Shelley Koch, a longtime resident of southwest Virginia, had witnessed a similar scene many Sunday mornings after church services. On this day, however, it played out in a parking lot outside a modest government building in Bristol where officials had just advanced a proposal that threatens to tear apart the very fabric of her community.

For months, residents of the town have battled over whether clinics limited by strict anti-abortion laws in neighboring Tennessee, Kentucky and West Virginia should be allowed to continue to hop over the border and operate there. The proposal on the table, submitted by anti-abortion activists, was that they shouldn’t. The local pastors were on hand to spread that message.

“We’re trying to figure out what we do at this point,” said Koch, who supports abortion rights. “We’re just on our heels all the time.”

The conflict is not unique to this border community, which boasts a spot where a person can stand in Virginia and Tennessee at the same time. Similar disputes have broken out across the country following the U.S. Supreme Court’s decision to overturn the landmark 1973 decision establishing a constitutional right to abortion.

As clinics have been forced to shutter in Republican-dominant states with strict abortion bans, some have relocated to cities and towns just over the border, in states with more liberal laws. The goal is to help women avoid traveling long distances. Yet that effort does not always go smoothly: The politics of border towns and cities don’t always align with those in their state capitals. They can be more socially conservative, with residents who object to abortion on moral grounds.

Anti-abortion activists have tapped into that sentiment — in Virginia and elsewhere — and are proposing changes to zoning laws to stop the clinics from moving in. Since Roe was overturned, such local ordinances have been identified as a tool for officials to control where patients can get an abortion, advocates and legal experts say.

In Texas, even before Roe was overturned, more than 40 towns prohibited abortion services inside their city limits. That trend, led by anti-abortion activist Mark Lee Dickson, has since successfully spread to politically conservative towns in Iowa, Louisiana, New Mexico, Nebraska and Ohio.

Under Roe, the high court had ruled that it was unconstitutional for state or local lawmakers to create any “substantial obstacle” to a patient seeking an abortion. That rule no longer exists.

While such zoning changes are no longer necessary in Texas, which now has one of the most restrictive abortion laws in the country, Dickson says he and others will continue to pursue them in other states with liberal abortion statutes.

“We’re going to keep on going forward and do everything that we can to protect life,” he said.

In New Mexico, which has one of the country’s most liberal abortion access laws, activists in two counties and three cities in the eastern part of the state have successfully sought zoning changes restricting the procedure. Democratic officials have since proposed legislation to ban them from interfering with abortion access.

In the college town of Carbondale, Illinois, a state where abortion remains widely accessible, anti-abortion activists have asked zoning officials to block future clinics from opening after two already operate in town. Thus far, they’ve been unsuccessful.

Meanwhile, some of the states that have severely restricted abortion access are trying to make it harder for residents to end their pregnancies elsewhere. Employees at the University of Idaho who refer students to a clinic just 8 miles (13 kilometers) away in the liberal-leaning state of Washington could face felony charges under a recently passed state law.

Perhaps no other place so neatly encapsulates the issue as the twin cities of Bristol, Virginia, and Bristol, Tennessee. Before Roe, an abortion clinic had operated for decades in Bristol, Tennessee. After Roe, which triggered the Volunteer State’s strict abortion law, the clinic hopped over the state line into Bristol, Virginia.

That’s when anti-abortion advocates began pushing back. At the request of some concerned citizens, the socially conservative, faith-based Family Foundation of Virginia helped draft an amendment to the city’s zoning code that says, apart from where the existing clinic sits, land can’t be used to end a “pre-born human life.”

“Nobody wants their town to be known as the place where people come to take human life. That’s just not a reputation that the people in Bristol want for their area,” said foundation President Victoria Cobb.

The amendment has stalled before the Planning Commission as the city’s attorney, the American Civil Liberties Union of Virginia and others question its legality. Meanwhile, the board of supervisors in Washington County, which surrounds Bristol, passed a similar restrictive zoning ordinance on Feb. 14, and at least three counties have since adopted resolutions declaring their “pro-life stance,” according to the Family Foundation.

Before Roe was overturned, such zoning restrictions would have been unconstitutional, noted ACLU attorney Geri Greenspan. Now, however, “we’re sort of in uncharted legal territory,” she said.

It’s a struggle that residents like Koch weren’t expecting.

In 2020 — when Democrats were in full control of state government — they rolled back restrictions on abortion services, envisioning the state as a safe haven for access. Virginia now has one of the South’s most permissive abortion laws, which comforted Koch when Roe was overturned.

Now, however, her relief has been replaced by anxiety.

“I realized how little I knew about the workings of local government,” she said. “It’s been a detriment.”

The Bristol Women’s Health clinic is battling multiple lawsuits but would not be affected by the proposed ordinance unless it tried to expand or make other changes. While some residents oppose the facility, “they’re more afraid that this industry is going to expand and that Bristol is going to just become a multistate hub of the abortion industry,” said the Rev. Chris Hess, who as pastor of St. Anne Catholic Church has advocated for the zoning change.

Debra Mehaffey, who has spent more than a decade protesting outside abortion clinics, said people are coming to Bristol from Texas, Louisiana, Mississippi, Georgia, “all over to come get abortions, you know, because they can’t get them in their state.”

“So it will be great to see it totally abolished,” she said.

Clinic owner Diane Derzis, who has owned numerous other abortion clinics — including the one in Mississippi at the center of the Supreme Court’s recent decision — downplays the pushback. She said she’s grown accustomed to protests and even experienced the bombing of a separate clinic.

But Derzis is also girding herself for many more post-Roe battles in the future.

Abortion “is just under attack and it’s going to be for years,” she said.