Activists who oppose abortion doubted Donald Trump when he was a candidate because he had once described himself as "very pro-choice." A year into his presidency, however, they happily point to victories he has achieved for them.

He is reshaping the judiciary, and supporters say this will be a lasting achievement. He successfully nominated Justice Neil Gorsuch to the Supreme Court, and has put a record number of textualist conservative justices on the federal bench in his first year. These are judges likely to side with state restrictions on abortion.

Trump's restrictions on abortion are further reaching than those of his Republican predecessors. He reinstated the Reagan-era Mexico City Policy banning government aid to organizations involved in abortion, and expanded it to cover all healthcare funding, rather than those funds aimed only at family planning. He defunded the United Nations Population Fund, blaming it for forced abortions and sterilizations, despite the group's denial.

Trump and congressional Republicans also moved to let states cut off family planning funds from Planned Parenthood, reversing one of President Barack Obama's final actions in office. The administration on Friday provided guidance on how to do so through Medicaid.

Trump expanded exemptions on Obamacare's birth control mandate, shielding groups who oppose contraception for religious or moral reasons. His administration created an office within its health agency to exempt doctors and other healthcare providers from being forced to provide abortion services that violate their religious or moral beliefs. The Justice Department opened an investigation into Planned Parenthood to see whether it is selling fetal tissue for profit.

"With regard to life policy issues, Trump has remained absolutely true to his promises, and it’s an area of his administration that he should be really proud of," said Jeanne Mancini, President of March for Life. The annual march, now in its 45th year, marks the anniversary of Roe v. Wade, the Supreme Court decision that made abortion legal nationwide.

It's quite a list for Trump, who had difficulty articulating his position on abortion while running for office.

"I consider him the unlikely top strategist of the pro-life movement, without question," said Marjorie Dannenfelser, president of Susan B. Anthony List, an anti-abortion political action committee.

While anti-abortion groups that felt locked out of policymaking during the Obama administration are now jubilant, groups that support legal abortion worry that the administration's policies will have a lasting impact on the ability of women to choose abortion.

"We have been seeing attacks on access to safe and legal abortion really double down with this administration taking over and the majorities in Congress," said a spokeswoman from Planned Parenthood.

NARAL Pro-Choice America raises similar concerns, and sounded the alarm over judicial appointments. "Trump continues to nominate grossly unfit, anti-choice judicial nominees, many already waiting for their confirmation to a lifetime appointment on the bench," spokeswoman Kaylie Hanson Long said in a statement. "If confirmed, they’ll advance Trump’s backwards agenda for decades to come.”

How Trump won the loyalty of abortion foes

(AP Photo)

During primary season, Trump said Planned Parenthood did "very good work for millions of women," even as he added, "but we're not going to allow and we're not going to fund, as long as you have the abortion going on at Planned Parenthood."

In an interview, he seemed to say he believed women should be punished for having an abortion, though he later restated his comments to say that doctors who perform abortions should be punished. At times, he has said he believes the question of abortion rights should be turned to the states.

Trump has attributed his evolution on abortion rights to a friend who had chosen not to have an abortion, and to later getting to know that child. He sent a letter to anti-abortion leaders during the campaign, making a list of promises that included one that he would nominate Supreme Court justices who supported their efforts. He also pledged to sign a bill to ban abortion after 20 weeks' gestation.

Dannenfelser, who was put in charge of Trump's "pro-life coalition," was once a strong supporter of abortion rights, too, but converted to Catholicism and became devoted to the anti-abortion movement.

She also used to oppose Trump. During the primaries, she urged voters to support other Republicans, criticizing him as "unacceptable" and someone who "cannot be trusted." She slammed Trump for comments he made about women.

Speaking from SBA List's Capitol Hill townhome in early January, Dannenfelser raised Trump's language in the infamous "Access Hollywood" tape, in which he boasted about grabbing women between their legs without their consent.

"That video kind of forced us to do a gut check," she said. "And, frankly, in the end it was helpful to have a gut check because it forced [us to] focus on the only thing we were about. It was never going to be about his personality, it was never going to be about [Hillary] Clinton's personality, never going to be about his character or hers, it had to be about policy. I think, frankly, it was not a moment anybody savored, but it was a gut check that ended in a really important last sprint to the finish at a time when a lot of other people were falling off."

They came to the conclusion that too much was at stake for their movement if Clinton won the presidency. Not only had a seat on the Supreme Court been left vacant by the death of conservative Justice Antonin Scalia, but Clinton had allied herself with Planned Parenthood and vowed to repeal the Hyde Amendment, which prohibits federal funds from paying for most abortions.

Dannenfelser believes Clinton's position on abortion helped their cause, as did Clinton's work years ago to undermine women who accused her husband of sexual harassment and rape.

"Contrast is a gift in politics," Dannenfelser said. "Sometimes, you don’t have it ... In this, you had contrasts on our top two best-polling issues: Taxpayer funding of abortion and late-term abortion. It was a gift from her, borne of over-confidence in her ability to win that election."

Other activists were slower to embrace Trump. "We are very pleased with some of the developments, gratified with some policies, but I wouldn’t say that we are aligned with any party or any politician," said Catherine Glenn Foster, CEO of Americans United for Life, adding, "We exist for the purpose of protecting life, saving lives, and giving life a chance."

"We will work with any legislator, Republican or Democrat, independent, Green, libertarian, you name it," Foster continued in an interview, "Any person who is trying to protect life. We exist to protect every human life from conception until natural death."

Trump surrounded himself with anti-abortion loyalists

The loyalty from SBA List paid off. Trump's administration is peppered with people in leadership positions who were previously involved in the anti-abortion movement. Ahead of the Washington Examiner interview with Dannenfelser, Charmaine Yoest, assistant secretary of public affairs at the Department of Health and Human Services, was on her way out of SBA List's Capitol Hill rowhouse. Yoest is a former president of Americans United for Life, which lobbies for abortion restrictions.

