By Melinda Young
Since the U.S. Supreme Court overturned Roe v. Wade, many states have changed their laws about abortion care — sometimes making three or more changes over the past couple of years. This has resulted in abortion providers and clinics having to make quick changes in policies and which patients they will accept.
Researchers of the policy changes in Ohio analyzed the effect on abortions over three time periods, from January to June 2022 — before Roe was dismantled, to July to September 2022, after Ohio enforced a six-week ban on abortions, and then from October 2022 to June 2023, which was when the six-week ban was blocked by a court.1
They found that clinic-based abortions in Ohio declined by 56% after the six-week ban was put into effect. When the ban was lifted a few months later, the monthly abortion means exceeded the numbers from before the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization.1
Typically, abortions decrease by half after six-week bans, which are currently in place in South Carolina, Florida, and Georgia, says Mikaela Smith, PhD, a research scientist in division of epidemiology at Ohio Policy Evaluation Network of The Ohio State University in Columbus.
These rates of decline likely would be even greater if it were not for abortion providers adjusting their schedules to see patients sooner than they would in a state without abortion restrictions, she notes.
“Part of that has to do with the huge increase in people donating to abortion funds during that time; providers were scrambling and dropping provisions to see patients, but that framework is not necessarily sustainable,” Smith explains. “Clinics and abortion funds are doing a lot to get patients in under six weeks, but the laws still are harming patients who cannot get in during the time period.”
Although Ohio’s six-week ban had been in place briefly during the time period studied, it had a large impact on abortion clinics and their providers.
“One of the stressors is there was also staff turnover during that time,” Smith says. “One facility said a patient advocate quit due to stress of the six-week ban; there was more staff turnover, and they had to juggle schedules.”
Another facility said they saw more patients at a higher gestation right before the six-week ban went into place. This was because of the May 2022 leak of the Supreme Court’s Dobbs decision.
“Facilities were gearing up for some change to happen, and they didn’t know it was a six-week ban immediately when Roe fell,” Smith says. “In anticipation of a changes, physicians increased provisions to see patients through 19 weeks and six days of pregnancy.”
This was a big change for abortion providers, who would refer later-stage pregnancy patients to another provider in the state before Dobbs was on the horizon.
Providers also said they had problems with managing patient confusion about abortion legality in Ohio during the pre-Dobbs time period when there were changes occurring elsewhere, such as Texas, where an abortion ban occurred earlier than in other states. When the Dobbs decision was leaked, patients expressed panic.1
After the six-week ban was enforced, clinics had to do an ultrasound scan on the first day a patient saw them and then a second ultrasound scan on the second day — the date of the procedure — to confirm there were no fetal heart tones. Other clinic staff said the six-week ban did not allow enough time for a minor to obtain a judicial bypass. The ban caused stress to clinic staff, and it resulted in their referring patients to abortion care in Colorado, Illinois, Michigan, New York, New Jersey, and Pennsylvania. One staff person said that “patients having to be navigated out of state significantly affected the staff emotionally.”1
The study used data from an ongoing monthly survey of abortion facilities in Ohio. The survey began in 2020, and eight of nine facilities in Ohio participated. All of the clinics that provide surgical abortions in Ohio are located in urban areas, including three in Cleveland and one each in Dayton, Cincinnati, Columbus, and Akron. A Toledo clinic and a second clinic in Columbus provide only medication abortion services.2
During Ohio’s six-week ban window, no clinics closed.
“But all expressed distress at adapting to these changes,” Smith says. “They have a long history of adapting to policy changes in the state.”
Ohio had been an abortion-hostile state for two decades, during which legislators passed more than 15 abortion restrictions, including limitations on dilation and evacuation (D&E) procedures, banning abortions after 20 weeks, and requiring in-person counseling and a 24-hour waiting period before the abortion could proceed.1
But the changes after Dobbs were the most challenging, in part because several states next to Ohio also imposed severe abortion bans, and their patients would come to Ohio for abortion care — increasing the caseload.
“Providers expressed how they were seeing patients from further away and from more states,” Smith recalls. “This was reaffirmed in the data we have.”
Kentucky and West Virginia had abortion bans immediately in place, and Indiana eventually had its own abortion ban.
“When Indiana, West Virginia, and Kentucky passed total bans after Dobbs, we see an increase in out-of-state abortions in Ohio,” Smith says. “Out of all the people coming to Ohio from out of state, 22% were from Indiana, pre-Dobbs.”
When Ohio had a six-week ban and Kentucky had a total ban, 75% of the out-of-state patients were from Kentucky. West Virginia only had about 1% of the out-of-state abortion-seekers, likely because that state is next to Pennsylvania and Virginia, where people can go for abortions, she adds.
Researchers are continuing to collect data on abortion providers’ experiences in Ohio, and future studies will address some of the significant changes that occurred after this study’s cutoff of June 2023.
The biggest one was that Ohioans voted for a constitutional amendment that ensures access to abortion and other forms of reproductive healthcare on Nov. 7, 2023. Since that major victory for abortion rights groups, providers, and patients, there have been numerous court cases seeking to reverse the abortion restrictions in place for years, such as the 24-hour waiting period. Each one has had to go through the court, Smith says.
“We have a temporary blocking of the 24-hour waiting period and dispensation of medication abortion pills,” she explains. “Now, Ohio is becoming more accessible for abortion; it’s an interesting case if we look at what’s happening around the country. Within Ohio, we’ve seen both sides of it.”
The newly passed amendment protects abortion through 22 weeks’ gestation. Each clinic in Ohio is making its own decision about gestational cutoffs and how to adapt to the changes, she adds.
One of the findings that impressed Smith the most was how invested abortion providers and staff were in the wellbeing of their patients.
“They express concern for them and for the things they have to go through to come to the clinic to get care,” she says. “One quote in our paper was a staff member who said there are not enough hours in the day to see all the patients.”
The clinics do all they can to cope with the emotional toll of dealing with patients they cannot help, and they have some pride in doing what they can, Smith adds.
“One staff member said, ‘The facility never closed, and we kept the doors open through all of Dobbs and could pivot right after the fall of Roe and then pivot again right after the lifting of the ban,’” she says.
One possible future change will be the opening of more abortion clinics as demand for abortion in Ohio increases.
As other states have changing abortion laws and bans, the takeaway is that abortion access and reproductive justice is a human right.
“Gestational bans unnecessarily decrease access to safe and normal healthcare,” Smith says.
“People are pushed out of their ability to access abortion care, and when they are denied an abortion, it has an impact on their health and life outcomes,” she adds. “It carries risks of criminalization, and the option of traveling out of state is not necessarily available to everyone.”
References
- Smith MH, McGowan ML, Kerestes C, et al. Longitudinal impact of Dobbs v. Jackson Women’s Health Organization on abortion service delivery in Ohio, 2022-2023. Am J Public Health 2024;114:1034-1042.
- Ohio Abortion Clinic Map. Ohio Policy Evaluation Network (OPEN). August 2024. https://open.osu.edu/publication/ohio-abortion-clinics/
