COLUMBUS, Ohio (WCMH) – Thursday ushers in a new era for abortion in Ohio – even if the impacts of the constitutional right to the procedure aren’t immediately realized.

Issue 1, which voters passed Nov. 7 with more than 56% support, enshrines the right to abortion and other reproductive health care in the Ohio Constitution. Under the state constitution, bans on the procedure before viability – as determined by a person’s physician – are prohibited, and restrictions on the procedure after viability must promote the life and health of the pregnant person.

Any abortion regulations impacting access to the procedure pre-viability must be the least restrictive way to promote patient health and based on “widely accepted and evidence-based standards of care,” the constitutional provision says. It also protects people’s right to make decisions about fertility treatment, miscarriage care, contraception and pregnancy more generally.

What about Ohio’s six-week ban?

There is no fixed point at which a fetus may become viable, but it most often occurs between the 22nd and 24th week of gestation. With the amendment going into effect Thursday, legal experts – including those against abortion – agree that the nicknamed “Heartbeat Law,” a suite of restrictions that amount to a six-week ban on the procedure, does not pass muster. 

While it’s likely that the six-week ban will be struck down under the new constitutional provision, its immediate future is not quite certain.

Abortion clinics and Attorney General Dave Yost’s office, locked in a legal battle over the six-week ban, have until Thursday to tell the Ohio Supreme Court how Issue 1’s passage may affect the case. In a court filing Monday, Lucas County Prosecutor Julia Bates, a defendant in the suit, wrote that Issue 1’s passage rendered the Heartbeat Act unconstitutional and urged the court to dismiss the suit for mootness.

It’s something Yost himself said before and after Issue 1’s passage. If it chooses to send the six-week ban back to the lower court for review, the high court can either allow a block on the ban to remain in effect or nullify it. It can also dismiss the suit outright.

What about other abortion restrictions?

The fate of Ohio’s more than 30 other laws restricting access to the procedure is far less clear. Many statutes restrict the procedure at all stages of pregnancy, from required 24-hour waiting periods to onerous record-keeping rules to hefty regulations on facilities that perform abortions. Abortion rights advocates have said many existing laws don’t promote patients’ health but rather are barriers to care.

Democratic Reps. Anita Somani (Dublin) and Beth Liston (Dublin) have introduced a bill to repeal many of the restrictions on abortion access – including the six-week ban, the 20-week viability ban, the 24-hour waiting period and requirements for clinics to have transfer agreements with hospitals. The lawmakers, both doctors, specifically left out the law requiring parental consent for minors to undergo the procedure, saying at a news conference last month that parental consent requirements are well-established in the medical field and have withstood legal challenges.

The proposal, however, is not likely to garner the support of Republicans, many of whom have vowed to use their legislative supermajority to preserve abortion restrictions.

Will more clinics pop up? What about access in rural counties?

Dozens of restrictions on providers are likely to remain in effect unless successfully challenged in court, impacting access to the procedure despite the constitutional guarantee. There are only nine abortion clinics in the state, all of which are concentrated in urban areas.

Three of Ohio’s nine abortion clinics provide only medication abortions, the first dose of which must be administered in person by a physician. Of clinics that do provide abortion procedures, three provide the procedure up until the legal limit – currently until 22 weeks – with others offering it until 15 to 19 weeks gestation.

Unless repealed or struck down, provider restrictions will likely make it impossible for clinics to pop up in many rural areas of the state, considering that clinics must have agreements with hospitals within 30 miles of their facilities. Public hospitals – like those run by public universities – are forbidden from entering into such agreements.

According to March of Dimes, which researches maternal and infant health, nearly 15% of Ohio’s 88 counties lack a single OB-GYN or hospital providing obstetric care, and more than 10% of women in those counties lack health insurance. Another third of counties have only one hospital providing obstetric care.

In Michigan, which passed a similar amendment in November 2022, the new constitutional right to abortion did not immediately increase access to the procedure, especially for rural pregnant people. Only two of Michigan’s 26 in-person providers offer the procedure up until the legal limit; 10 of those clinics only offer medication abortions up to 11 weeks.

All Michigan clinics that offer abortions at 20 weeks and later are located in the southeasternmost part of the state. Only medication abortion is available in northern Michigan, including from the sole provider in the Upper Peninsula.