Ohio sees spike in out-of-state abortions, but access to abortion care can be challenging

Even though abortion is legal in Ohio, accessing abortion care can be burdensome

Northwest and Southeast Ohio don’t have any surgical abortion centers — meaning folks in those corners of the state have to travel far distances, sometimes even going out-of-state, to receive abortion care. 

“People go wherever they can get in quickest and that might be Columbus, it might be Cleveland, it might be Cincinnati, it might be Pennsylvania,” said Erica Wilson-Domer, president and CEO of Planned Parenthood of Greater Ohio. 

But for those in neighboring states with near-total bans, Ohio can be an abortion destination.  

“We’ve seen about a 25% uptick in travelers,” Wilson-Domer said. “I know that Southwest Ohio has seen they’ve doubled their volume of travelers from out of state, if not more.”

There were 18,488 abortions performed in Ohio in 2022, a 27.4% decrease compared to 2012, according to Abortion Forward. Of those abortions, 1,287 were people who came to Ohio from a different state, according to Abortion Forward. 

“People need abortion care,” said Abortion Forward Deputy Director Jaime Miracle. “When somebody decides to have an abortion, they should be able to get access to it, and they need access to it, and they’re going to do what they have to do to get access to it.”

Ohio has six surgical abortion clinics located in Columbus, Cleveland, Cincinnati, Bedford Heights, Cuyahoga Falls, and Dayton. Toledo’s abortion clinic switched to just a medication abortion facility in 2019. 

“Lack of clinics is a huge (barrier),” Miracle said. “We’ve lost nearly half of the abortion clinics in Ohio since 2011.” 

All 88 Ohio counties have an abortion facility within 99 miles as of February 2022, according to an Ohio Policy Evaluation Network (OPEN) report. 

“Choice on where to get care is very complex and very personal, so it’s important to have a lot of options out there so that people can be making those choices for what’s best for them,” said OPEN research scientist Mikaela Smith. 

Abortion is legal in Ohio up until 22 weeks of pregnancy. Ohio voters passed a ballot measure last year that added protections to abortion care and reproductive rights to the state’s constitution.

Neighboring states

Indiana, Kentucky and West Virginia all have near-total abortion bans — causing Ohio abortion clinics to be inundated with travelers, Wilson-Domer said. 

Indiana’s abortion ban took effect Aug. 1 2023. 

Kentucky’s abortion ban went into effect July 15, 2022. Before the ban, 48 Ohio women traveled down to Kentucky to get an abortion in 2022, according to data from Abortion Forward. 

West Virginia’s abortion ban took effect Sept. 16, 2022. One hundred and three Ohioians went to West Virginia for an abortion earlier that year — accounting for about 15% of the total abortions that were performed in West Virginia in 2022, according to data from Abortion Forward. 

“There’s a whole bunch of people who live right across the Ohio border in Charleston, West Virginia that don’t have access to abortion care in their state anymore, so where are they going?” Miracle asked. “A clinic in Southeast Ohio would not only help the people in Southeast Ohio … but also would help a whole lot of people in West Virginia and rural Kentucky who are probably closer to going into Pennsylvania or into Virginia … to get access to care.”

There is no limit on abortion in Michigan, meaning a woman can abort her pregnancy at any point. Michigan has 26 in-person abortion providers, according to AbortionFinder.org. 

Abortion is legal in Pennsylvania through the 23rd week of pregnancy and there are 21 in-person abortion providers, according to AbortionFinder.org. 

An estimated 1,260 Ohioans went to Michigan to receive an abortion in 2023, 920 went to Pennsylvania, 230 went to Illinois and 100 went to Virginia, according to the Guttmacher Institute. 

Access barriers 

There are a variety of barriers when it comes to abortion access, including some that are unique to Ohio.

One is Ohio’s transfer agreement. The state requires an abortion clinic to have a transfer agreement with a hospital within 30 miles of the clinic so a patient can be transferred if medical care “beyond the care that can be provided at the ambulatory surgical facility” is needed.

“The transfer agreement is completely medically unnecessary because any patient that gets sent to an ER is going to be treated,” Wilson-Domer said.

State funded hospitals can’t sign a transfer agreement. 

“In many places, the only non-state funded hospitals are Catholic hospitals … (that) obviously are not going to sign a transfer agreement with an abortion provider,” Wilson-Domer said. “So this makes it incredibly challenging to operate a surgical facility with all of the trap laws that are sort of surrounding abortion care in Ohio.”

There’s also a 24-hour waiting period in Ohio, meaning women have to go to an abortion clinic twice. The ACLU and Planned Parenthood Federation of America filed a lawsuit in ​​the Franklin County Court of Common Pleas earlier this year that would undue Ohio’s 24-hour waiting period.

Transportation is a big barrier for people. Cost is another hurdle. 

Depending on the location and the provider, a first trimester abortion can cost around $800 or less, but the cost of a second trimester abortion can range from $715 to $2,000, according to Planned Parenthood. There can be additional costs that accompany getting an abortion including childcare, lodging, travel and food.

“All of those costs just increase anytime someone has to leave, and it can really put abortion care out of reach for too many people,” said Kristin Hady, a volunteer with the Aggie Fund, a Northwest Ohio abortion fund. “It’s a huge barrier for people to have to travel out of the places that they live for their health care.”

Northwest Ohio 

Toledo used to have two full-service abortion clinics — Center for Choice and Capital Care Network. But the Center for Choice closed in 2013 when it was unable to get a transfer agreement. 

Coincidentally, the number of out-of-state residents getting abortions in Michigan jumped from 531 in 2012 to 906 in 2013 to 1,308 in 2014, according to data from Abortion Forward. Michigan’s data doesn’t track which state patients come from, Miracle said. 

Capital Care changed ownership in 2019 and switched to a medication abortion facility. Medication abortions accounted for 63%  of all abortions in the formal health care system in 2023, according to the Guttmacher Institute. 

Today, the clinic is called Toledo Women’s Center and their sister clinic is Northeast Ohio Women’s Center, meaning women in the Toledo area typically either go there or Michigan, Hady said. 

Michigan performed 1,162 abortions on out-of-state residents in 2018; 1,437 in 2019; and 1,621 in 2020. There were 2,761 out-of-state abortions in Michigan in 2022.

Now that abortion is protected in the Ohio’s constitution, Miracle hopes abortion access will expand. 

“It’s our hope that … more people will start looking into where these places are that we should expand access,” she said. 

This story was originally published by the Ohio Capital Journal