“Does it go back to people having abortions in back alleys? Haven’t we overcome that?” she asked, questioning the restrictive laws passed recently in states like Alabama and Kentucky.

At the same time, Smith-Holmes, who works for a day care center in the Allentown neighborhood of Pittsburgh and votes Democratic, said there should be limits. And she is not comfortable with the idea of taxpayer money going to fund abortions — a position that has become almost impossible to hold in the Democratic presidential primary. “Who’s paying for these?” she wondered.

The nuance in how Americans like Smith-Holmes view abortion has largely fallen out of the noisy national dialogue about when women should be able to end their pregnancies. Complex questions — of medicine, morality, personal empowerment and the proper role of government — are often reduced to the kind of all-or-nothing propositions that are ever more common in the polarized politics of the Trump era.

President Donald Trump and the Republican Party are rallying their base by falsely portraying efforts to expand abortion rights in states like New York as condoning the murder of healthy full-term babies delivered by healthy mothers. The leading national organization for Republicans who support abortion access, Republican Majority for Choice, closed down last year, saying it saw no more space for common ground within the party.

In the Democratic Party, where politicians could once straddle the abortion divide by airing personal misgivings while also promoting supportive policies, holding a gradated view is no longer the norm. The debate on the left today is far less modulated than it was a decade ago when Barack Obama, then the party’s presidential nominee, spoke of how Americans wrestled with the issue in good faith, saying that “anybody who tries to deny the moral difficulties and gravity of the abortion issue, I think, is not paying attention.”

By contrast, Democrats running for president today often characterize abortion rights as absolute. And they steer clear of saying what polls have repeatedly shown about Americans’ views since Roe v. Wade made abortion a constitutionally protected right in 1973: It’s complicated.

“Nonnegotiable,” Sen. Kirsten Gillibrand has said. “There is no middle ground,” Sen. Bernie Sanders declared.

Even on the issue of abortions later in pregnancy, which causes the most consternation among Americans, candidates are reluctant to go on record about where they would set limits. “I trust women to draw the line,” said Pete Buttigieg, the mayor of South Bend, Indiana, when asked about third-trimester terminations.

The 2020 election could be the first time in recent memory that abortion is as galvanizing a voting issue for Democrats as it is for Republicans, who for decades have held out hope of flipping the Supreme Court and reversing Roe. Now, with a conservative majority on the court, Roe’s fate appears as tenuous as ever.

A no-compromise posture may be heartening for activists who worry about appearing timid on the issue at a time of such uncertainty and anxiety. But prominent allies to the cause have grown increasingly worried that the impulse to take a hard line has weakened their efforts politically and legally and left them vulnerable to conservatives who eagerly portray them as out of step with the sentiments of most Americans.

“There’s always this sense that we can’t say anything that would create doubt about abortion,” said Frances Kissling, president of the Center for Health and Social Policy. “And the current situation hardens people’s sense of absolutism.”

Kissling, who is often called “the philosopher of the pro-choice movement,” said that to gloss over the complexity and morality of ending a pregnancy is to deny the reality that women experience. “I think that if you do not express any moral doubt about any aspect of abortion nobody trusts you,” she said. “You are so far from the sensibility of women who actually have abortions.”

But others say the questions around abortion have moved away from difficult issues of morality and toward control over women, especially as states move to enact restrictive laws in an attempt to challenge Roe. In this context, many Democratic voters see little room for ambiguity.

“Women see this as ‘my autonomy,’ and there is no space for compromise in their minds on autonomy,” said Tresa Undem, a partner with the research firm PerryUndem who studies public opinion on the issue. “Honestly, Democratic candidates are catching up to Democratic voters who have been feeling this way for a few years.”

Few states have a political history as shaped by the subtleties of the abortion debate as Pennsylvania. It has been home to Democrats like former Gov. Robert P. Casey, who defended the state’s restrictive abortion laws in the landmark Supreme Court case Planned Parenthood v. Casey, which reaffirmed Roe but also allowed states to set new limits. Today, Pennsylvania is represented in the U.S. Senate by the former governor’s son, Bob Casey, who is one of only a handful of Democratic senators with a record of voting to limit abortion access.

The state is also home to one of the last Republican House members who supported abortion rights, Charlie Dent, the former congressman who represented the Lehigh Valley area until he retired in 2018. There are none today.

