FARGO-Ken Koehler has been a regular presence among picketers outside the Red River Women's Clinic and its predecessor for more than 35 years in his enduring crusade to end abortion.

Along with his like-minded counterparts, he has had the occasional satisfaction of persuading a woman not to enter the clinic to end her pregnancy. Koehler admits, however, that those triumphs are sporadic, often months apart.

But now Koehler and other abortion opponents who gather regularly outside North Dakota's lone abortion clinic have a new sense of optimism that Roe v. Wade, the Supreme Court decision that has made abortions legal in all 50 states for 45 years, could be headed for a reversal.

President Donald Trump has nominated Brett Kavanaugh, a conservative appeals judge, to replace Justice Anthony Kennedy on the Supreme Court. Kennedy has been a "swing vote" on the court, and voted repeatedly to uphold the landmark 1973 abortion case.

"I certainly hope and pray that it will make a difference," Koehler, who lives in West Fargo, said on Wednesday, July 11, while picketing near the clinic in downtown Fargo.

Koehler, a retired director of Christian education and youth ministry for a Lutheran church, said he believes Kavanaugh would adhere to the Constitution, which he believes would lead him to vote to dismantle Roe v. Wade, which used as its legal foundation a woman's right to privacy.

"I believe that the Constitution itself supports life," he said. "Roe v. Wade, in my opinion, developed quite frankly out of thin air this right to privacy, which they assumed, and this right to kill your unborn children, which is horrendous. Human life is a precious gift of God."

Another veteran picketer who opposes abortion, Lila Harmsen of Valley City also believes the Supreme Court majority to sustain Roe v. Wade could dissolve if Kavanaugh is confirmed.

"Let's just say that I'm hopeful that it will make a difference," she said. "I am optimistic. With every abortion, a child dies. These are babies that are dying. This isn't just an issue. It's human life. We know that."

Like Koehler, Harmsen has been maintaining a vigil outside the clinic for many years on days when abortions are performed.

"We come here to offer help," she said. "It's not about judging or harassing." Abortion opponents try to send women to FirstChoice Clinic, which provides pregnancy services and encourages women to have an ultrasound before having an abortion.

"We have taken many women there," Harmsen said.

Jay Stewart of Williston has recently joined the ranks of abortion opponents who gather outside the Fargo clinic to dissuade women from having an abortion.

"It's wrong because God says it's murder," said Stewart, 26, who said he is studying theology and philosophy at Grand Canyon University in Phoenix. The issue of abortion, he said, goes to the very soul of the nation.

"I think it all boils down to does the heart of the nation want abortion or does it want life?" he said.

Stewart was accompanied by his wife, Larissa, and two high school-aged sisters, Reagan and Lauren Burckhard of Minot. Lauren, the older of the two sisters, welcomed Kavanaugh's nomination and what it could mean for the anti-abortion movement.

"It's definitely encouraging," she said, adding it was not the reason they joined the protest outside the clinic. "We would come out here no matter what."

Tammi Kromenaker, director of the Red River Women's Clinic, worries about what will happen to women the clinic serves in North Dakota, South Dakota and Minnesota if Roe v. Wade is overturned.

"Ending legal abortion does not end abortion," she said, and predicted the country would once again see "back alley" abortions that were common before abortion became legal. "It ends safe abortion."

If abortions are illegal, desperate women will try to abort their pregnancies using medications or other means, Kromenaker said.

"People will take matters into their own hands," she said.

North Dakota is one of four states that have passed so-called "trigger laws," statutes that outlaw abortions in the event Roe v. Wade is undone. Five years ago, federal appeals judges threw out a North Dakota law seeking to ban abortions of fetuses once they are six weeks old.

"It's a prime example in the state of how Roe v. Wade protects women's rights in the state of North Dakota," Kromenaker said.

In recent years, 1,100 to 1,200 abortions per year have been performed in North Dakota, according to state health statistics. Abortions in the state peaked in 2008 at almost 1,400.

North Dakota is following a trend across the country that has seen abortions decline by 10 percent to 15 percent in recent years, a drop Kromenaker attributes to better access to birth control, health insurance and sex education, not restrictions on access to abortion.

Even if Kavanaugh is seated and would vote to overturn Roe v. Wade, it would take years for a case to reach the Supreme Court, Kromenaker said.

If Roe v. Wade were reversed-something Kromenaker regards as a "clear and present danger"-would she move her clinic to Moorhead, since Minnesota is viewed as a state likely to allow legal abortions if left to state control?

"I'm not even going to try and think about that," Kromenaker said. But she is looking forward to celebrating the clinic's anniversary at the end of the month.

"Folks didn't think we'd last a year or five or 10 years, and here we are at 20," she said.