With New Abortion Restrictions, Ohio Walks a Narrow Legal Line
Under a law that took effect in Ohio this month, the Cleveland abortion
clinic she visited had to offer her a chance not only to view an
ultrasound of the fetus but also to watch its beating heart, which she
said she resented.
“It’s a hard decision for anybody to make,” she said of abortion, asking
that her surname not be published out of privacy concerns. “To make it
more difficult by passing these laws and making women feel guilty is
terrible.”
Ohio has become a laboratory for what anti-abortion leaders call the
incremental strategy — passing a web of rules designed to push the hazy
boundaries of Supreme Court guidelines without flagrantly violating
them. Many of the rules, critics say, are designed to discourage women
from getting abortions or to hamper clinic operations, even forcing some
to close.
The mandated discussion of fetal heartbeats is one of a cascade of
abortion restrictions adopted in Ohio over the years, from a waiting
period to curbs on the medication-induced abortions preferred by many
women. The pace has quickened since John R. Kasich became governor in
2011, cementing Republican domination of state politics. Avowedly
anti-abortion, Mr. Kasich said through a spokesman that he considered
the restrictions he signed this year “reasonable.”
These laws have passed without the national drama provoked by
far-reaching abortion bans that were approved, then overturned in court,
in states like Arkansas and North Dakota.
But taken together, they affect patients and clinics in myriad ways —
in the view of the laws’ proponents, rightly making women think twice
before ending a pregnancy and ensuring clinic safety or, in the view of
opponents, imposing heartless obstacles and guilt on women who are
seeking a legal procedure.
“In Ohio, the last few years have been fantastic if you support the pro-life movement,” said Mike Gonidakis, the president of Ohio Right to Life.
His group has even lobbied against a more sweeping ban on early-term
abortions, incurring the wrath of more restless abortion foes. But he
says, “We’ve been able to craft pro-life laws that can withstand court
scrutiny.”
On Wednesday, the American Civil Liberties Union filed a challenge in
state court to the heartbeat mandate and other new restrictions,
asserting that they were adopted in violation of the Ohio Constitution’s
“single subject” rule because they were part of an unrelated budget
bill.
More broadly, abortion-rights advocates call the incremental strategy,
which has been refined by several national groups and pursued in a
number of states, an insidious way to limit access to abortion and shame
women who in many cases already have to walk past shouting protesters
to enter clinics.
“If you can’t outlaw abortion outright, just make it harder and harder to get,” said Chrisse France, the executive director of Preterm,
a large nonprofit abortion clinic on the East Side of Cleveland that
performs about 4,900 abortions a year, mainly for low-income women.
“They say they’re doing this to protect women’s health, but some of the
laws are actually harmful, and some are just cruel.”
Conversations with patients at Preterm revealed diverse reactions to the
mandated waiting period and counseling, but no sign that any women were
changing course.
Madelyn Puterbaugh, 23, said that her birth control had failed and that
it was “not the right time” for her to bear a child. She said she had
turned down the chance to view the fetal heartbeat. “I didn’t look,” she
said. “I thought I’d be too sad.”
She went ahead with the abortion, but said she had not minded the
required 24-hour wait between the counseling and the procedure. “They
gave me a lot to think about,” she said, “but it’s my choice.”
Ohio has long required abortion clinics to have a formal transfer
agreement with a nearby hospital for emergency care, something
physicians say is medically unnecessary because hospitals are required
to treat emergency patients. Now, a new measure bars public hospitals
from signing such agreements — a shift that could force two or three of
the state’s remaining 11 clinics to close because they cannot find
willing partners.
Other measures wrapped into the state budget bill this year, and signed
by Governor Kasich, include a requirement that women seeking an abortion
be told the probable odds that their pregnancy would go to full term if
they changed their minds; a diversion of federal welfare money to
so-called crisis pregnancy centers; new financing for rape-crisis
centers on the condition that they provide no abortion referrals; and a
tightening of parental consent requirements for minors.
To avoid passing money to Planned Parenthood, the state also ended
competitive bidding for federal family planning grants, giving priority
to public agencies. As a result, some nonprofit women’s health centers
that have no connection to Planned Parenthood or abortion also face
drastic cuts.
The newest rules follow a flurry of changes in 2011, when, among other
things, the state banned abortions, except to save the mother’s life,
once the fetus is viable. Fearing potential criminal charges, clinic
doctors around the state have stopped performing abortions beyond the
22nd week of pregnancy, even in cases involving severe birth defects or
serious medical conditions.
Since a federal court allowed it here in 2011 after years of litigation,
Ohio has been the only state to require what doctors call an outdated,
less safe and less effective regimen for medication abortions.
The law mandates adherence to the original Food and Drug Administration
approval, which called for three times the drug dosage now standard and
authorized the method only through seven weeks of pregnancy. As a
result, while later studies showed them to be safe through nine weeks,
medication abortions can no longer be offered in the eighth and ninth
weeks of pregnancy.
Similar restrictions on medication abortion were passed this year in
Texas and are under court challenge; they have been voided as
unconstitutional barriers in North Dakota and in Oklahoma, which is
seeking a review by the Supreme Court.
At Preterm, the annual number of nonsurgical abortions plummeted to 90
in 2012 from more than 600 in earlier years. But “there’s no evidence
that this cut down on abortion,” said Ms. France, the clinic director.
“Women just said, ‘Never mind, I’ll get a surgical abortion.’ ”
In Ohio, as elsewhere, abortions have declined over all in recent years,
although there was a slight uptick to 25,473 reported procedures in
2012, with black women accounting for a growing share. Whether the new
laws have significantly reduced the numbers or simply made abortions
more fraught is disputed.
Mr. Gonidakis, of Ohio Right to Life, said he felt sure the measures had
persuaded many women to change their minds and predicted that even
more, when confronted with the fetal heartbeat and other information,
would do so in the future.
“There are so many families waiting to adopt,” he added, offering an
alternative that crisis pregnancy centers and others are increasingly
promoting.
In the coming months, Mr. Gonidakis said, his organization plans to
focus its lobbying on the easing of state adoption rules and an increase
in tax breaks for adoptive parents.
But other anti-abortion groups and conservative legislators are pressing
ahead with a proposal to ban abortion altogether once a fetal heartbeat
is detectable, as early as six weeks into pregnancy
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