South Texas's only abortion clinic, located in the border town of McAllen, has become a battleground for abortion activists on both sides. (Whitney Leaming/The Washington Post)

The young woman lay on the exam table, waiting for her abortion. She expected pain. Tears. The grip of regret. But the dimly lit room smelled of lavender, and the nurse was asking about the butterfly tattoo on her right wrist.

“It’s beautiful,” the nurse said. “What’s it mean?”

“It’s for my daughter,” the woman replied. “My butterfly.”

She was 28, a single mother of three, her youngest 10 months old. She lived with her parents and was studying to become a medical assistant. She could not afford this procedure; her Catholic grandmother had slipped her the $440. She didn’t want to bring another child into poverty just as she was climbing out.

That was how she wound up at Whole Woman’s Health of McAllen, an abortion clinic in this border town that opened as a physician’s practice in 1971, two years before the Supreme Court legalized abortion nationwide. Thousands of women had undergone the procedure in the brick shoe box of a building, the setting for about 60 abortions a week.

Both the clinic and the political landscape have changed radically since those early years. Most recently, a Texas law imposed strict new requirements that the clinic could not meet. So the owner filed suit, arguing the law illegally restricts women’s right to an abortion. The case will be argued Wednesday before the U.S. Supreme Court, the most consequential abortion case to come before the court in a generation.

The debate over abortion often involves sweeping abstractions. But what happens inside this clinic — and just beyond its walls — illustrates how abortion is lived in America, 43 years after Roe v. Wade.

On one side are the clinic’s dedicated supporters, including its current owner, who are deeply engaged in an intensifying battle to push back against state restrictions. On the other are the protesters, the fiercest critics of abortion, who have flocked to this clinic as its profile has risen and other facilities around the state have been forced to close.

One of few providers

Opened by an Argentine immigrant, Peter Kowalyszyn, the clinic has long provided a range of family planning and health services for women in the rural Rio Grande Valley. At first, even some of Kowalyszyn’s closest colleagues did not know he also performed abortions.

Over time, however, word got out, and the clinic began attracting protesters. Juan Campos, a family doctor with an office next door, stopped speaking to Kowalyszyn. He lobbied town officials to shut the clinic down.

“We don’t let prostitution go around. Why are we allowing an abortion clinic?” Campos said. But the city was “afraid of lawsuits, so they didn’t do anything.”

Kowalyszyn had seen patients with complications from illegal abortions, and he wanted women in this predominantly Hispanic city to have safer options. Eventually he came to focus primarily on birth control and abortion. In 1999, he changed the clinic’s name to “Motherhood Choice.”

That year, Kowalyszyn’s wife, Ines, became general manager. With her husband aging, she sought a successor, eventually finding Amy Hagstrom Miller, a veteran abortion clinic administrator who had purchased an Austin clinic to keep it from going out of business.

Miller, who owns eight clinics across the country as part of her company, Whole Woman’s Health, bought the McAllen clinic in 2004, out of concern, she said, that its closure would create a void for its clientele, many of whom lacked health insurance. Today, Miller said, patients come from across South Texas, as well as Mexico, many paying the $440 the clinic charges for the procedure out of pocket.

Miller brought a modern sensibility to the clinic, updating equipment and putting a greater emphasis on counseling. She also inscribed the walls with quotes from famous women.

Around that time, state officials in Austin began stepping up standards and inspections at abortion clinics. During the summer of 2011, Miller said, her Texas clinics were the subject of 13 unannounced state health inspections.

In 2013, Texas passed a law that required abortion clinics to meet hospital-like standards and required doctors who perform abortions to have admitting privileges at a nearby hospital.

Antiabortion groups say the new regulations are critical to protecting women’s health. Texas clinics went years without proper inspections or regulations, they say, leaving the door open to criminals such as Kermit Gosnell, the Philadelphia abortion doctor now serving a life sentence for killing babies born alive during late-term abortions.

Abortion rights groups counter that the law has shuttered about half the state’s 40 abortion clinics and could force the closure of eight or nine more. The McAllen clinic was among the first to close. But it reopened a year later, after a federal judge granted it a temporary injunction as the only abortion clinic serving the Rio Grande Valley.

Whether that reprieve continues depends on the Supreme Court’s decision in Whole Woman’s Health v. Hellerstedt. The McAllen clinic does not meet either of the law’s new standards.