“They used to talk about the Catholic Democrat, or the Casey Democrat, who was pro-labor, pro-life, pro-gun,” Dent said in an interview. “But that doesn’t seem to be so common today. Or many of them have become Republicans.”

There are still some opponents of abortion barely hanging on as Democrats. “I’m really sad because I don’t want to be a Republican,” said Jeannie Wallace French of Pittsburgh, who has worked with groups like Feminists for Life, which oppose abortion but are less partisan than many mainstream groups. She was pregnant with twins when she said the doctors discovered one had a form of spina bifida and advised her to abort. She declined, and the baby, a girl, died shortly after birth. But doctors were able to use her heart valves to save two other infants.

She worries that stories like hers are getting drowned out. “It has become so loud, going both ways,’’ she said. “And the divide is only getting bigger.”

Liz Allen, a Democratic member of the Erie City Council who calls herself “anti-abortion but pro-choice,” said she wishes her party encouraged women with a wide range of experiences around pregnancy to speak up. She arrived at her own “nuanced” position about abortion, she said, after two traumatic moments: a first-trimester miscarriage and, later, the death of her adult son. “That, to me, wasn’t a person,” she said of her miscarriage, contrasting it to her son’s death. But she said she could understand how some women might feel that way.

“This is being framed as a health care discussion, but in other health care discussions we are talking about the moral issues involved,” Allen said. “Why can’t we acknowledge that this is a moral question and that women have the moral agency to decide this. But let’s not dismiss it as nothing, like you’re going to have a tooth pulled.”

About 1 in 3 voters in Pennsylvania is Catholic — higher than the national figure of about 1 in 5. Catholic voters there turned out at the highest rate of the three Midwestern states Trump won by a threadbare margin of 77,000 total votes, according to exit polls.

Most Catholics, said Steven Krueger, president of the Catholic Democrats, are like most other Americans in that they do not accept the Church’s hard line on abortion. But they do wrestle with it and expect politicians will, too. “It isn’t a question of what their churches teach, it’s an instinct,” he said.

Both political parties are doing a poor job of connecting with the sensibilities of Americans who “are both pro-life and pro-choice,” Krueger said. And the result is a situation where “a lot of people are feeling like orphans on this issue.”

(Trump, who attacked Hillary Clinton’s support for abortions late in pregnancy, won among Catholics nationwide by 7 points, propelled by a 23-point margin with white Catholics, the Pew Research Center reported.)

Clinton’s public comments on abortion show how much the conversation has changed. In 2005, she said abortion “represents a sad, even tragic choice to many, many women.” When she ran in the 2008 Democratic primary against Obama, she said her goal was to reduce the number of abortions, using Bill Clinton’s often-borrowed line that the procedure should be “safe, legal and rare.” Then she added, “By rare, I mean rare.”

The party dropped the word “rare” from its platform in 2008 at the urging of activists who felt it was shaming to women. And Democrats today seldom discuss reducing the number of abortions as a goal. “The argument,” said Kissling, the pro-abortion rights ethicist, “is if we want to reduce the number of abortions, there must be something wrong with it.”

Many on the left are framing it as a question of trusting women, Kissling added, which she thinks precludes a more comprehensive, persuasive discussion about abortion rights. “We have one answer, the same answer, to every single objection or concern that is raised around abortion,” she said. “It’s not about trusting women, really. Every decision every woman makes about every abortion is an ethically good decision? No. It may not be.”

Some who are progressive-minded on issues other than abortion say the Democratic Party’s embrace of this approach makes it more “pro-abortion” than “pro-women,” leaving them without much of a political home.

In Pittsburgh, Aimee Murphy founded a group called Rehumanize International that holds many positions embraced by progressives: opposing racial discrimination, capital punishment, torture and drone strikes, for instance. But because it also opposes abortion, she said, it has been marginalized in progressive circles. “In mainstream feminist circles, the word ‘pro-life’ is like a swear word,” she said.

One of Murphy’s colleagues at Rehumanize, Herb Geraghty, a self-described atheist and Marxist who is bisexual, said when he set up a table at the Pittsburgh LGBT Pride festival recently, a lot of people wanted to yell at him. But when he tried to draw some of them into a conversation, he was heartened by how well it worked.

“We either want to ban abortion outright or see abortion as good, as empowering,” he said of society in general. But most people think it’s a tough decision, he said, including him. “It’s a hard issue.”