COLUMBUS, Ohio (WCMH) – Abortion remains a tug-of-war battle in Ohio, with advocates’ sights set on either stamping out – or keeping in check – the U.S. Supreme Court’s year-old decision to overturn the constitutional right to abortion. 

On the anniversary of the court’s ruling in Dobbs v. Jackson Women’s Health Organization, providers and patients in Ohio have scrambled to keep up with constantly changing abortion law, and advocates on both sides of the debate are gearing up for a contentious election cycle.

“There are so many people who thought that we would never even live to see Roe v. Wade overturned, and so to have that happen, it definitely caught a lot of us off-guard – in a good way,” said Ohio Right to Life spokesperson Elizabeth Marbach.

How abortion numbers changed in Ohio

In the six months since the Dobbs v. Jackson decision, Ohio abortion providers performed an estimated 4,290 fewer abortions – the fourth-largest drop in the country, according to an April report from the Society of Family Planning.

The sharpest decline in Ohio abortions occurred from June to July, the point at which Attorney General Dave Yost successfully petitioned a judge to reinforce the state’s six-week abortion ban, also known as the “heartbeat bill,” which had been placed on hold since 2019. The law, Senate Bill 23, provides no exceptions for rape or incest.

“We did see that there were lives that were saved, just from June until September when it was enacted that short period of time,” Marbach said.

Abortion procedures gradually ticked back up in September, when Hamilton County Common Pleas Judge Christian Jenkins issued a temporary injunction to block the law’s enforcement. After his ruling – in which he called abortion “undoubtedly healthcare” – the procedure was available up to 20 weeks' gestation.

The ever-changing nature of abortion law – both in and out of Ohio – left some residents scratching their heads about the legality of the procedure, which contributed to the decline in the number of abortions obtained, according to Sarah Hayford, a sociology professor at The Ohio State University and researcher at the nonpartisan reproductive health research collaborative Ohio Policy Evaluation Network.

“There’s been a back-and-forth between Ohio and Kentucky, sometimes when abortion has been restricted in both places, sometimes when it’s legal in one place and not the other place,” Hayford said. “So there’s a lot of flux.”

Dueling interpretations of Ohio’s abortion law

In the 11 weeks the heartbeat bill was in effect, Ohio politicians, physicians and advocates alike adopted wildly different interpretations of the types of patients that qualified for an abortion under the law.

For instance, when a 10-year-old rape victim – six weeks pregnant at the time – crossed Ohio lines to obtain an abortion in July, Yost appeared on Fox News to claim she didn’t have to leave the state for treatment.

Yost pointed to the three instances in which an abortion can be obtained under the heartbeat bill: to prevent the death of the mother, due to a “serious risk of the substantial and irreversible impairment of a major bodily function of the pregnant mother,” and in ectopic pregnancies.

But it’s unclear whether a 10-year-old giving birth constitutes a “serious risk of substantial and irreversible impairment” to their body. In Ohio, more than 230 Ohioans between the ages of 10 and 14 obtained an abortion in 2016, according to the Ohio Department of Health.

“When the language in the bill isn’t precise, they (medical professionals) have a hard time interpreting it; they may go to their hospital administration to interpret it; the hospital administration has to work on sort of this specific case, how to interpret the policy,” Hayford said. “So again, it adds a lot of levels of confusion.”

Shortly after Jenkins released his decision to temporarily block the heartbeat bill, Senate President Matt Huffman (R-Lima) said his caucus would revisit Senate Bill 23 to clarify language pertaining to its exceptions that critics called vague.

Gov. Mike DeWine echoed Huffman’s sentiment to the Statehouse News Bureau in April, when he urged lawmakers to moderate the bill’s language to better reflect the public opinion of Ohioans, 54% of whom said they oppose the state’s six-week ban in an October poll.

Marbach said while the organization supports any effort to bring clarification to the law, its language is already quite clear as to who is exempt from the law’s restrictions.

“The wording in that is pretty clear about protecting the life of the mother,” she said. “However, I would say our top legislative priority going forward – from now until it really gets done – our North Star is always to end abortion from conception.”

The heartbeat law’s “ambiguous” language had profound effects in operating rooms across Ohio, too, said Dr. Amy Burkett, an OBGYN at the Cleveland Clinic.

Under SB 23, doctors who performed an abortion after six weeks faced a fifth-degree felony charge. With the threat of jail time and license revocation dangling over their heads, Burkett said she and her fellow physicians were forced to err on the side of caution, potentially leading to delays in patient’s care.

“Living under a time period where you’re doing the right thing for a patient and it’s illegal was not something I thought I would experience in my career – that doing the right thing was not supported by my state legislature,” she said.

To date, no legislation nor amendments aimed at tackling some of the suggested clarifications to the heartbeat law have been introduced, a Huffman spokesperson said.

Ohio’s six-week abortion ban also hurt hospitals’ ability to recruit the “best and brightest” health care professionals, Burkett said. In April, the Association of American Medical Colleges found that states with restrictive abortion bans saw greater declines in the number of medical students’ residency applications than those with looser abortion laws.

“You don't want to train in the state where you can’t provide the care,” Burkett said, “and you don't want to necessarily live in the state where you can't get the care.”

But Beth Vanderkooi, executive director of the Greater Columbus Right to Life, said that argument goes both ways. In coming weeks, she said a new organization Do No Harm Ohio – a coalition of anti-abortion health care professionals – is poised to campaign against the November ballot initiative, fearful of its potential to drive anti-abortion physicians out of the state.

“You don’t see a massive desire for people who are actually practicing medicine and willing to be the person who is actually going in there and terminating a pregnancy,” Vanderkooi said. “You just don’t see that.”

A looming abortion battleground

Dr. Lauren Beene, executive director of Ohio Physicians for Reproductive Rights, said the abortion rights amendment eyed for the November ballot is their solution to remedying the “poorly written” laws currently on the books.

The physicians’ group, part of a larger Protect Choice Ohio coalition, is confident that it will collect enough signatures to place the amendment – which restores abortion rights up to the point of fetal viability – on the November ballot.

Even with the threat of Issue 1 – which will ask voters on the August ballot whether to require 60% of voter support to amend the state constitution, as opposed to the current 50% plus one vote – the physicians’ group is confident it has the support to enshrine abortion into Ohio’s constitution.

“We think we could possibly win our amendment both at a supermajority and a majority,” said Dr. Marcela Azevedo, a Cleveland-based ICU physician and member of the Ohio Physicians for Reproductive Rights.

Conversely, Vanderkooi said anti-abortion groups across Ohio are drumming up support for Issue 1, not only to prevent abortion from being enshrined into the state constitution – but a plethora of other issues that don’t belong in Ohio’s founding document.

In November, Vanderkooi said she hopes Ohioans will continue the U.S. Supreme Court’s momentum in upholding the dignity of human life by voting against the “extreme and dangerous” abortion rights amendment.

“This is less a mere matter of Constitution,” Vanderkooi said. “It’s also a matter of making sure that women are empowered to choose life, and that has always been our goal: to live in a world where abortion is not necessary, it’s not needed, and it’s not wanted.”

A legal challenge to Jenkins’ preliminary injunction against SB 23 remains pending before the Ohio Supreme Court.