Other appointments that the anti-abortion movement values include Nikki Haley, ambassador to the United Nations; Ben Carson, secretary of Housing and Urban Development; Valerie Huber, a former abstinence advocate who is now chief of staff for the office of the assistance secretary of health at HHS; and Scott Lloyd, director of HHS' Office of Refugee Resettlement, who has prevented teens who are in the country illegally and in federal custody from getting abortions.

Yoest did not respond to requests to interview administration officials for this story.

Abortion rights groups expressed deep concerns about these ties between the administration and the anti-abortion movement. They have cited other officials who work at HHS, such as Mary Vigil, Cathy Deeds, and Shannon Royce, who were formerly involved with opposing certain forms of birth control or with opposing abortion.

"One of the things we have been seeing from the administration that is really concerning is the appointment of really extreme anti-choice members of the administration," said a spokeswoman from Planned Parenthood.

For activists opposed to abortion, one of the most important selections that helped put them at ease was Trump's pick of Mike Pence as his running mate. Pence, a longtime opponent of abortion, also led a campaign to "defund Planned Parenthood" when he was in Congress.

"I think when he asked Pence, it calmed many fears in terms of him being serious about this," March for Life's Mancini said.

Pence and counselor to the president Kellyanne Conway spoke at the March for Life last year, becoming the highest-ranking administration figures ever to do so.

"From a personal standpoint, one of our favorite victories was unprecedented support for the March for Life from the White House. ... Symbolically, it speaks volumes for where they stand on the right-to-life issue," Mancini said.

This year, Trump addressed the march live by satellite, and House Speaker Paul Ryan headlined the event in person.

As the March for Life neared, SBA List said it had another specific request of the administration: Enforcement of Obamacare regulations that say private health plans subsidized by the federal government cannot cover abortions.

Activists look to Congress

Anti-abortion groups point to Congress as a reason Trump has been unable to keep all of his promises to their cause, saying he had done nearly all he could at the administration level.

"If I have a gripe right now, it's with the Senate," Mancini said.

Anti-abortion groups say they are taking an incremental approach to restricting abortion. They are urging the Senate to bring the Pain-Capable Unborn Child Protection Act to the floor near the March for Life. The bill would ban abortions after 20 weeks' gestation. Its supporters know it will not get the 60 votes it needs to pass, but they hope to get candidates' votes on the record ahead of the midterm elections. Trump has vowed to sign the bill.

Just over 1 percent of abortions occur after the 20th week of a pregnancy, and abortion rights groups oppose its passage.

"There are many reasons why a woman might need abortion care after 20 weeks, and she should be able to make that decision with those she trusts," Vicki Saporta, president and CEO of the National Abortion Federation, said in a statement. "Instead, this bill would deny abortion care to a woman even if her healthcare provider determined that an abortion was her best medical option. It would also force a woman to wait until severe medical conditions became life-threatening before she could obtain the abortion care she needed."

Anti-abortion groups have also stayed deeply involved in Republican efforts to repeal and replace Obamacare, and would support a bill that cuts federal family planning funds from medical facilities that provide abortions. They would also expect to see a GOP healthcare bill that bans people from using federal subsidies to buy medical coverage that pays for abortions.

Planned Parenthood fought all of these efforts in 2017, and several bills were defeated. The group mobilized more than 350,000 calls to Congress and held more than 2,700 events across the country. A Planned Parenthood spokeswoman said the group was pleased that the Senate was more secure in 2018 for abortion rights, after Republicans lost a seat in Alabama to someone who supports their cause.

She says policies aimed at restricting access to birth control and to abortion have faced a public backlash. The group considers the Women's March, which resulted in 500,000 protesters in Washington, D.C., and in droves around the world, as a sign that the public supports abortion rights, and the second annual march took place in Las Vegas on Jan. 21.

"While we saw a number of anti-abortion bills pop up in Congress, we really saw a tremendous amount of backlash to those efforts," she said, adding that people are "revolting in numbers and volume in ways we have never seen before." The group has added 1.5 million financial supporters, 200,000 of whom are new volunteers.

Each side of the abortion debate insists that public opinion has turned overwhelmingly in their favor, but public opinion surveys show a divide. Fewer people support abortions later in a pregnancy, but more people support abortions in other circumstances, such as when a pregnancy is the result of a rape, or when a pregnancy endangers a woman's life.

A 2017 Pew Research Center survey found that a quarter of adults believe abortion should be allowed in all cases, while 16 percent believe it should be illegal in all cases. The largest plurality, 33 percent, say that abortion should be legal in most cases, while 24 percent say it should be illegal in most cases.

A Gallup poll found that while slightly more people identify as "pro-choice" than "pro-life," 49 percent compared to 46 percent, the totals have shifted since 1995, when 56 percent of people identified as "pro-choice" and 33 percent identified as "pro-life."

Today's abortion debate is occurring against a historic backdrop of the lowest teen birth rates on record, and abortion is at its lowest rate since the passage of Roe v. Wade. Abortions in America peaked in 1990, at 1.61 million, but by 2011 had dropped to a million, according to the Guttmacher Institute, which supports abortion rights and studies and tracks reproductive policy.

Anti-abortion groups say that improved technology, allowing pregnant women to see their sonograms, has contributed to this. Abortion rights supporters instead credit easier access to contraception.

Ultimately, anti-abortion groups say they know they must make inroads with Congress to push their cause futher.

"In terms of any presidential priority or any legislative action, there are a lot of factors that go into it," Foster said. "No man is an island and no person in the U.S. is king — no one is acting unilaterally."