PITTSBURG, Kan. (AP) — The Rev. Anthony Navaratnam stood before his congregation and urged them to pray for the women from surrounding states who will flock to the new abortion clinic in town that opened in August.

“God is giving us an opportunity to be missionaries in Pittsburg, Kansas,” he told those at Flag Church, which hosted a training on how to protest outside of the clinic.

The debate over reproductive rights has landed in this college town of 20,000 in the southeast corner of one of the few states left in the region still allowing abortions. It is near Missouri, Oklahoma and Arkansas and not terribly far from Texas.

A place this size, especially one in a historically red state, was unlikely to have an abortion clinic before Roe v. Wade was overturned in 2022. Since then, Kansas has become one of five states that people are most likely to travel to in order to get an abortion when they’re unable to at home, said Caitlin Myers, an economics professor at Middlebury College who researches abortion policies.

Abortions spiked in Kansas by 152% after Roe, according to a recent analysis by the Guttmacher Institute, which supports abortion rights. Using Myers’ count, six of the clinics in Kansas, Illinois, New Mexico, North Carolina and Virginia that have opened or relocated post-Roe are in communities with fewer than 25,000 people. Two others are in communities of fewer than 50,000.

“Kansas is really the only one in this region that can provide care to many people in these surrounding states,” said Kensey Wright, a member of the board of directors for the Roe Fund in Oklahoma, which supports Kansas abortion clinics through grants.

“Without abortion clinics in that state, we would be without hope,” Wright said.

Housed in a former urology office, Pittsburg’s Planned Parenthood clinic sits across the street from a medical clinic run by a Catholic health care system. Behind the clinic are houses.

Clinic manager Logan Rink said her mother used to work in this building as a nurse — a connection that’s “small-town stuff.” She loves this town, and said her neighbors agree the clinic is needed. But she was guarded in her optimism, saying ” the reception that we are going to get from the community is going to be favorable in some ways and probably not always.”

Experts said smaller-sized clinics can be less overwhelming for women who are coming from rural areas, like those surrounding Pittsburg. But there is no anonymity in these smaller communities, where religious and family ties often run deep. Pittsburg was established in 1876, and settled largely by immigrants from Catholic-leaning countries who came to work at surrounding coal mines. There’s a typical main street and a state university with about 7,400 students.

“In a small town, it’s not just that you’ll know that person. Your family will know them. You will have known them for 40 years,” said Dr. Emily Walters, a supporter of the Pittsburg clinic who works as an anesthesiologist at a hospital in neighboring Missouri. “Your stories will be intertwined.”

She wondered aloud, “How do I see you at a protest and then see you the next day at the grocery store and still be able to be polite and civil with each other?”

Walters also chairs the Crawford County Democratic Party in an area that is increasingly Republican and has no Democratic state legislators — a change from 20 years ago when there were six. The county also has become increasingly religious in the same span; it now has twice as many white evangelical Protestants as the national average, and slightly more Catholics, according to the Public Religion Research Institute.

Just five weeks after Roe was overturned in 2022, voters in Kansas had to decide whether to strip the right to an abortion from the state constitution, which could have led to an outright ban. Despite the Republican and religious leanings, 55% of Crawford County voters were part of the 59% of voters statewide who killed the proposal.

It’s in line with an Associated Press-NORC poll from 2024 that showed 6 in 10 Americans think their state should generally allow a person to obtain a legal abortion if they don’t want to be pregnant for any reason. But the rural counties that surrounded Pittsburg chose otherwise at the ballot box.

“I remember people were stealing yard signs, putting up different ones in people’s yards,” said Anastin Journot, an 18-year-old from Independence, Kansas, who is majoring in elementary education at Pittsburg State. She said she was alarmed by Roe getting overturned, remembering she thought: “What if I’m in a situation where I’m needing to get an abortion and it’s not an option?”

Abortion in Kansas is generally legal up until the 22nd week of pregnancy. The clinic’s southern location puts it closer to states that have banned abortions instead of sending people to Kansas’ larger cities, where hours have been expanded and appointments are still in short supply.

About 60% to 65% of people who call Planned Parenthood clinics in Kansas for an abortion appointment are turned away because there isn’t enough capacity, said Emily Wales, president and CEO of Planned Parenthood Great Plains. Already, Wales said, the bulk of people seeking abortions in Kansas are from out of state — mostly Texas, which is about five hours south. After that, it’s Missouri, a few minutes’ drive east and Oklahoma, less than an hour away. She said some come from as far away as Louisiana and even Florida, which now prohibits the procedure after six weeks.

Clinics “strategically placed near (a state’s) border can really help ease the congestion,” said Ushma Upadhyay, a public health scientist at the University of California San Francisco who studies abortion.

Most of the area that’s 100 miles from the new clinic has been designated as medically underserved for primary care by the federal government, and the number of obstetricians and gynecologists for every 100,000 female residents is less than half of the U.S. average.

For now, though, the focus at the Pittsburg clinic will be on abortion. Wales said Planned Parenthood wants to slowly add more services over the next two to three months, and one future goal for the clinic is to provide gender-affirming care. Neighboring states have restricted that, too.

“Pittsburg is going to lift up a whole lot of states in the South and help people get care,” Wales said.

But those additions, she added, will come after staff gets used to the patients and the presence of protesters and opposition.

Donations are up at Vie Medical Clinic, the town’s crisis pregnancy center, executive director Megan Newman said. Such centers are typically religiously affiliated and encourage clients to continue their pregnancies.

People opposed to the Planned Parenthood clinic also are picking up pamphlets about Vie so they can hand them out to those seeking abortions. “When we got word that Planned Parenthood was coming, you could just kind of feel that in the town,” Newman said.

Jeanne Napier, a 68-year-old who attends a local Baptist church, vowed as she shopped at the local mall that she’ll “be there every day with signs.”

Her daughter, Terri Napier, said in a phone interview she believes part of her parents’ opposition to the clinic is from watching her struggle about 20 years ago. She was in an abusive relationship with someone who has since died. She got pregnant. The family was fearful of bringing a child into the situation.

She had an abortion, and spiraled into drug use. “I was at war with forgiving myself,” said the 43-year-old, who is now clean.

Jeanne Napier said she felt like she encouraged the abortion. “And I hate that,” she said, “because I wish I could take that sin upon myself, so it’s real personal. I had an active play in terminating a life, and we don’t have that right.”

Brianna Barnes, a 19-year-old journalism major at Pittsburg State who is from Wichita, has protested and prayed outside of a clinic in her hometown.

“If someone made eye contact with us, we just smiled at them, kind of showing that love and care because no one responds well to screaming, yelling, violence no matter what side it’s on,” she said just after arriving on campus for the fall semester. Most of the students the AP talked to voiced support for the clinic.

Her mother, Crystal Barnes, 42, turned to her daughter: “You’re going to be the odd man out being a Catholic, and conservative, especially with things like abortion. It is so heated.”

The Friday before the clinic opened, crews installed a wooden facade outside, the air filled with the smell of fresh-cut lumber. Walters, the local anesthesiologist, had stopped by to check on the progress.

Walters’ support comes from a personal place. When she was 20 and the same number of weeks pregnant, she went to an emergency room, bleeding. She said she was sent home to miscarry instead of having her labor induced or having a procedure to remove the fetus.

That experience — “horrific, and wouldn’t be considered standard of care, in modern practice,” she said — left her with a deep empathy for women in tough positions.

Just before the 2022 vote, an ad backed by 400 Kansas doctors who support abortion rights ran in some of the state’s largest papers, including The Kansas City Star. Walters’ name was listed first. During that time, her home address appeared online, a frightening prospect in a state where abortion provider Dr. George Tiller was shot dead in 2009 at his Wichita church by an anti-abortion extremist.

“It is critical health care for women,” she said. “It is going to be disruptive to Pittsburg. And that part hurts my heart.”

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Hanna reported from Topeka, Kansas.

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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

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