'We knew': Abortion rights advocates who predicted the Alabama ruling warn about more restrictions

The Alabama Supreme Court ruling last week that embryos are people, imperiling in vitro fertilization, shocked many Americans. But the decision was vindicating for abortion rights activists who have warned for years that the fall of Roe v. Wade would put other forms of reproductive health care on the chopping block.

“This is something that we knew was coming,” Mini Timmaraju, the president of Reproductive Freedom for All, told NBC News, adding, “For the folks who were watching closely, this was not a shock.”

NBC News spoke to several leaders in the abortion rights movement who said they view the Alabama decision as the latest target in the yearslong history of anti-abortion advocacy that won't end with IVF. They also said they hoped the ruling would galvanize support for protecting access to abortion and other reproductive rights.

'Never just about abortion'

Since the U.S. Supreme Court announced in 2021 that it would take up a Mississippi law banning abortions after 15 weeks, abortion rights supporters began to prepare for the possibility of Roe's downfall. And once the high court struck down the landmark abortion ruling in its 2022 Dobbs v. Jackson Women's Health Organization decision, those same activists began to prepare for further threats to reproductive health care.

“With the Dobbs decision, we knew that the opposition wasn’t going to stop at that,” Candace Gibson, the director of state policy at the Guttmacher Institute, a pro-abortion rights think tank, said in an interview. “We always have known that the anti-abortion movement, the opposition, will try to find any avenue to … restrict the right of bodily autonomy.”

Another area of reproductive care that abortion rights groups say anti-abortion politicians are eyeing is contraception, both regular contraception and emergency contraceptive care.

“We’ve been saying that it was never just about abortion, it’s about, you know, control and … who gets to decide whose personal medical decisions,” said Sara Spain, the national press secretary for EMILY’s List, a group that seeks to support Democratic, pro-abortion rights women running for office.

She added, “It’s going to be IVF. It’s going to be birth control, and we’re going to continue to see this.”

Advocates also warn that conservative groups are using the same strategies that have proved successful in restricting abortion to target LGBTQ rights.

“They’re using the same playbook now to restrict the total autonomy and rights of LGBTQ people, right, especially young, trans people,” Gibson said, adding, “That is all part of this, like, larger picture to really, you know, restrict the bodily autonomy of people in this country.”

The decadeslong links between anti-abortion activism and IVF

One major signal to abortion rights activists who predicted restrictions on IVF was the long-standing push for policies that emphasize the belief of some conservatives that life begins at conception.

“This idea of fetal personhood has been a long-term goal in the anti-abortion movement,” Gibson said.

In the 1970s, in the wake of the Supreme Court’s Roe decision and as research into IVF was advancing, abortion opponents mounted a campaign to restrict research using embryos, despite recommendations from medical and ethics panels that some research should be permitted.

"To this day — we in this country — we do not allow the federal funding of research on human embryos if any embryo will be destroyed," said Margaret Marsh, a professor at Rutgers University and co-author of "The Pursuit of Parenthood: Reproductive Technology From Test-Tube Babies to Uterus Transplants."

"They had a fairly powerful impact on the way in which IVF developed in this country," she said.

So-called fetal personhood bills have been introduced in at least 14 states in the current legislative session, according to data from the Center for Reproductive Rights and the Guttmacher Institute.

Katie Daniel, state policy director for the anti-abortion group Susan B. Anthony Pro-Life America, applauded the Alabama decision and insisted that the group's position isn't anti-IVF, but rather that "fertility treatments need not carelessly or intentionally destroy the new life created."

But the vast majority of IVF procedures require the creation of multiple embryos, according to Barbara Collura, the president and CEO of RESOLVE: The National Infertility Association.

"If doctors and embryologists are forced to limit the number of embryos created, they are not giving their patient the best chance at achieving pregnancy. And this will no doubt increase the financial, physical and emotional burden of the patient," Collura said in a statement to NBC News.

A surge in abortion rights activism

Abortion rights groups saw a surge in support and activism in the wake of the Dobbs decision, and following the Alabama Supreme Court’s ruling last week, they expect support to rise again, particularly among those who have sought and used fertility treatments, not just among people on the left.

“Folks are fired up. Folks are really motivated and they’re terrified. And it’s not just women; it’s men and women. It’s so many people who have used, you know, reproductive technologies to build their families,” Timmaraju said, adding, “So, I do think it’s going to be a mobilizing moment.”

Infertility is an issue that bridges ideological gaps: Former Vice President Mike Pence and his wife Karen Pence underwent IVF and former South Carolina Gov. Nikki Haley, who is running for president, used fertility treatments (though not IVF).

“One in 6 people face infertility, and so making sure that we’re speaking about these issues that impact voters, that impact constituents,” Spain said, adding, “Really speaking up about these cases and reaching … a bipartisan audience [is important] because we know that that is who this impacts, it’s not just Democrats.”