Kentucky law requires that women receive counseling, either in person or by video, at least 24 hours before an abortion. Their stories offered a glimpse into the varied reasons, and often painful decisions, involved in ending pregnancies — especially in a state like Kentucky, where, Dr. Marshall said, many of his colleagues in obstetrics and gynecology oppose abortion.

One 37-year-old woman tearfully confessed that she had had an affair with a co-worker, who was married: “I’m his boss, and this is strictly forbidden; we could both lose our jobs.” She quietly asked for a copy of her ultrasound picture.

Another, 29, appeared nonchalant. “I’m working,” she said flatly. “It’s not in my plan right now.”

A third, 31 and a mother of two, said she was trying to escape an abusive relationship. “It’s been a struggle for me,” she told Ms. Ahola. “I am a religious person, I’ve been crying and battling with my beliefs, but I also think God understands.” She said she worried that the clinic would close: “We need this option.”

Ms. Ahola ended each talk with the same question: “Are you sure this is the right decision for you, and did you reach this decision yourself?”

Reproductive rights advocates say women in Kentucky, especially those in poor rural parts of the state, have long faced economic and geographic barriers to obtaining abortions. Many cannot afford to travel or to pay for the procedure. And as surrounding states have enacted restrictions, their options are narrowing.

“We used to have people who lived in Bowling Green; the Nashville clinic was closer than Louisville,” said Patricia Canon, who volunteers with the Kentucky Health Justice Network, a nonprofit that helps women pay for abortions and transports them to clinics. “But then Tennessee decided to enact a 48-hour, in-person waiting period. That means two trips, two days.”