Newport, a city of about 6,800, was getting a little better, Ms. Smart said. There was the updated movie theater and pool at the park. But many people they knew from school were now addicted to drugs — particularly methamphetamine. Grandparents were left raising children.

Ms. Ramsey stood in her office, reflecting on her mission. She could remember only three times when a client said she had come to Options thinking about abortion.

“I don’t ever look at a baby and think, ‘This is going to make this girl’s life way worse,’” she said. “When I see people that are living in poverty, I don’t look at it like, those people shouldn’t have a kid because they aren’t going to take care of it. I look at it as, ‘Those people aren’t in a good situation; how can we help them be in a better situation, with or without a kid?’”

She finds truth in the critique by many who support abortion access that their opponents do not care about life beyond birth. “All we want is the baby to be born, and then we are not going to give the parents any kind of tools to take care of it,” she said of many others in the anti-abortion movement. “We are not going to come alongside them, we are just going to feel like we won.”