Heartbeats, the Supreme Court, and Vanishing Clinics: A Decade of Abortion Regulation in Ohio

When former Ohio Governor John Kasich took office in 2011, he went on to become the most pro-life governor in state history. Nearly one decade later, Ohio -- and the entire country -- faces a crossroads on what the future of abortion will look like. An enormous, heart-shaped balloon sat outside the Ohio statehouse in the summer of 2012, urging passersby to research the “heartbeat bill.” A few months prior, in October 2011, the first version of such a bill — which would outlaw abortions after a fetal heartbeat is detected — had just been introduced to Ohio legislators, and the pro-life movement had been pushing hard to pass it. Over the years, the bill endured much opposition and revision; citing it as unconstitutional, former Gov. John Kasich vetoed a version of the heartbeat bill in 2016, but the bill, in one version or another, never left discussion in Ohio’s legislature.[AdSense-A]The latest version of the bill — which many pro-choice advocates describe as a complete ban on abortion — passed in the Ohio Senate in March and passed in the Ohio House on Wednesday and signed into law by Gov. Mike DeWine by Thursday.The heartbeat bill has quickly become one of the most well-known abortion restrictions in Ohio, but more constraints have also been implemented in Ohio over the last decade. Though these restrictions don't receive the same amount of attention as the heartbeat bill, they impact the abortion landscape in Ohio every day.  In 2017, 20,893 abortions were induced in Ohio, which is down from 28,123 in 2010 — a 25 percent decrease. While the overall birth and abortion rate has been declining across the nation, there are additional factors causing abortion rates to drop so quickly in Ohio. Some of the decrease can be attributed to increased access to healthcare — specifically, access to contraceptives. The Affordable Care Act passed contraceptive mandates that increased access to birth control under more insurance plans. The sharp decline in abortion rates is also related to the restrictions placed on both patients and healthcare providers. While many restrictions have been suggested and passed by pro-life lawmakers, increased support from third party pro-life groups has also made the path to restricted abortion much faster. Ohio Right to Life, the largest pro-life organization in the state, did not endorse the heartbeat bill until this past December. Jamieson Gordon, director of Communications and Marketing for Ohio Right to Life, says this is because Right to Life felt the latest version of the bill had the best likelihood of passing through the legislature. But even with its delayed support for the heartbeat bill, Right to Life has endorsed -- and even been credited with passing -- multiple other pieces of anti-abortion legislation in the last decade. These include for a late-term abortion ban in 2011, a 2013 law which required doctors to let a woman listen to her fetal heartbeat; and a “pain capable” fetal protection law which moved Ohio outside of Roe v. Wade’s viability standards of 27 weeks.  Gordon says that the organization will continue to push for new legislation, which she hopes will be assisted by pro-life advocates in the statehouse.   “I think Ohio is definitely a very pro-life state,” Gordon said. “We’ve very thankful and blessed to have a pro-life legislature and governor, so I don’t think that will be changing anytime soon. We’ll be passing a lot more pro-life laws that are protecting children and women.” Additionally, for the last several years, there have been day-to-day restrictions on women trying to receive abortions, some of of which may not be as publicized as much as the heartbeat bill.These constraints include a requirement for patients to meet with a physician 24 hours before an abortion, mandatory ultrasounds, and laws that require patients to visit an abortion center twice before terminating the fetus. Furthermore, a controversial bill that banned the common “dilation and evacuation” procedure was signed into law by Kasich last December, around the same time he vetoed the heartbeat bill.Many of these laws and regulations have been left out of the public conversation . Part of this may stem from the prevalence of more encompassing laws like the heartbeat bill, but there is a much simpler reason for the average Ohioan’s silence on abortion.“Abortion is a hard thing to talk about,” Gordon said. “It’s messy. A lot of people don’t do a lot of digging into it; they might not want to.” Even with an issue as difficult as abortion, Catrina Otonoga, Outreach and Advocacy Coordinator for the pro-choice group Preterm Ohio, said the general public should tune in to conversations about abortion rather than turn away — especially because abortion is so personal and a lot more common than it might appear. “I think what we forget about a lot in the public dialogue is that one in four women have an abortion in their lifetime,” Otonoga said. “You know and love four women, so someone you know has had an abortion.”