This State Is Quietly Becoming One Of The Worst For Women’s Health (And No, It’s Not Texas)


Thanks to the high-profile battle over new abortion restrictions in Texas this past summer, the national media typically associates the Lone Star State with harsh abortion laws. The dire situation in Texas is certainly alarming for reproductive rights activists — but it’s hardly the only state where women’s access to abortion is under siege.

Ohio has recently dramatically tightened its restrictions on abortion, and the number of clinics in the state is dwindling. State lawmakers haven’t shown any signs of ceasing their politically-motivated attacks on reproductive health care. Yet unlike Texas, Ohio women’s fights haven’t garnered much widespread attention.

“Ohio is one of the most restrictive states in the U.S. when it comes to abortion care. Texas gets a lot of the press, but really, some of the laws that Texas is enacting are stolen from Ohio,” an abortion provider who practices in Ohio, speaking anonymously to protect her identity, told ThinkProgress in an interview earlier this month.

Some of the laws that Texas is enacting are stolen from Ohio.

In 2011, Ohio enacted a ban on later abortions that prohibits doctors from ending a pregnancy after 20 weeks unless the fetus is nonviable. Since the new law doesn’t adequately distinguish between elective abortions and medically necessary abortions, that leaves some women who discover serious fetal abnormalities — which typically aren’t evident until later in pregnancy — in a difficult spot. They’re either forced to carry the doomed pregnancy to term, or doctors are forced to refer them out of state.


“Some of the only complaints I get from patients are when I have to turn them away. When I tell them, I’m sorry, I can’t help you, I know how to do the procedure and I could do it safely, but I can’t,” the anonymous Ohio provider told ThinkProgress. “It’s heartbreaking. People are begging you — as a physician, you know you can help them, but the only reason you can’t is because of a state law.”

On top of that, Ohio pushed through a package of stringent abortion restrictions this past summer by attaching them to an unrelated budget bill. The anti-choice groups in the state celebrated the passage of that legislation as “historic.” Some of the new restrictions are intended to dissuade women from ending a pregnancy, requiring their doctors to give them an opportunity to listen to the fetal heartbeat and tell them about the fetus’ likelihood of “surviving to full term.” Others are specifically aimed at abortion clinics, using a tactic known as the Targeted Regulation of Abortion Providers (TRAP) to indirectly undermine women’s access to the procedure.

Ohio’s TRAP law is actually even more stringent than the ones in place in other states.

Over-regulating abortion clinics is a popular anti-choice strategy, and Texas’ new TRAP law has grabbed headlines for forcing dozens of clinics to close. But Ohio’s TRAP law is actually even more stringent than the ones in place in other states.

TRAP laws typically take two different forms (and many states, like Texas, enact both versions). The first type requires abortion clinics to bring their building codes in line with the standards for ambulatory surgical centers, which typically involves costly and unnecessary updates like widening hallways and installing drinking fountains. The second type requires abortion doctors to enter into partnerships with local hospitals, in case one of their patients experiences severe complications and needs to be transferred to emergency care. These transfer agreements are totally superfluous, don’t indicate how skilled an abortion provider is, and are opposed by major medical groups.


Ohio’s version of the second type of TRAP law is unique. In addition to requiring abortion providers to make a transfer agreement with a local hospital, Ohio’s law forbids public hospitals from entering into those partnerships. That means the University of Toledo, which used to partner with the abortion clinics in the state’s fourth-largest city in order to allow them to stay open, can no longer play this role. That’s forcing multiple abortion clinics to close their doors even though they have a record of providing safe reproductive health care.

Ohio’s law also gives the governor considerable power to ensure that clinics are forced out out of business. It’s written in a way that allows the director of the state health department — a politically appointed position — to have the final say about whether clinics’ transfer agreements are good enough. Kellie Copeland, the executive director of NARAL Pro-Choice Ohio, referred to the new clinic standards as “a regulatory witch hunt” when facilities first started shutting down this past fall.

Cincinnati may become the largest metropolitan area in the country without an abortion clinic.

Now, the women who live in Toledo and Cincinnati — some of the state’s most populous cities — are in danger of losing access to nearby abortion clinics altogether. Two clinics in the Cincinnati area are struggling to remain open, and if they’re unsuccessful, the region will become the largest metropolitan area in the country without an abortion clinic. Meanwhile, Toledo’s last abortion clinic is fighting to get the state health department to approve a transfer agreement with a private hospital located across the border in Michigan, but state officials appear poised to argue that Michigan hospitals don’t count as “local.”

As women in Ohio are facing mounting barriers to reproductive health services, they’re being forced to leave the state to get the care they need. Abortion clinics in neighboring Michigan have seen an influx in Ohio patients over the last several months. The facility located nearest to Toledo has even hired additional staff to accommodate the recent increase, and is worried about what will happen if Toledo’s last clinic shuts down. Not every woman can afford to make a trip across state lines.

Reproductive rights advocates in the state are well aware of what they’re up against.

“Governor John Kasich has enacted more restrictions on access to reproductive health care — including safe, legal abortion and family planning services — than any governor in memory. None of his policies will help prevent unintended pregnancy and therefore the need for abortion. In fact, quite the opposite,” NARAL’s Copeland told ThinkProgress in an email exchange. “And more anti-choice measures are pending in the Ohio Legislature. On top of all of that, Governor Kasich is abusing his regulatory authority in an attempt to close abortion clinics across Ohio.”

Governor Kasich is abusing his regulatory authority in an attempt to close abortion clinics across Ohio.

So why haven’t you heard more about Ohio? Because the abortion opponents there are doing a good job framing the situation on their terms and largely remaining under the radar.


“Ohio has become a laboratory for what anti-abortion leaders call the incremental strategy — passing a web of rules designed to push the hazy boundaries of Supreme Court guidelines without flagrantly violating them,” the New York Times reported in October. “These laws have passed without the national drama provoked by far-reaching abortion bans that were approved, then overturned in court, in states like Arkansas and North Dakota.”

Ohio Right to Life, the largest anti-choice group in the state, is hoping that this incremental approach will eventually end abortion in the state altogether. The group’s president, Mike Gonidakis, recently told Gannett Ohio that closing all of Ohio’s abortion clinics is well within the bounds of Roe v. Wade because women would still have “access” to clinics in other states.

“There is no law or court ruling about mileage or length of time to get to a clinic,” Gonidakis said.

And abortion opponents show no sign of stopping, indicating that they’ll continue to use the state’s regulatory system to accomplish that ultimate goal. This past week, anti-choice groups began calling for a larger investigation into Ohio’s abortion clinics, claiming that it’s “ironic” that reproductive rights advocates have complained about the harsh new clinic standards when “it appears that the regulations aren’t strict enough.”

Copeland told ThinkProgress that the state’s elected officials will eventually feel the consequences of their recent anti-abortion crusade. “Ohio women are fed up with politicians interfering with their medical decisions and they will make that known when they go to the polls in November,” Copeland noted.