'Living in Ohilead:' Budget, heartbeat bill, and state of Ohio reproductive rights

Jul. 28—Ohio just tightened access to abortion and other reproductive freedoms.

When Gov. Mike DeWine signed off on the state budget on July 1, he implemented three provisions that will restrict transfer variance for abortion clinics, expand conscious clauses, and regulate sex education. The changes are the latest in a long line of policies clamping down on reproductive rights that officials say will make it even harder for women to access abortion services in northwest Ohio, despite the area being home to one of the state's only clinics.

"We've lost more than half of the clinics that provide the full extent of abortion care since 2011 and that's the result of restrictions that have been added to the state budget and that the Republican legislators have passed," NARAL Pro-Choice Ohio's Executive Director Kellie Copeland said.

The new restrictions will only make it harder for the remaining clinics to keep their doors open, she said.

Under Ohio law, abortion clinics must have transfer agreements with local hospitals or variances, contracts between clinics and doctors confirming that the doctor will come to the clinic and treat patients in case of emergency. Under the new law, those doctors must now work within 25 miles of the clinic and are prohibited from teaching at public hospitals or medical schools.

The residency rule would immediately endanger operations at existing clinics by forcing doctors to choose between stable practice and providing critical medical care, reproductive rights advocates say. It also impacts the ability for variance doctors to educate others about abortion services. There are doctors at Women's Med in Dayton, for example, who teach at Wright State University's Boonshoft School of Medicine.

Proponents for the rule say it would hold abortion clinics to the same standards as other medical facilities.

"The variance issue applies to every single facility in Ohio," Michael Gonidakis, the president of Ohio Right to Life, said. "If you're a laser eye surgery facility, an ENT doctor, or an abortion clinic, there are rules you have to follow."

Kristin Hady with Capital Care in West Toledo defends the services they provide for women and worries about the impact the new policies will have on making care accessible to every patient.

She walks with each patient, blocking them from an onslaught of verbal — and sometimes physical — attacks as they enter the clinic. On some of the worst days, she's witnessed anti-abortion protestors following, grabbing, or trying to get in cars with Capital Care clients. She likened it to "living in Ohilead," a reference to Margaret Atwood's The Handmaid's Tale.

Historically, Capital Care's patients have come from all over Ohio, as well as neighboring states Indiana and Michigan, to access medication abortions, but not everyone has the ability to cross state lines, Ms. Hady said. Imposing additional restrictions could force clinics to close, widening the gaps in access to care, she said.

Health care should be accessible to all, Ms. Copeland agreed.

"Most deeply impacted are younger people, people who are struggling to make ends meet, people of color, and people who are non-binary or transgender," Ms. Copeland said. "We have a situation in Ohio and across the country where people of wealth and means can still access the care they need."

Legal abortions available for Ohioans grew more difficult in 2011 with the introduction of the so-called "heartbeat bill," which would penalize doctors who perform abortions once a fetal heartbeat can be detected. A heartbeat usually begins after six weeks of gestation, a time at which many women do not yet know they are pregnant.

Mr. DeWine signed the bill in 2019, but just before the law was to go into effect, a federal judge blocked the provision. The heartbeat bill remains in limbo, but if the Supreme Court votes to overturn the landmark abortion rights case, Roe v. Wade, next June, it can still become law.

Currently, Ohio women may choose to get an abortion until they have been carrying for 20 weeks.

Also included in the latest state budget is the "Medical Practitioner Conscience Clause," which strengthens the ability of health care practitioners, hospitals, and insurance companies to deny treatment or compensation based on moral, ethical, or religious grounds.

Reproductive rights activists lambast the clause, and they are not the only ones who are angry. Human Rights Campaign President Alphonso David called it a "dangerous provision" that will allow medical professionals to refuse to treat LGBTQ+ individuals because of their sexuality.

Center for Christian Virtue President Aaron Baer dismissed these concerns as "fear-mongering."

Sex education restrictions also were added. Now, schools must notify parents if they are to teach sex education content, including contraceptives or prevention for sexually transmitted infections, beyond abstinence-only policies, and schools will have to report the teachers, curricula, and materials used in health classes.

Opponents argue that the provision is either an attack on evidence-based sex education or a way to increase classroom oversight.

It is unclear how the new legislation will impact many students in Lucas and Wood counties.

Alexander Clarkson, director of Secondary Teaching and Learning at Sylvania Schools, said he's not sure what exactly came up in the district's health curriculum because it has never been an issue before, but they will be complying.

"With the new requirement by the state, we will be reviewing and assessing what sex ed is happening in classrooms," he said.

Perrysburg Schools is awaiting guidance from the Ohio Department of Education before proceeding with any changes, a spokesman said.

Advocates on both sides of the reproductive rights argument claim that their ultimate goal is to become obsolete: pro-life groups want to permanently ban abortion and pro-choice groups want it embedded in the Constitution.

But the question of what will happen to abortion is far from a forgone conclusion.

The Supreme Court currently has a conservative majority. Though they have made unpredictable decisions this cycle, many believe that they will decide to overturn Roe in the Mississippi Department of Health v. Jackson Women's Health case.

If Roe falls, the abortion question will fall back to the states, Mr. Gonidakis said, and the divide between conservative and liberal swaths of the country may grow starker.

First Published July 28, 2021, 1:13pm