By Brad Cooper, The Kansas City Star

The future couldn’t have been gloomier for the inner-city abortion clinic in Kansas City, Kansas.

Increasingly tighter state restrictions. Relentlessly hostile opposition. And fewer patients.

Targeted by anti-abortion forces for years and nearly closed in 2011 by new state licensing requirements, Aid for Women locked its doors in late July.

“I’m tired of fighting the young girls’ fight,” said Jeff Pederson, the clinic manager.

The closing leaves Kansas with three abortion clinics, two in Kansas City suburban Johnson County and one in Wichita.

It was the latest in a series of closings nationwide in an ever more difficult political climate for abortion providers.

“It is incredibly challenging,” said Julie Burkhart, who last year opened an abortion clinic in Wichita. “We have very active anti-choice groups that make it their job to try and shut us down.”

Abortion opponents were jubilant when reports surfaced that Aid for Women closed July 25.

“Kansas City Abortion Free!” declared the website for Operation Rescue. Kansans for Life joined in, sending out a news release celebrating the closure of the “sordid clinic.”

Pederson won’t specifically say what led to the closing, although he said he was exhausted from getting “beat up” by a legislature determined to limit abortion.

While pressure from abortion opponents contributed to the closing — the clinic had been picketed and a complaint was lodged against the facility with state medical regulators — Pederson talked vaguely about other factors.

“It’s not just one thing. It’s a plethora of things.”

Abortion foes were skeptical about the clinic’s reasons for closing. They believe their pressure, coupled with new state laws ensuring women are informed about abortion risks, helped drive the clinic out of business.

“This abortion mill was the one making the least amount of money and was the most disgusting,” said Troy Newman, president of Operation Rescue.

Clinics across the country are closing in the face of new restrictions that abortion opponents say are intended to protect women and that abortion supporters say are obstacles to a woman’s constitutional right to an abortion.

Virginia and Pennsylvania have each lost five clinics since 2011. Texas has lost 21 clinics, and Arizona has lost four. Missouri has just one left, in St. Louis, after three closed since 2011.

A federal appeals court halted a Mississippi law that would have closed that state’s only abortion clinic. The law required clinic doctors to get admitting privileges at local hospitals, something they were unable to do.

Many of the clinic closings are the result of tough new rules — like Mississippi’s — aimed at curbing abortion.

In other cases, it’s an inability to replace an aging generation of physicians to provide a service that’s been stigmatized.

But the closing of the Kansas City, Kansas, clinic raised a different issue: fewer patients.

The clinic’s physician, Ronald Yeomans, said Aid for Women wasn’t seeing enough patients to stay in business. He attributed that partly to better use of contraception, reducing unwanted pregnancies.

He also said the opening of the clinic in Wichita took away some of the western Kansas patients who once traveled to the his clinic.

“We basically just reached a place where we weren’t needed anymore,” Yeomans said.

The number of abortions is plummeting, a trend attributed to reduced demand because of higher contraception use and hundreds of new laws restricting the procedure.

A study released last winter by the Guttmacher Institute concluded that state laws enacted from 2008 to 2011 were minimally restricting access to abortion.

Researchers concluded from numbers showing declines in the birth and abortion rates that women were turning to more effective forms of birth control.

The study found abortions were falling nationally, including in states such as California, New Jersey and New York that tend to be more supportive of abortion rights.

“That these states also experienced a slight drop in the number of clinics offering abortion services may reflect a decline in demand as opposed to the imposition of legal barriers,” the study said.

The anti-abortion group Americans United for Life called the Guttmacher study “an abortion industry propaganda piece short on data and long on strained conclusions.”

When the study came out, Americans United for Life president and CEO Charmaine Yoest said “common sense” limits on the procedure are protecting women and the unborn.

“No matter how many abortions there are, abortion carries serious risks,” Yoest said in a statement. “Abortion should come with a warning label and be regulated like the medical procedure that abortionists claim it to be.”

Guttmacher, which tracks reproductive rights issues, acknowledged that its research did not account for the surge in new abortion laws that states passed after 2010.

The institute said more research will be needed to know their effect on abortion rates.

Thirty states enacted 205 laws limiting abortion rights from 2011 through 2013, more than all the restrictions passed during the decade before, according to Guttmacher.

Legislatures banned abortion as early as six weeks into pregnancy, required abortions in hospital-type settings and required abortion physicians to secure admitting privileges at local hospitals.

Last year, Texas passed a law requiring abortion clinics to meet standards for surgical care. It also required abortion doctors to have admitting privileges at an area hospital.

In less than a year, the number of abortion clinics in Texas fell to 19 from 35. Eventually, abortion rights supporters believe the state will be left with six abortion providers as the Texas law is phased in.

In 2011, Kansas passed a licensing requirement that nearly closed all of the state’s abortion clinics, including Aid for Women. The law was challenged in court and blocked. The case is still pending in state court.

The laws are “designed to make it difficult, if not impossible, to access services and make it difficult for providers to perform abortions,” said Elizabeth Nash, state issues manager for the Guttmacher Institute.

Pederson acknowledged, for example, that he would not have been able to meet the new Kansas licensing requirements if they were ever put into place.

Carole Joffe, a sociologist at the University of California-San Francisco who follows reproductive rights issues, said it can be hard to separate which clinics are closing because of falling demand and which clinics are shutting down because of the costs of complying with new laws.

“In some cases, we have very clear-cut evidence that clinics are closing because of political reasons, not because of financial” reasons, Joffe said.

There has been a significant decline in abortions in Kansas. The abortion rate for Kansas residents fell about 34 percent from 2006 to 2012. During the same time, the state’s birth rate fell about 6 percent.

While abortion rights supporters have attributed the decline to new laws, they also have pinned the decrease on fewer unintended births and the shooting death of Wichita abortion provider George Tiller in 2009.

Burkhart, chief executive of Wichita’s South Wind Women’s Center, said demand for abortion is reduced by limited access, contraception and women using drugs to induce their own abortions.

“What it boils down to is we’re going to have lower abortion rates,” she said.

Operation Rescue’s Newman said the clinic closures are a sign that the anti-abortion movement is succeeding as it educates women about the procedure.

“We are taking away their business,” Newman said. “We’re convincing women not to have abortions before they even decide to look up an abortion clinic. All around, the pro-life movement is winning.”

Photo via Wikimedia Commons