In June 2013, after 30 years in business, the Center for Choice performed its last abortion and closed its doors. The Toledo, Ohio, clinic had long been a target for anti-abortion activists — there was Marjorie Reed, the arsonist who set fire to the center in 1986, and a man staffers called “B.O. Bob,” a local schoolteacher who would call the clinic after hours, jamming up the voice mail box with his rants. But it was not firebombs or bellicose picketers that eventually forced the Center for Choice to close. The clinic packed it in because of a far more discreet, yet in some ways harder to ignore, incursion: a torrent of restrictions on abortions and abortion providers from Ohio’s statehouse.
“It started to feel like a witch hunt,” Sue Postal, the center’s director, told me in October. She always knew the anti-abortion movement was pushing legislation that would make her job more difficult, but the past five years have been some of the hardest for Ohio abortion providers, now that a new Republican, anti-abortion governor has taken over. “Under Kasich it’s happening.”
Since entering office in January 2011, John Kasich, Ohio’s governor and now a GOP presidential hopeful, has signed every abortion and women’s reproductive health provision that has landed on his desk. In four and a half years he has enacted 16 legislative proposals related to family planning funding and abortion access across the state. Although anti-abortion provisions are not limited to the Buckeye State — a July count from the Guttmacher Institute, an abortion-rights advocacy group, showed that 31 states have enacted a total of 282 abortion restrictions since January 2011 — Ohio stands out for the rate at which it’s adopting this legislation. The measures have altered when, where and by whom a pregnancy can be terminated in the state. And although Ohio is seen as a wild success story for anti-abortion advocates, the details of Kasich’s hard-line stance are often obscured. As governor he concealed his administration’s role in the creation of several anti-abortion measures, and now he is viewed as one of the most moderate candidates in a GOP race that tips far to the right.
Sue Postal, formerly the director of Center for Choice, in her Toledo home last month.
Iain Maitland
The Center for Choice in Toledo, Ohio, closed in 2013 because of difficulties securing an agreement with a local hospital to accept abortion patients in the event of a complication.
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Michael Gonidakis, president of the anti-abortion group Ohio Right to Life and a 2012 Kasich appointee to the state medical board, considers Ohio to be in a “golden era” for anti-abortion activism, with an anti-abortion supermajority in the state House and Senate. But he said the swift passage of new laws limiting abortion would not have been possible without Kasich’s leadership. “We’ve never had a governor in my lifetime that was laser-focused on the issue of life like John Kasich is today,” he said, later adding, “John Kasich deserves the credit for creating an environment and atmosphere here for the 65 [anti-abortion] members of the House and the 23 [anti-abortion] members of our Senate to pass a litany of pro-life bills.”
Since Kasich entered office, half of the state’s surgical abortion clinics have stopped providing abortion services, including Center for Choice. In 2011, there were 16 surgical abortion providers in Ohio serving nearly 2.3 million women of reproductive age. By 2013, the number had dropped to 14. The next year, after a slew of restrictions passed in the budget, that number dipped to 10. By 2015, eight abortion providers had closed their doors, moved to different states or stopped providing services. No state, other than Texas, with nearly 6 million women of reproductive age, has lost so many clinics in this span of time. After a clinic an hour south of Cleveland was approved this summer to start performing surgical abortions, the now nearly 2.5 million women of reproductive age in Ohio have nine surgical abortion providers to choose from. (Women in their first trimester of pregnancy have the option of abortion through surgery or medication. In 2014, only 5 percent of women who had abortions in Ohio opted for the medication method. The state requires doctors administering medication abortions to adhere to an older standard, one known to have high failure rates, and many of Ohio’s abortion providers do not offer abortions via medication for this reason.)
The slew of new provisions has meant not only fewer options but also more obstacles for women looking to terminate a pregnancy, and in turn it has affected who is able to get an abortion in the state.
Overall, abortions in Ohio were down 25 percent in 2014 from 2010, according to the state Department of Health. Nationally, abortion rates fell by 12 percent in that time period — a reduction that is in line with a downward trend that started in the 1990s, though some believe that trend has less to do with restrictions and more to do with a decrease in unwanted pregnancies.
According to state data, white women accounted for a slightly smaller share of those who got abortions in Ohio in 2014 compared with 2010. Abortions among teens fell 50 percent, a decrease that abortion-rights advocates attribute to a 2011 bill Kasich signed that made it more difficult for minors to obtain consent from a judge if they wanted an abortion without a parent or guardian’s permission.
Less-educated women were 42 percent less likely to get an abortion in 2014 than in 2010, and women were also getting abortions later in their pregnancies. Abortion-rights advocates say the reason for this latter trend is threefold: Women living in the 82 of Ohio’s 88 counties with no abortion provider must take into consideration the protracted travel times, the costs of getting to a clinic not once but twice (Ohio requires an ultrasound 24 hours before an abortion procedure), and the fact that there are longer wait times at the remaining clinics.
| NUMBER OF INDUCED ABORTIONS | ||||||
|---|---|---|---|---|---|---|
| AGE | 2010 | 2011 | 2012 | 2013 | 2014 | PERCENT CHANGE 2010 TO 2014 |
| 4.7k | 3.6k | 3.5k | 2.9k | 2.3k | -50% | |
| 20-29 | 16.2 | 14.6 | 14.8 | 13.8 | 12.7 | -21 |
| 30-39 | 6.2 | 5.6 | 6.2 | 5.6 | 5.4 | -12 |
| 40 | 0.8 | 0.8 | 0.8 | 0.7 | 0.7 | -17 |
| Education | ||||||
| 0.4 |
0.3 |
0.3 |
0.3 |
0.2 |
-52 |
|
| Grade 9-12 | 17.3 | 15.2 | 13.9 | 12.3 | 10.2 | -41 |
| A year or more of college | 9.9 | 8.8 | 10.2 | 9.6 | 9.4 | -5 |
| Gestation | ||||||
| 16.3 | 14.1 | 14.4 | 13.1 | 11.1 | -32 | |
| 9-12 weeks | 7.7 | 6.9 | 7.2 | 6.6 | 6.6 | -14 |
| 13-18 weeks | 3.2 | 2.9 | 3.2 | 2.9 | 3.0 | -8 |
| 19-20 weeks | 0.3 | 0.3 | 0.4 | 0.4 | 0.4 | 9 |
| 21 weeks | 0.5 | 0.4 | 0.2 | 0.2 | 0.1 | -71 |
In October, Sheva Guy, a 23-year-old doctoral student at the University of Cincinnati, publicly recounted her journey traveling more than 300 miles to get an abortion. Guy was about 22 weeks into her planned pregnancy when she learned that the fetus had a fatal spinal abnormality; she could carry the pregnancy to term and give birth to a stillborn baby or seek an abortion. The only clinic in the state that performs abortions at 22.5 weeks was booked, so it referred her to a clinic in Chicago. Guy estimated that the trip, including the procedure, cost $3,000.
In his first year at the helm, Kasich signed off on six abortion measures. One bill prohibited health plans on the state’s Obamacare insurance exchange from providing abortion coverage, except in cases of rape or incest or if the woman’s life was in danger. Another, the late-term ban, required doctors to test the viability of a fetus if a woman sought an abortion at 20 weeks or later in her pregnancy. Those early laws placed limits on the individuals seeking abortions, but as time progressed the legislation widened its target, aiming less at the consumer — women — and more at the provider — clinics.
Two years later, in June 2013, the same month Wendy Davis stood in the Texas statehouse for 11 hours filibustering a bill threatening to close 88 percent of her state’s 42 abortion providers, Kasich quietly signed a budget with some of Ohio’s most stringent abortion and family planning clauses — another six measures. Unlike Davis and the Texas measures, which received ample national media attention, Kasich’s budget flew under the radar. There was no YouTube live stream, no protesters cheering and singing, no infamous pink sneakers. Just a flick of a pen and some smiles for the local reporters.
Many of the provisions in the budget dealt specifically with how abortion providers in the state could operate, either through funding limitations or new mandatory procedures. One measure banned rape-crisis counselors in state-funded facilities from referring women to abortion services; another moved Planned Parenthood to the bottom of the list of organizations in Ohio receiving federal family planning dollars, stripping the organization of $1.4 million. One of the most controversial measures prohibited ambulatory surgical centers and public hospitals from entering into “transfer agreements,” mandatory pacts between an abortion provider and a hospital saying the latter will take patients in the case of a complication. This is the provision that eventually led Sue Postal to close the Center for Choice in Toledo.
When Kasich signed the state’s 2016-17 budget this summer, he enacted four more measures related to abortion and family planning, including the allotment of $1 million in tax dollars to crisis pregnancy centers, nonprofit facilities that offer pregnancy care — such as pregnancy tests, family planning courses and ultrasounds — that have been accused by abortion-rights advocates of trying to counsel women against having an abortion.
Abortion-rights advocates say these measures, while perhaps limited in effect individually, have an overwhelming effect on providers when working in concert. “I don’t want to give them credit, but the anti-choice movement has put together a very clear and concise campaign,” Postal said. “I think you notice just by the amount of legislation introduced. It’s nonstop.”
Gonidakis and other abortion foes call it the incrementalist approach. Instead of passing controversial bills that try to reverse Roe v. Wade, the plan calls for a series of laws that undermine abortion rights and ultimately, as they add up, force the 1973 Supreme Court ruling to collapse. “You get what you can now, you continue to demonstrate the pragmatic approach, the compassionate approach, and the next thing you know you wake up and you have 16 things done,” Gonidakis said.
Kasich, who served four years in the Ohio state Senate and 18 in the U.S. House of Representatives representing suburban Columbus, has long supported legislation limiting abortion. Among other anti-abortion bills he voted for during his House tenure were the Child Custody Protection Act, a 1998 bill that would have made it a federal crime to transport a minor across state lines for an abortion, and a 2000 ban on partial-birth abortions, an uncommon late-term procedure.
His campaign spokesman, Robert Nichols, declined to comment for this article and instead directed me to a section of the campaign website titled “Respecting the Sanctity of Human Life.” The page highlights Kasich’s anti-abortion accomplishments as governor, with a section explaining that he has “enacted more measures to protect unborn children than any other governor in the history of the state, including bans on late-term abortions and bans on elective abortions in public hospitals.”
Beyond this, however, Kasich’s 2016 presidential campaign has so far largely glossed over his role in passing anti-abortion legislation in Ohio as he seeks to position himself as the most moderate and mainstream candidate in the GOP race. He supports Medicaid expansion, stands behind the Common Core educational standards, is open to immigration reform and believes in climate change. When abortion does come up, his public statements are succinct; he explains that he is “pro-life,” like all the other GOP candidates, but does not go into detail. In an August interview with CNN’s Dana Bash, Kasich said conservatives focus “too much” on the topic and should instead turn their attention to other issues like “early childhood, infant mortality, the environment, education” — all topics that generally highlight his centrism and set him apart from his conservative competition.
The comment was picked up by abortion-rights advocates and opponents, who both wondered why Kasich was shying away from the success of anti-abortion legislation in Ohio. To abortion foes, Kasich’s record is a point of pride. “He needs to get his message out that he is pro-life and he can show his body of work,” Gonidakis said.
Abortion-rights advocates feel similarly but for different reasons: They want to make sure voters who may like Kasich for his moderate stances on other issues also know where he stands on abortion. Kasich “hides behind a moderate mask, but the truth is he has been quietly working behind the scenes to impose his radical personal views on Ohioans,” said Kellie Copeland, executive director of NARAL Ohio, an abortion-rights advocacy group.
Recently uncovered emails reported on by The Associated Press show that Kasich’s office helped craft abortion legislation that showed up in the 2014-15 budget, legislation that he had claimed no knowledge of or involvement with before the measures were introduced in the House. When asked during a public forum whether he would veto the measures, Kasich gave the air of a more neutral observer, saying he still had to mull the provisions over: “First of all, I’m pro-life, so we’ll have to see how this proceeds through the House and Senate and the conference committee. Then I’ll make a decision on that as to whether I think it goes too far, but keep in mind I’m pro-life.”
A few weeks later, Kasich vetoed 22 amendments in the budget, including a provision that would have blocked the expansion of Medicaid — a win for liberals in the state. He then signed on to six anti-abortion measures, two of which his team had helped to mold.
Capital Care Network’s clinic in Akron closed in April 2013. A state inspection identified issues that could have affected patient safety, and the clinic was given the option to fix the issues or to close.
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Akron Women’s Medical Group remains open.
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The provision in the budget that prohibited transfer agreements between abortion providers and public hospitals is considered the most controversial that Kasich signed. Although these pacts, which are required in seven other states, have been a requisite for Ohio abortion providers since 1996, the new rule greatly limited the pool of potential partners.
In addition to the Center for Choice, four other clinics in Ohio, where 15 percent of private hospitals are Catholic, have since stopped providing abortions because they were unable to find emergency care centers to team up with. If an abortion provider can’t find a private hospital that will agree to a transfer arrangement, it will likely lose its license.
“It was an evolution in our strategy,” explained Gonidakis, whose organization was involved in drafting these provisions as well as the 14 others enacted under Kasich. “Because of Roe v. Wade we unfortunately can only do so much as it relates to bans and restrictions on the timing and timeline of abortions.” Although legislation relating to how late a pregnancy can be terminated, for example, is often tied up in lawsuits, a state has more freedom in how it regulates health care. Adopting measures that placed limits on how abortion providers could operate became the method of choice for anti-abortion advocates who wanted to make abortion rare without running the risk of losing a fight in court, where the precedent set by Roe v. Wade allows women to have an abortion up until the point of fetal viability (which at the time was defined as between 24 and 28 weeks).
