A combination photo shows Republican U.S. presidential nominee Donald Trump (L) and Democratic presidential nominee Hillary Clinton during their third and final debate in Las Vegas Wednesday. (Carlos Barria/Reuters)

Antiabortion activists, already experiencing a difficult year, say their movement faces a pivotal moment as another Democrat who staunchly supports abortion rights appears likely to occupy the White House.

First came the death of Antonin Scalia, an ardent ally on the Supreme Court. Then came a stinging defeat before the justices over a sweeping Texas law regulating abortion providers. Now, activists are afraid that Hillary Clinton is headed to victory — and angry that Donald Trump has done his share, they say, to set back a movement that has strived to show sensitivity toward women.

For years, antiabortion activists have succeeded in advancing their agenda in part by not vilifying women. They have portrayed women as sometimes coerced into the procedure — in other words, they are victims as much as their unborn children are. Activists have targeted groups and doctors who perform abortions and have pushed restrictive laws in the name of women’s health.

Trump has not followed that playbook. Earlier this year, he suggested that women who have abortions should be punished, a position he later reversed. His campaign manager, Kellyanne Conway, said in a recent interview with the New Yorker that the remark was “a great example of him just undoing decades of work where we worked really hard.”

And Wednesday, in a nationally televised debate, he criticized his opponent for wanting women to have access to a procedure in which, he said, doctors “rip the baby out of the womb . . . just prior to the birth” — a crude description of abortions that he claimed occur late in pregnancy.

“Politically, we’re on defense,” said Eric Scheidler, executive director of the Pro-Life Action League. “There are some really serious things at stake in this election, and we’ve seen the legislation we fought hard for being rolled back by the Supreme Court.”

Many antiabortion activists preferred other Republican contenders for president, particularly Sens. Ted Cruz (Tex.) and Marco Rubio (Fla.), whose antiabortion credibility is ironclad. In January, some prominent activists urged voters in Iowa to caucus for any candidate other than Trump.

But in a sense, Trump is the antiabortion movement’s best chance of rebounding after the crushing loss over the Texas law, which imposed regulations so strict that many abortion clinics in the state were forced to close. Five of the high court’s eight remaining justices found that the restrictions put an undue burden on women’s constitutional right to an abortion. The ruling hampered efforts to enact similar laws across the country.

Trump has pledged to appoint judges who oppose Roe v. Wade, the 1973 decision legalizing the procedure nationally. That promise is particularly significant because there is one vacancy on the court, left by Scalia, and the next president could be called upon to nominate several more justices.

Trump also selected as his running mate Indiana Gov. Mike Pence, one of the antiabortion movement’s most well-known champions. That decision led many antiabortion leaders to endorse Trump despite his past support for abortion rights.

But now, with his chances of winning the White House fading, some worry that he may be doing more harm than good.

“It almost made me want to throw up,” said Cathie Lynn Gisi, 65, a well-known Republican organizer in Las Vegas, of Trump’s remarks during the debate. Gisi says she opposes abortion but is considering casting a ballot for Clinton. Trump, she said, was unnecessarily “graphic” and seemed to “use unborn babies to try to get at” Clinton.

The remarks follow the release of a video from 2005 in which Trump lewdly describes making unwanted sexual advances on women; accusations of groping by a growing number of women; and a crystallizing narrative that Trump is tone-deaf on women’s issues. He also came under fire for saying of Clinton during the debate: “such a nasty woman.”

“To have Donald Trump be the standard-bearer for the pro-life movement is horrific, because we’re on the verge of overcoming so many of the bad stereotypes about the movement” as driven by “old white guys with lots of money telling women what to do,” said Charles Camosy, a bioethics professor at Fordham University and a board member of Democrats for Life.

Added Scheidler: “It would be more encouraging to have [as the nominee] somebody we know has been with us for a long time, and really understands the issue deeply and is able to articulate it, and not make some of the stumbles we’ve seen along the way from Donald Trump.”

At the debate, it was Clinton who more directly spoke to the challenges faced by women who “make the most intimate, most difficult, in many cases, decisions about her health care that one can imagine,” as she put it.

“The kinds of cases that fall at the end of pregnancy are often the most heartbreaking, painful decisions for families to make,” she added. “I have met with women who toward the end of their pregnancy get the worst news one could get, that their health is in jeopardy if they continue to carry to term or that something terrible has happened or just been discovered about the pregnancy. I do not think the United States government should be stepping in and making those most personal of decisions.”

Groups that support abortion rights pounced on Trump’s comments, issuing a flurry of news releases, videos and interviews to criticize the Republican nominee. The groups have united behind Clinton, launching field efforts and advertisements, and having top officials speak on her behalf.

“Never before has our movement had such a clear champion running for president,” Cecile Richards, president of Planned Parenthood, said in a statement.

The groups also highlighted comments by medical professionals who said Trump’s description of abortions late in pregnancy is medically inaccurate.

“Statements like that do not reflect medical reality,” said Diane Horvath-Casper, an obstetrician with Physicians for Reproductive Health. She said that if, in the third trimester — the time of pregnancy Trump was referring to — there is a medical complication or the fetus is not viable or dead, doctors typically induce labor, with the woman delivering vaginally. Depending on the circumstances, if a fetus is alive its heart can be stopped with a cardiac drug, she said. According to the American Congress of Obstetrics and Gynecologists, abortions in the second trimester typically use a procedure called dilation and evacuation, in which the fetus is removed with surgical instruments.

Some of Trump’s supporters were pleased at his tenor during the debate, finding him passionate if inarticulate. The movement increasingly favors graphic language to describe abortion, believing that it more appropriately conveys the violence of the procedure.

“Donald Trump is a convert to the pro-life issue, as he has explained,” said Marjorie Dannenfelser, president of the Susan B. Anthony List. “Converts do not always use the same words as longtime activists, but they do speak with passion and conviction when faced with the reality of the horror of abortion.”

Added Penny Nance, president of Concerned Women for America: Voters “understand his tendency to clumsily state facts or issues or his opinions, so I’m not really concerned about that. I’m much more concerned about the fact that we have between one and four Supreme Court justices in play, we have 500 lower-court judges and 5,000 governmental appointees.”

Regular voters were less forgiving. Nina Nititadakul, 24, a special-education teacher who voted for Mitt Romney in 2012, said that after the debate she felt more comfortable voting for Clinton, not least because of her stance on abortion.

“The way he described it was really disgusting. A lot of women have gone through this or know someone who has. He was so crude.”

She said the decision to have an abortion is deeply personal, and “I don’t think it should be regulated by the government.”

Now, with fewer than three weeks until Election Day, antiabortion groups are girding for the prospect of a Clinton presidency. Scheidler said that, should Clinton win the White House, his focus will turn to grass-roots mobilization by trying to prevent abortions from happening, rather than enacting a long-term political or judicial strategy.

“That mission goes on unchanged,” Scheidler said.

Emily Guskin and Mary Jordan contributed to this report.