Latin American countries where Zika has spread impose restrictions on abortion, too.

Science blogger Mike the Mad Biologist has that Zika may become for certain Central and South American nations what rubella was for the US in the mid-20th century: a birth defect–causing disease that becomes an exception to social and political barriers to abortion.

Even the staunchest anti-choice crusaders found it hard to stomach the thought of forcing a woman to carry a fetus with rubella to term, as it could have permanent, life-altering conditions. Thus, in the 1950s and 1960s, rubella became a from abortion bans and doctors’ policies against the procedure.

Though its affected population was narrow, it gave the public an undeniably sympathetic case study for abortion, bringing a stigmatised act into full view and providing a stepping stone for future discussions around reproductive rights.

Travel advice

The US Centers for Disease Control and Prevention has that pregnant women in the US postpone any travel to affected regions, and it doctors to ask all pregnant patients about their travel histories.

It’s possible that the CDC came about as close as it could to suggesting infected women consider abortion: “In a pregnant woman with laboratory evidence of Zika virus in serum or amniotic fluid, serial ultrasounds should be considered to monitor fetal anatomy and growth every 3–4 weeks. Referral to a maternal-fetal medicine or infectious disease specialist with expertise in pregnancy management is recommended.”

When Latin American countries’ urgings against pregnancy prove futile, their health officials may find similarly coded ways to address the likely upsurge in birth defects. But without a parallel conversation on policy, unsafe and illegal abortions may prove as great a danger to Zika-infected women as the virus itself.

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