If an abortion provider in Ohio is unable to find a private hospital to partner with, it can apply for a variance, a pact with local doctors from either a public or private hospital — physicians from the former must get a private hospital to sign off on admitting privileges. The approval of a variance application comes from the director of the state Department of Health, Richard Hodges, a former director of the Ohio Turnpike Commission whom Kasich appointed to lead the health department in 2014, and it’s not guaranteed. Hodges denied a variance from Planned Parenthood of Southwest Ohio because its final application listed three partner physicians when it had originally listed four. A further provision in Ohio’s latest budget says that variance applications are automatically denied after 60 days if Hodges doesn’t respond.
Capital Care Network, Toledo’s only remaining abortion provider, thought it had found a way to get around the transfer agreement law without applying for a variance. After being dropped by the University of Toledo — a public hospital — Capital Care Network entered into a transfer agreement with the University of Michigan Health System, a public hospital but one that doesn’t receive funds from the state of Ohio.
Shortly after, the Department of Health notified the clinic that the Ann Arbor, Michigan, hospital was too far away — 50 miles — to be considered “local.” It tried to revoke the clinic’s license — a move that would have left Lucas County, and the 87,568 reproductive-age women living there, without an abortion provider. A county judge ruled this summer that the clinic’s transfer agreement was valid and it could stay open.
Two weeks later, Kasich signed Ohio’s 2016-17 budget, which included a measure that defined “local” for the purposes of the transfer agreements as within 30 miles. The clinic is scrambling to find a new partner hospital; however, the only nonreligious, private hospital within 30 miles, ProMedica, has declined to partner with Capital Care, saying it doesn’t want to get involved with politics.
Three of the nine licensed surgical centers in Ohio — serving Toledo, Cincinnati and Dayton — have uncertain futures because of the new transfer agreement requirements. If clinics close in all three cities, there will be no abortion provider on the west side of the state.
Carol Dunn, the founder of Center for Choice, in the Toledo home of Sue Postal, the clinic’s former director, last month.
Iain Maitland
The Center for Choice in the late 1980s. The clinic closed in 2013.
Courtesy of Carol Dunn
Abortion-rights advocates say the transfer agreement provisions threaten to send Ohio back to an earlier era. Carol Dunn, who founded the Center for Choice in 1983, recalled helping to connect Ohio women seeking abortions to providers in New York, where abortion became legal in 1970. She worked for Planned Parenthood as a referral agent to what “the stewardess” called the “abortion flight”: a direct flight between Toledo and New York’s LaGuardia Airport. The Supreme Court’s decision in Roe v. Wade in 1973 brought this long-distance traveling to an end. With abortion legal in every state, it was no longer necessary to cross state lines.
But there’s evidence that some Ohio women, like Sheva Guy, are seeking abortions elsewhere as restrictions tighten. A recent Associated Press survey tracked abortion rates in every state since 2010 and found declines in all but two: Michigan and Louisiana. Both states have Republican governors and their own share of abortion restrictions, but their legislation has not closed clinics at the same rate as their more forcefully anti-abortion neighbors: Ohio and Texas.
Michigan has seen a 43.7 percent decrease in abortions since 1987 — when the number hit an all-time high — however, it started to see an uptick in 2013. From 2012 to 2013 abortions rose by 11.6 percent, and from 2013 to 2014 they increased 5.8 percent. Data from Michigan’s health department shows that the number of abortions performed on nonresidents jumped from 708 in 2013 to 1,318 in 2014, an increase of 86 percent. That same year, Ohio saw an 8.7 percent reduction in abortions; Lucas County, on Michigan’s border, saw a 44 percent decrease.
The county accounted for 9.1 percent of Ohio’s abortions in 2010, the year before Kasich entered office. That share fell to 7.7 percent in 2012, the year before the law prohibiting public hospitals from entering into transfer agreements with abortion providers. In 2014, the year after Center for Choice closed, Michigan continued to see a spike in abortions, and Lucas County accounted for 3.5 percent of Ohio’s abortions. No other county in Ohio has seen such a big drop.
Today, if you navigate to Center for Choice’s website you are redirected to a site advertising Northland Family Planning Centers — a trio of clinics in Michigan’s metro Detroit area that Postal and Dunn trust to care for the Center for Choice’s former patients. “Relax … you are not in the wrong place,” reads the text, noting that Northland’s Westland clinic is only 60 miles away.
CORRECTION (Dec. 2, 12:04 p.m.): An earlier version of the map in this article, depicting the reduction in the number of Ohio abortion clinics, showed a circle that was too large for the number of clinics in Cincinnati in 2010; the number declined from two in 2010 to one in 2014. The map has been updated to show a smaller circle.