Antiabortion groups say that is a good reason to shut it down. “We don’t want any abortion facility to stay open that doesn’t meet standards that are typical for any other procedure,” said Melissa Conway, spokeswoman for Texas Right to Life. “Why should women in those areas be penalized and subjected to a lack of good care?”

Andrea Ferrigno, corporate vice president of Whole Woman’s Health and a niece of the clinic’s original owners, acknowledged that the two doctors who perform abortions at the clinic do not have local admitting privileges. But, she said, that is because one drives 500 miles from Dallas and the other flies 350 miles from Houston, and hospitals in McAllen won’t accept their applications. She argued that admitting privileges are unnecessary because hospitals would admit any patient in an emergency.

Ferrigno started working at the clinic’s front desk when she was 19 and has seen the tone change among the antiabortion protesters who have long gathered on the downtown streets outside the clinic. She remembers a group of four who used to meet every Wednesday to silently pray the rosary.

Today, dozens of louder protesters typically gather outside the clinic, forcing Whole Woman’s Health to erect a wooden fence patrolled by a security guard and two pink-vested escorts who guide the patients.

An uneasy peace

On a recent Friday, Yolanda Chapa, 73, was among the protesters. She watched two young women park in a church-owned lot next to the clinic. She walked up to the car and offered them directions to a nearby Crisis Pregnancy Center that encourages women to consider adoption. The clinic’s security guard snatched her fliers, she said, “but I was able to throw one into the car window.” Then she called police.

Chapa has come here nearly every morning for eight years to practice what she calls her “sidewalk ministry.” She views abortion as murder and her vigil as a bid to save lives.

Kristeena Banda, the clinic’s director, views Chapa as trespasser, which is exactly what she said when Officer Daniel Rodriguez showed up.

Chapa “stops right in the middle as someone’s trying to come in, and she does this staring game with the car,” Banda said.

Rodriguez tried to broker an uneasy peace.

“It’s a very hot topic,” he told Banda. “Just make sure you guys stay on your property, and I’m going to tell them to stay off your property.”

The next morning, 10 men stood in a circle, heads bowed, praying in Spanish. They call themselves the Caballeros De San Miguel, or the gentlemen of Saint Michael. They usually bring a basket of tiny plastic babies.

Carlos Sanchez, 46, an X-ray technician, said he prays for the women and talks to them about God’s plan. “There are other options. You never have to kill a baby,” he said.

Sanchez said he also works to educate men. “This isn’t all on women,” he said. “Men need to know — if you do this, this will happen. You need to take responsibility.”

Inside the clinic, on the exam table, the young mother of three — who requested anonymity because the sensitivity of the issue — struggled to relax. The hurdles the state of Texas has placed in the path of any woman seeking an abortion nearly deterred her.

Texas requires a 24-hour waiting period, so the woman scrambled to find two full days of child care — one for the consultation, and one for the abortion. Other rules compelled her to view a sonogram of her 8-week-old embryo, which she worried would change her mind. She also was required to talk to a counselor who asked twice whether she was sure she wanted an abortion. Yes, she said both times.

A shot of mild sedatives relaxed her. So did the classical music playing softly on the clinic’s sound system.

“I’m going to try to enjoy it,” she told the nurse.

“Enjoy it, girl. Enjoy it.”

“Have you ever had a pap smear?” asked a doctor in maroon scrubs.

“Yes,” the woman said.

“It starts the same way.”

She fixed her eyes on the ceiling. She relaxed her feet in the stirrups. She thought of her 10-year-old daughter, who was in Dallas for a cheerleading competition. Her other children, a 5-year-old boy and a 10-month-old girl, were with a babysitter, probably watching “Bob’s Burgers.”

“Relax,” the doctor said. “Do the best you can.”

The woman focused on her breathing. She heard a machine switch on.

The clinic counselor had asked her if anyone — a boyfriend, perhaps — had pushed her into this decision. The woman said no. He wanted her to have the baby. But they’d been fighting long before that talk, and she knew she didn’t want to raise another child without a father.

“You’re not judging me?” she had asked the counselor.

“Who are we to pass judgment on you?” the counselor had said. “There are lots of reasons to do what you do.”

After five minutes, the machine switched off. The abortion was done.

She thanked the doctor, got dressed and went to meet her boyfriend, who was waiting outside.