PITTSBURG, Kansas — Under the bright lights of Planned Parenthood Great Plains’ newest health center, staff are busy cleaning exam tables in between patients.
The southeast Kansas clinic opened in August, making it the state’s third new abortion provider since the U.S. Supreme Court’s 2022 Dobbs v. Jackson Women’s Health Organization decision that prompted abortion bans in a host of nearby states. The facility brings reproductive health care, including abortions, to a largely rural region with few other options.
“I'm from a small town close to here,” said Makenzie Erker, a registered nurse at the clinic. “It’s really nice being able to provide these services to our community, especially because it's such a drive to go elsewhere.”
Pittsburg, a college town, sits just five miles from the Missouri border, 30 miles from Oklahoma and 80 from Arkansas. All three states enacted strict abortion restrictions in 2022.
Now, across the state line in Missouri, a two-and-a-half year long abortion ban is lifting after voters approved an amendment to the state’s constitution in November.
The change is expected to significantly expand abortion access in the region. But it may not do much to quell demand at the Pittsburg clinic. Among the approximately 150 patients who secure abortion appointments here each month, Kansans and Missourians make up less than a fifth combined. The vast majority come from Arkansas, Oklahoma and Texas.
Clinic manager Logan Rink said a lot of those patients overcome significant barriers to get here. Transportation and child care costs. Flat tires and getting time off work. And fear.
“The biggest trend that we've seen is patients coming to us needing care, but being fearful of receiving it — based on the political climates in their home states,” she said. “That’s something I think that we navigate nearly every day.”
A region in flux
Since Dobbs, Planned Parenthood's Kansas clinics have fielded a surge of people from states that banned abortion across the South and Midwest.
At first, they only had capacity to see around 20% of people who sought appointments. But with the addition of a clinic in Kansas City, Kansas, and now Pittsburg — along with a new independent clinic in Wichita — those numbers are improving.
“Between 40% and 50% of patients who call on any given month are able to get in for an appointment,” Planned Parenthood Great Plains President and CEO Emily Wales said.
Across the four states where the organization operates, its providers are starting to see people come in seeking follow-up care after natural miscarriages. Miscarriage management is legal in every U.S. state, but Wales said the increase is tied to reports of some women being turned away from hospitals in states with abortion bans.
“People are seeing the stories about criminalization of pregnant people," she said. "They are seeing the horror stories of patients not getting care in emergency rooms."
Planned Parenthood could soon restart abortion services in Western Missouri for the first time in six years. Long before the state’s total ban, there were stringent restrictions that made it hard for clinics to stay licensed. By 2022, only a single clinic in the state — in St. Louis — offered abortions.
The organization is now challenging a slew of laws that had contributed to that lack of access, including a mandatory 72-hour waiting period for surgical abortions and rigid rules regarding doctors' hospital admitting privileges.
But the reproductive rights movement’s victory in Missouri comes at a time of much uncertainty. Many advocates are worried the incoming administration of President-elect Donald Trump could try to enact national limits on abortion — or further restrict access to the drugs required for medication abortions.
“Those are real threats to access even in states where we have protected care,” Wales said.
Abortion opponents mobilize
In Pittsburg, anti-abortion activists are ramping up outreach efforts.
At the entrance to the Planned Parenthood clinic’s parking lot, they flag down cars and try to reroute them to a local crisis pregnancy center — one of dozens of anti-abortion nonprofits in the state that counsel people to choose alternatives to abortion.
“We care deeply about the women within,” said Michelle Thomas, who’s come here every week since the clinic opened. “We believe Planned Parenthood doesn’t care about them.”
She said she doesn’t think of herself as a protester, but a helper.
“People sometimes feel like they have no place to go and no place to get help,” she said. “But we have women and some men out here always ready to care.”
As cars leave the parking lot, Thomas tries to hand out pamphlets containing information about abortion pill “reversal,” which is a controversial hormone treatment that proponents say can retroactively undo a medication abortion. Its safety and efficacy records are mixed, and the American College of Obstetricians and Gynecologists holds that it is not supported by science.
Last year, Kansas lawmakers passed a law requiring abortion providers to distribute information on the “reversal” treatment to patients, but a district court judge temporarily blocked it.
Still, Rink — a lifelong Pittsburg resident — says that local reception to the clinic has been largely positive.
“I know Pittsburg,” she said, “and I know that the majority of people here just want people to mind their own business.”
Coming political fights
Some abortion opponents in Kansas are now turning their attention to the courts, where judges have repeatedly ruled in favor of abortion rights. This summer, Kansas Supreme Court justices affirmed their 2019 decision that the state’s constitution protects the right to obtain an abortion.
That’s prompted some politicians — including Republican Attorney General Kris Kobach — to call for changes to the state’s Supreme Court justice nomination process.
“There needs to be greater accountability in the process of selecting justices,” he said in an email to the Kansas News Service. “Attorneys control an unelected nominating commission. And the governor has no freedom to select any person he or she prefers.”
Kansas lawmakers and voters put the current system in place because of a political scandal in the 1950s. When there’s a vacancy on the seven-member court, a commission of five lawyers and four governor-appointed nonlawyers nominates three candidates for the role. The governor appoints one to the court. Lawmakers have no role in confirming justices.
Proponents describe the system as merit-based. Detractors call it undemocratic — including Danielle Underwood, communications director of the anti-abortion lobbying group Kansans for Life.
“The current system for nominating Kansas Supreme Court justices is the least democratic process in the nation and controlled by lawyers,” she said in an email.
University of Kansas law professor Stephen Ware, who studies judicial selection, has advocated for changing the state’s system for years. He argues the current process skews the court’s ideology.
“Lawyers all around the country now are more progressive than their states’ electorate,” he said. “It has sort of predictable consequences that, if you empower lawyers in the Supreme Court selection nominating commission process, you get a court that is more progressive than the center of political gravity in that state.”
Not everyone agrees with that view. The court’s recent decisions protecting abortion rights have been in line with Kansas voters, who overwhelmingly rejected an anti-abortion proposed constitutional amendment two years ago.
But last month, Kansans also voted to expand state Republicans’ legislative supermajority. That will likely bolster GOP power to enact anti-abortion legislation and pursue judicial selection changes.
In September, Kobach told attendees of a Shawnee County GOP event that state lawmakers didn’t attempt to make judicial selection changes last session because they were a few votes short of the two-thirds majority needed to advance a constitutional amendment. After approval in the Statehouse, amendments must secure a simple majority in a statewide vote.
If lawmakers do manage to give themselves a say in Supreme Court confirmation, Ware said the change wouldn’t be immediate.
“If a vacancy on the court only happens rarely, it takes a long time to change the ideological center of the court,” he said.
Still, that ideological change could reach far beyond the issue of abortion — touching things like school funding and voting rights.
In light of the threats, Wales said Planned Parenthood is taking things day by day.
“It is sobering to us that people are open about their plans to interfere politically with what should be a non-partisan process,” she said.
“But,” she added, “we're certainly not strangers to a fight to ensure that patients can access their constitutional rights.”
Rose Conlon reports on health for KMUW and the Kansas News Service.
The Kansas News Service is a collaboration of KCUR, KMUW, Kansas Public Radio and High Plains Public Radio focused on health, the social determinants of health and their connection to public policy.
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