“It can feel really ephemeral to talk about abortion restriction like it will never affect a person, but that is the nature of health care. You never know when any medical decision might affect you or someone you love.” Kellie Copeland, the executive director for non-profit lobbying organization NARAL (National Association for the Repeal of Abortion Laws) Pro-Choice Ohio, has been involved in the Ohio abortion debate since 2002, and she is quick to note that the Ohio abortion landscape has not always been this strict. Before 2011, few pro-life bills were being introduced in Ohio, and even fewer ultimately went made it to the floor for debate. But when Kasich became the Governor of Ohio in 2011, he signed more restrictions and barriers to reproductive health care than any governor in Ohio history — 21 restrictions in eight years. Kasich is now succeeded by DeWine, who has made support of children and women part of his ongoing platform. One especially notable change from the last decade is the decrease in Ohio’s abortion clinics. NARAL Ohio currently lists twelve abortion clinics accessible to Ohio residents, but only nine of these are actually within state lines. Many clinics have been staving off closure for years. One of the largest issues for struggling clinics in Ohio is the law around transfer agreements. In 2013, House Bill 58 passed, dictating that clinics need to obtain a transfer agreement with a local hospital to determine which hospital a patient will be taken to in the case of an emergency during the abortion procedure.  This quickly caused issues for many clinics. Clinics are limited to hospitals within 30 miles of their location, but are banned from getting transfer agreements from public hospitals. Transfer agreements also have to be renewed every two years — another change by Kasich — and Copeland notes that during this time, hospitals often receive pressure from outside groups to break their transfer agreements. Under these new conditions, some clinics have had to take extreme actions to stay open. One of the most well-known cases came in 2014, when Toledo’s Capital Care Network fought a lawsuit with the Ohio Department of Health over transfer agreements. After struggling to find a hospital to sign an agreement with, they entered into a contract with the University of Michigan Health System, which is about 53 miles away from Toledo. The Department of Health rejected the agreement and attempted to revoke Capital Care’s license.The Department of Health also attempted to fine the clinic $40,000 for bringing a patient to a local hospital as a precaution in a non-emergency situation.Even after the clinic’s license was renewed, Right to Life Action Coalition of Ohio and Greater Toledo Area Right to Life claimed the Department of Health did not properly investigate Capital Care Network and encouraged the department to once again revoke the clinic’s license. This law has greatly challenged clinics, and Gordon and many others in the pro-life movement see this as a positive change for patients. “I think that a lot of the clinics are not able to keep up with the health and safety standards that have been put into law,” Gordon said. “Honestly, I think it’s a good thing that they’ve closed, because if they’re not able to hold up to the standards, they shouldn’t be open.” But according to Copeland, transfer agreements simply regulate what hospitals are already required to do, which is to take care of patients in emergencies regardless of where they were transferred from.  She also noted that transfer agreements are mainly useful when conducting a procedure with a high level of risk to the patient. In 2017, 152 patients had one or more complications during the procedure -- 0.007 percent of total abortions performed that year. As a whole, abortion rights in the United States are reaching a turning point. After the appointment of Brett Kavanaugh, the Supreme Court now has a conservative majority, and Copeland is already speculating about the possibility of the court to overturn Roe v. Wade. If Roe’s precedent is overturned, Otonoga said each state would have total control over what abortion laws look like. While such a turnover will impact the whole country, for a state as consistently pro-life as Ohio, the lack of a national benchmark would change state abortion laws forever. And as Copeland notes, it seems like what was once a far-fetched outcome is creeping ever closer. “We’ve never seen, with one exception, where a right a citizen had enjoyed had been taken away from them, and that was prohibition,” Copeland said. “I think America is potentially headed for a very shocking time, which for most people is inconceivable. But I think that it’s undeniable that it is.”