Want To Understand Why Abortion Clinics Are Disappearing? Look No Further Than Ohio.


This week, Ohio moved closer to shutting down the last abortion clinic in Toledo, the latest installment in a yearlong battle over a harsh new law that’s threatening clinics across the state. If state officials are eventually successful in what anti-choice activists refer to as an “incremental strategy” to end women’s access to legal abortion, the women who live in the northwestern area of Ohio will quickly run out of options.

This situation is playing out across the country, as abortion clinics are increasingly being forced out of business by stringent state laws imposing new regulations that are virtually impossible for them to meet. But since these laws are often cloaked in the language of “protecting women’s health” and shrouded in layers of bureaucratic red tape, they don’t necessarily incite public outrage. The anti-choice community is successfully encroaching on abortion rights even though there’s substantial evidence that its claims about patient safety simply aren’t true.

To understand exactly how that regulatory strategy operates, just take a look at what’s been going in the Buckeye State.

Last summer, Ohio lawmakers approved several harsh restrictions on abortion, including much tighter regulations on the clinics that provide the procedure. Now, abortion providers must obtain transfer agreements from local hospitals, in case one of their patients experiences serious complications and needs to be taken to the ER.

They cannot outlaw abortion, so they crafted a scheme to abuse their regulatory authority to close clinics instead.

If that sounds logical enough, well, that’s the whole point. Abortion opponents in Ohio claim that the state law is a common sense method to protect women, and have praised state lawmakers for “refusing to allow the abortion industry to escape complying with health and safety standards.” But that’s misleading. Abortion is already an incredibly safe and highly regulated medical procedure; less than 0.05 percent of abortion patients ever need to go to the hospital in the first place. And on top of that, it’s not actually necessary to have a specific agreement with a certain hospital in order to get them admitted.


“Transfer agreements have nothing to do with patient safety, because if there is an emergency an ambulance will take the patient to the nearest hospital, and that hospital will treat the patient because they are required to under federal law,” Kellie Copeland, the executive director of NARAL Pro-Choice Ohio, explained in an interview. “Governor John Kasich and his anti-choice cronies know they cannot outlaw abortion, so they crafted a scheme to abuse their regulatory authority to close clinics instead.”

Over-regulating abortion clinics is a popular anti-choice strategy that’s spreading rapidly throughout conservative states. It’s not uncommon for states to require abortion doctors to make some sort of unnecessary partnership with local hospitals. Ohio’s law actually goes a step further than that by forbidding public hospitals from entering into transfer agreements, which prevents the University of Toledo from partnering with any of the clinics in the surrounding area. That’s left the clinics in Ohio’s fourth largest city scrambling to find a solution.

One of the abortion clinics in Toledo has already been forced to close because it can’t find any way to comply with the new law. Now, the city’s last clinic, the Capital Care Network, is approaching the same fate: This week, a hearing examiner for the Ohio Department of Health concluded that its transfer agreement isn’t valid.

What’s the issue with the Capital Care Network’s transfer agreement? Is the clinic potentially endangering its patients? Not exactly. Capital Care is simply trying to partner with a hospital that isn’t quite “local” enough for state officials.

No one stops and says, ‘wait, who do we have a transfer agreement with?’

Since Capital Care can’t partner with the University of Toledo anymore, it attempted to make an arrangement with the University of Michigan, which is located about 52 miles away. But since Ohio’s stringent law requires clinics to obtain transfer agreements with hospitals that are no further than 30 minutes away, an examiner has determined that Capital Care’s partnership with the University of Michigan doesn’t count.


It’s important to remember that the state’s definition of what’s “local” doesn’t matter at all in practice. According to Celeste Glasgow Ribbins, the communications director for Planned Parenthood Advocates of Ohio, a transfer agreement with a Michigan institution wouldn’t actually affect the way Capital Care operates. In the rare instances when patients experience serious complications, the clinic staff simply calls 911 and tells an ambulance to take them to the nearest hospital, which will treat individuals regardless of arbitrary arrangements with clinics. The new law doesn’t change that procedure.

“No one stops and says, ‘wait, who do we have a transfer agreement with?’ We just ensure that patients get the care they need at the closest hospital,” Glasgow Ribbins explained. “The transfer agreement is just another bit of red tape we have to deal with, just another hoop we need to jump through.”

The decision about Capital Care’s transfer agreement isn’t yet final; the health department’s interim director will have the final word on whether the agreement complies with state law. The clinic’s director has indicated that she’s ready to appeal if state officials rule against her. More broadly, the American Civil Liberties Union is currently engaged in a legal challenge against the state to overturn the transfer agreement requirement altogether.

Still, reproductive rights advocates are wary to rely on the court system when their lawmakers have recently pushed through some of the most restrictive anti-abortion laws in the nation. An increasing number of women are already crossing the border into Michigan to receive reproductive health care, and if Ohio’s largest metropolitan areas continue to lose their clinics, the situation is poised to get much worse.

The real threat to women’s health will come if Kasich succeeds in closing the last abortion clinic in Toledo.

“The real threat to women’s health will come if Kasich succeeds in closing the last abortion clinic in Toledo,” Copeland pointed out. “And the threat will grow if he is able to close the only clinic in Dayton and the two clinics in Cincinnati as well. That would leave the entire Western half of Ohio with no abortion providers.”


“Patient safety remains Planned Parenthood’s top priority. But these laws were written by politicians, not by medical experts,” Glasgow Ribbins added. “They’re based on individual ideologies that a small portion of politicians want to impose on Ohio women and their families.”

While Capital Care’s dilemma provides a particularly clear example of the arbitrary nature of clinic restrictions, Ohio certainly isn’t the only state where abortion providers are facing these challenges. These laws have gained enough political traction to sweep across the South — Alabama, Mississippi, Texas, Louisiana, and Oklahoma have all enacted unnecessary laws requiring abortion doctors to make business arrangements with local hospitals, and if they’re all allowed to take effect, there will be huge swaths of the country without a single reproductive health facility. In Texas, the only one of those five states whose clinic restrictions are already being put into practice, that’s already becoming a reality.