The following Article was originally published in the Ohio Capital Journal and republished on News5Cleveland.com under a content sharing agreement.
Even though abortion is legal in Ohio, accessing abortion care can be difficult.
There are no surgical abortion centers in northwest and southeast Ohio, meaning people in those parts of the state must travel long distances and sometimes even travel to other states to get an abortion.
“People go wherever they can get in the quickest, and that could be Columbus, Cleveland, Cincinnati or Pennsylvania,” says Erica Wilson-Domer, president and CEO of Planned Parenthood of Greater Ohio.
But for those in neighboring states with near-total bans, Ohio can be a destination for abortion.
“We’ve seen about a 25% increase in travelers,” Wilson-Domer said. “I know that in southwest Ohio, the number of out-of-state travelers has doubled, if not more.”
According to Abortion Forward, 18,488 abortions were performed in Ohio in 2022, a 27.4% decrease from 2012. Of those abortions, 1,287 involved people who came to Ohio from another state, according to Abortion Forward.
“People need abortion care,” said Jaime Miracle, deputy director of Abortion Forward. “If someone chooses to have an abortion, they should have access to it, and they need access to it, and they will do what they need to do to get access to it.”
Ohio has six surgical abortion clinics in Columbus, Cleveland, Cincinnati, Bedford Heights, Cuyahoga Falls and Dayton. The Toledo abortion clinic converted to a medication-only abortion facility in 2019.
“The lack of clinics is a major obstacle,” Miracle said. “We’ve lost nearly half of the abortion clinics in Ohio since 2011.”
According to a report by the Ohio Policy Evaluation Network (OPEN), as of February 2022, all 88 Ohio counties have an abortion clinic within a 99-mile radius.
“The decision about where to seek treatment is a very complex and personal matter, so it is important that there are many options so that people can make the best choice for them,” says OPEN researcher Mikaela Smith.
Abortion is legal in Ohio up to 22 weeks of pregnancy. Ohio voters passed a law last year that added protections for abortion care and reproductive rights to the state constitution.
Neighbouring countries
Abortion is almost completely banned in Indiana, Kentucky and West Virginia, which leads to a flood of travelers at Ohio’s abortion clinics, Wilson-Domer says.
Indiana’s abortion ban went into effect on August 1, 2023.
Kentucky’s abortion ban went into effect on July 15, 2022. Before the ban, 48 women from Ohio traveled to Kentucky to have an abortion in 2022, according to data from Abortion Forward.
West Virginia’s abortion ban went into effect on September 16, 2022. 103 Ohio residents had abortions in West Virginia earlier this year – about 15% of all abortions performed in West Virginia in 2022, according to Abortion Forward data.
“There are a whole lot of people who live just across the Ohio border in Charleston, West Virginia, who no longer have access to abortion care in their state. So where do they go?” Miracle asked. “A clinic in southeast Ohio would not only help people in southeast Ohio…but it would also help a whole lot of people in West Virginia and rural Kentucky who are more likely to live in Pennsylvania or Virginia…to get access to care.”
There is no limit on abortions in Michigan, meaning a woman can terminate her pregnancy at any time. According to AbortionFinder.org, there are 26 providers in Michigan that perform on-site abortions.
In Pennsylvania, abortions are legal up to 23 weeks of pregnancy, and according to AbortionFinder.org, there are 21 providers that perform abortions locally.
According to the Guttmacher Institute, an estimated 1,260 Ohio residents will have an abortion in Michigan by 2023, 920 in Pennsylvania, 230 in Illinois and 100 in Virginia.
Access barriers
There are a number of barriers to accessing abortion, including some that exist only in Ohio.
One example is Ohio’s transfer agreement. The state requires an abortion clinic to have a transfer agreement with a hospital within a 30-mile radius so that a patient can be transferred if medical care is needed “beyond that which can be provided in the outpatient surgical facility.”
“The transfer agreement is completely unnecessary from a medical perspective because every patient referred to the emergency department is treated there,” Wilson-Domer said.
State-funded hospitals cannot sign a referral agreement.
“In many places, the only non-federally funded hospitals are Catholic hospitals … (which) obviously will not sign a transfer agreement with an abortion provider,” Wilson-Domer said. “That makes it incredibly difficult to operate a surgical facility, given all the trap laws that surround abortion care in Ohio.”
Ohio also has a 24-hour waiting period, which means women must visit an abortion clinic twice. The ACLU and Planned Parenthood Federation of America filed a lawsuit earlier this year in the Franklin County Court of Common Pleas seeking to overturn Ohio’s 24-hour waiting period.
Transportation is a major hurdle for many people. Cost is another.
Depending on the location and provider, a first-trimester abortion can cost about $800 or less, but the cost of a second-trimester abortion can range from $715 to $2,000, according to Planned Parenthood. There may be other costs associated with an abortion, including child care, lodging, travel and meals.
“All of these costs increase every time someone has to leave, and that can make abortion care unaffordable for too many people,” said Kristin Hady, a volunteer with the Aggie Fund, an abortion fund in northwest Ohio. “It’s a huge hurdle for people to have to leave their hometown for their health care.”
Northwest Ohio
Toledo used to have two full-service abortion clinics – the Center for Choice and the Capital Care Network. However, the Center for Choice closed in 2013 when it could not reach a transfer agreement.
Coincidentally, the number of abortions performed by out-of-state residents in Michigan rose from 531 in 2012 to 906 in 2013 to 1,308 in 2014, according to data from Abortion Forward. Michigan’s data does not reveal which state the patients are from, Miracle said.
Capital Care changed ownership in 2019 and became a medication abortion facility. According to the Guttmacher Institute, medication abortions will account for 63% of all abortions in the formal health care system by 2023.
Today, the clinic is called the Toledo Women’s Center and its sister clinic is the Northeast Ohio Women’s Center. That means women from the Toledo area typically go either there or to Michigan, Hady said.
Michigan performed 1,162 abortions on out-of-state residents in 2018, 1,437 in 2019, and 1,621 in 2020. In 2022, there were 2,761 out-of-state abortions in Michigan.
Now that abortion is protected under Ohio’s Constitution, Miracle hopes abortion access will be expanded.
“We hope that … more people will be interested in where these places are, so we should expand access,” she said.
