Amy Hagstrom Miller of Whole Women's Health had been having a banner year. Her organization, based in Charlottesville, Va., operates several abortion clinics around the country and brought a legal challenge that led the Supreme Court to issue a landmark ruling this past summer.

The court struck down abortion restrictions in Texas, setting a precedent that abortion rights groups believe could help turn back a wave of restrictions passed by legislatures across the country in recent years.

But now that Donald Trump is the president-elect? "I'm devastated," Miller says. "I feel stunned. I'm numb."

Trump's election could have a profound impact on access to abortion. He has said he'll nominate Supreme Court justices who would be likely to overturn Roe v. Wade, the 1973 ruling that legalized the procedure. And he's set to take office with one opening on the court, since Republican senators have refused to consider President Obama's nominee to fill the vacancy created after Justice Antonin Scalia died earlier this year.

Miller worries that Trump could have several vacancies to fill, all due to departures from the moderate to liberal wing of the court. Justice Ruth Bader Ginsburg is 83; Anthony Kennedy is 80; and Stephen Breyer is 78. Replacing them could put a conservative stamp on abortion law for decades to come.

In a statement, Nancy Northup, president of the advocacy group Center for Reproductive Rights, said, "Our country now stands perilously close to a return to the dark days when women were forced to put their own lives at risk to get safe and legal abortion care."

Still, in the short term, Miller says this year's high court ruling in her case will continue to have a ripple effect. It says states must consider whether limitations on clinics that provide abortion offer any benefit to women's health. A string of court rulings have already cited the precedent in striking down various restrictions.

"We're poised to win back access for women in a state-by-state level in multiple states because of the strength of the decision we got," she says. "And Trump doesn't get to change that."

But with the GOP sweep of Congress and the White House, abortion opponents are emboldened. "The Democrats overreached, and this was a rejection of an extreme agenda," says Clarke Forsythe, the acting president of Americans United for Life.

Americans United for Life and other abortion opponents have a long wish list, including ending Obamacare's coverage of contraception; banning abortion after 20 weeks of pregnancy; and passing a permanent ban on the use of federal funds to pay for abortion, except in cases of rape, incest, or when the life of the mother is at risk. That ban, called the Hyde Amendment, is a four-decade-old compromise between abortion rights groups and opponents, and it generally applies to abortions through Medicaid. Hillary Clinton had campaigned on overturning the ban.

Forsythe and others say they'll also work with supporters in Congress to end $500 million in annual federal funding to Planned Parenthood. "Essential gynecological care for poor women can be addressed by many more community health centers, and state and local government," he says.

Reproductive health experts dispute that. After Texas ended funding for Planned Parenthood in 2013, research found that lower-income women had trouble accessing contraception, and that led to a substantial rise in births.

Forsythe says with the sizeable Democratic bloc in the Senate, none of this will happen overnight.

"The road ahead is not going to be easy," he says, "and I think we have to be realistic about what can be achieved."

Still, he says the GOP election sweep presents abortion opponents with "historic opportunities."

Trump is an unlikely champion for abortion opponents, many of whom base their views on morality and religion. In the past, he's described himself as "pro-choice in every respect," and during the campaign he made conflicting statements on the issue. But he will face pressure from a lobbying force that's newly energized by his election.

Copyright 2016 NPR. To see more, visit http://www.npr.org/.