Legislative and legal battles have helped to close at least 10 abortion clinics in Ohio and surrounding states since 2010, creating vast areas where the procedure is all but banned unless women are able to travel long distances — 100 miles or more in some cases.
A University of Cincinnati doctoral candidate who faced the strong likelihood that she would have a stillbirth baby traveled 300 miles to Chicago in 2015 after struggling to get in anywhere else.
Kentucky has just one licensed clinic, located in Louisville, and it is fighting an order to revoke its license because the state claims it doesn’t have sufficient emergency agreements with local hospitals. If the EMW Women’s Surgical Center closes, Ohio’s neighbor to the south will be the first state in the United States where abortions are not available except in emergency situations.
West Virginia also has just one licensed clinic in operation.
Abortion opponents claim the closures as victories, saying their efforts have prevented thousands of abortions and put the movement one step closer to the ultimate goal: overturning Roe v. Wade, the landmark U.S. Supreme Court case that legalized abortion.
But advocates for reproductive rights say limiting access to safe, legal abortions will lead to more women taking dangerous measures to terminate unwanted pregnancies. And they say women, many of them in dire economic situations, are already spending thousands of dollars on travel and lodging to get an abortion, even in cases when it is medically necessary.
The increasing need for women seeking an abortion to travel long distances or cross state lines also places additional burdens on existing clinics, many of which are fighting legal battles to keep their doors open, the officials in those clinics say.
Planned Parenthood of Southwest Ohio’s Cincinnati clinic, the only location providing surgical abortions in the city of nearly 300,000, saw a 12 percent increase in surgical patients travelling from Kentucky from fiscal year 2015 to 2016.
Patients have come to that clinic from Mississippi, Alabama, Utah and California, according to Danielle Craig, vice president of communications for Planned Parenthood Southwest Ohio Region.
“It’s the people with low incomes, those who cannot afford to travel long distances or take absences from work, who are impacted the most,” Craig said.
Pro-choice advocates fear a situation like the one that unfolded in Texas in recent years. As more than half the abortion clinics in that state closed due to restrictions that were eventually struck down by the Supreme Court, studies showed maternal mortality rates doubled in just a two-year span.
Ohio recorded 20,976 abortions in 2015, with just 1,211 involving patients who traveled from out of state, according to the state Department of Health. But that number was an increase from the previous year, which suggests more patients may be coming to Ohio because of declining options in neighboring states.
Abortions overall have been down for years, a fact many attribute to the shrinking number of clinics, better access to contraceptives and sex education.
The number coming to Ohio would likely be much higher if not for the increasing restrictions imposed by the legislature in recent years, which include a two-visit, 24-hour waiting period requirement. Last year, Ohio also banned all abortions performed 20 weeks after gestation.
“If they travel from some distance to Ohio, they are going to have to add to the logistical and expense difficulties of having to stay at least overnight,” said Kellie Copeland, executive director of NARAL Pro-Choice Ohio. “That may make it so that for many people, it will just put abortion out of reach.”
Michigan’s out-of-state abortions increased by 62 percent from 2015 to 2016, according to state health data. It’s unknown how many of those patients were from Ohio, but a recent study by the Guttmacher Institute included interviews with women who had travelled from Ohio to Michigan for abortions.
“They say that travelling just makes the whole experience that much more difficult,” said Jenna Jerman, research associate with the institute, which advocates for advancing sexual and reproductive health and rights on a global scale.
“What we find is that when women have to travel they come up against travel-related logistical issues, like making the arrangements for transportation and accommodation and getting someone to watch their kids,” Jerman said.
Sixty-three percent of women who had abortions in Ohio in 2015 have at least one child already, according to the Department of Health.
The Guttmacher study points out that many women, including those on state-sponsored insurance, have to pay for abortions out-of-pocket. Add in the cost of gas, food and an overnight hotel stay and the expense can be into the thousands of dollars.
Pro-life groups in Ohio applaud the closings of abortion clinics and say women instead should seek out federally qualified health centers and pregnancy resource centers.
“We’re obviously very happy for our neighboring states and their life-saving efforts,” said Katherine Franklin, director of communications for Ohio Right to Life. “If women are in fact looking to come to Ohio to have an abortion, we’re prayerful and hopeful that they will instead turn to one of Ohio’s pregnancy centers. We have 142 in the state, which vastly outnumber Ohio’s abortion facilities.”
Pregnancy resource centers are often religiously-affiliated non-profits that offer pre-natal care free of charge to those in need. They do not refer women for abortion services, instead steering them toward adoption services or parenting. They’ve been criticized for not giving accurate information on abortion procedures and risks.
Franklin said the idea that women are going to die from at-home abortions if clinics closed is overblown by abortion rights advocates.
“Abortion is an elective procedure. The idea that a woman is forced to travel or forced to perform an at-home abortion is a bit of a farce and unfair to her personal autonomy and making rational judgments,” she said.
One woman’s story
Sheva Guy didn’t feel she had much of a choice when she had an abortion in 2015. She said her doctors told her the child wouldn’t survive through birth.
The now 24-year-old remembers being eager for her 22-week ultrasound because she and her husband were anticipating finding out the sex of the baby.
She was in her first year of graduate study at UC and the pregnancy hadn’t been planned, but the couple was excited and family members were planning baby showers, she said.
Then the ultrasound revealed something was wrong. The baby’s head and body weren’t the right size. Additional ultrasounds revealed abnormalities that would prove fatal.
“They basically told me it would definitely not survive through or past child birth, let alone, maybe not even through my pregnancy,” Guy said.
She and her husband made the decision to terminate the pregnancy as soon as possible rather than have to wait for a still birth.
“It would have been more dangerous for me to continue to carry the baby and deliver it,” Guy said. Then there was the emotional toll. “People knew I was pregnant… having people ask me, ‘When are you due?’ Would have been an emotional turmoil,” she said.
The couple soon ran into roadblocks. The Cincinnati Planned Parenthood told Guy it wouldn’t be able to accommodate a late-term abortion and put her in touch with the Women’s Med Center in Kettering. But she wouldn’t be able to get in for an appointment there until she was past 23 weeks.
The nearest clinic she could find that would take her on short notice was in Chicago. So, accompanied by her husband and his parents, she headed there.
Guy’s trip to Illinois cost more than $2,000, she said, not including the procedure. Her grandparents helped with the expenses.
“Most people would not really have that choice,” she said. “Even though abortion is ‘legal’ most people are unable to have access to it. The fact that I was lucky enough to be able to even get to Chicago is a big deal.”
The abortion battles in Ohio continue to heat up. Along with the closing of abortion clinics, Planned Parenthood is fighting to keep state funding for its centers, only some of which perform abortions.
The organization says abortion accounts for just 3 percent of its services, but that number has been questioned. Its centers also provide STD testing and treatment, pregnancy testing, pre-natal care, sex education, cancer screenings and other health services to millions of patients annually.
Copeland said efforts to restrict access to abortion or cut off funding to Planned Parenthood serves only to hurt women.
“We should be making access to all reproductive health care more affordable and more accessible, but it’s sadly been the opposite, and it’s to the detriment of women’s health and to their futures,” she said.
But Ohio Right to Life’s Franklin said the fight isn’t over access to health care. Her organization strongly supports access to health care for all women, she said.
“Abortion isn’t health care,” she maintains. “Abortion ends a human life.”
Toggle the map to see which abortion clinics closed between 2010 and 2017: