Ohio is known for having some of the strictest and most unnecessary regulations on abortion care in the country.
Since John Kasich took office as governor of Ohio in 2011 he has enacted 20 anti-choice provisions that have severely affected access to reproductive health care throughout the State. There are only eight abortion clinics left in Ohio, leaving 91% of counties without an abortion provider. Because many healthcare plans are banned from covering abortions, while mandatory waiting periods as well as clinic closings have made travel costs alone unmanageable for some women, abortion care is financially out of reach for many women.
Evaluating the State of Choice does not stop at simply looking at abortion statistics. Birth and fertility rate, contraception access, sexual education, prenatal care, adequate OB/GYN services, domestic and sexual violence rates and response programs, paid family leave, the state of foster care and a whole host of other issues impact reproductive decisions and create a clearer picture of the safety conditions of women in Ohio.
The purpose of this report is to make Ohio specific data on all issues related to choice accessible in one consolidated resource. This report does not include original research but rather is a collection of information, data and statistics from other sources, including private and public health research projects, Ohio Department of Health collected data, and national government statistics collection sources. The report is intended to create as comprehensive as possible a picture of the state of reproductive choice in Ohio, with currently available data sources.
Most of the research presented in this article reports only along the gender binary, categorizing groups as either female or male. The erasure of transgender and non-binary individuals is a problem with this research; therefore the information in this report should not be considered complete. There is virtually no Ohio-specific data on reproductive care and choice for transgender and non-binary people. There should be more research done on the reproductive needs and barriers to choice that the Ohio transgender and non-binary community face.
There are limitations to the data in the report. In many cases the data available is at best a couple years old and in the worst cases almost a decade out of date. It will be useful to have this older data as a baseline to compare with new numbers as studies are released. However it is difficult to evaluate the current situation in some areas related to choice such as, for example, paid family leave, where the most recent Ohio-specific statistics are from 2007. Furthermore, socio-economic status is either not tracked or under-covered in many of the studies across all of the reproductive issues included in this report. Financial obstacles are one of the biggest barriers to access and control. The lack of demographic information related to economic status or income is a problem in evaluating who has reproductive choice in Ohio. Additionally, data in this first report is limited to the physical health and wellbeing of women. It is our hope that future issues of the report will also include information on mental health and substance use and abuse as it relates to women’s health in our state.
Ohio is known as an epicenter for health services, with world-class facilities such as the Cleveland Clinic and The Ohio State University Medical Center; yet women are being forced to leave the state to access abortion care. Ohio’s total numbers of induced abortions decreased in recent years while at the same time Michigan’s abortion numbers have increased. From 2012 to 2014 the total number of abortions in Michigan increased 18.2 % (Michigan Department of Community Health, 2014 and 2015). The number of out-of-state residents receiving abortion care in Michigan also increased from 531 in 2012 to 1,300 in 2014 (Michigan Department of Community Health, 2014 and 2015). The number of abortions in Lucas County, which borders Michigan and where one of Ohio’s larger cities, Toledo, is located, decreased from 2,563 in 2010 to only 733 in 2014, the largest decrease in the state (ODH, 2015). These statistics indicate that Ohio women are having to cross state lines to receive necessary health services, increasing their travel time, expenses, and time away from work and school.
Women in Ohio are also having abortions at later stages in their pregnancy, indicating that recent changes in access could be causing women to delay care. From 2008 to 2014, the percentage of abortions that took place before nine weeks of pregnancy dropped from around 56% to 52%; however during that same time period the percentage of abortions that took place between nine and 12 weeks of pregnancy increased from around 28% to 31%, and the percentage that took place between 13 and 18 weeks increased from 12% to 14%. These numbers suggest that women may be having to delay care, making procedures more costly and resulting in potentially more side effects. This postponing of abortion care is a new emerging trend in Ohio, illustrating a potential developing crisis in access to reproductive health access.
Another substantial change in abortion access in Ohio is the decrease in use of the medication abortion method, known as the RU 486/mifepristone and misoprostol or “abortion pill.” Between 2010 and 2011, medication abortions declined from almost 21% of total abortions to only 5%. This drop in the use of the medication abortion method can be attributed to new stringent regulations that affected access. In 2004 the Ohio legislature passed a law requiring Ohio follow the outdated FDA protocol rather than the newer evidence-based protocol for medication abortions. An Ohio court decision in 2011 upheld the law and required the use of the FDA protocol, most likely explaining the shift away from medication abortions in the state. In March of 2016 the FDA changed the protocol, necessitating significantly less amounts of mifepristone (200mg instead of 600mg), fewer doctor visits, and extending the length in pregnancy that the method can be used (up to 70 days). These changes will most likely improve access to abortion because they provide more options for women, facilitating greater control over their bodies.
Contrary to many myths propagated by the anti-choice movement, abortions in Ohio are safe. One positive trend in the state of choice is the consistently low complication rate for legal abortions, with the year with the highest rate at less than half of one percent of the procedures resulting in complications (Ohio Department of Health). The abortion complication rate is substantially lower than the maternal morbidity rate, which measures complications during pregnancy, meaning that the health risks rising from abortion are much lower than the complications surrounding childbirth.
Although health insurance is required to cover some contraception options, Ohio women are still in need. The Patient Protection and Affordable Care Act, colloquially known as Obamacare, directly caused an increase in coverage for contraception through health insurance across the nation (Guttmacher 2014). The Affordable Care Act was signed into law in March of 2010, though coverage without cost-sharing for contraception was not instituted until August 1, 2011 (US department of Health and Human Services, 2011). The Act does not require that all brands of birth control be covered, meaning some women still face the financial burden of controlling their reproductive destinies. The ACA also exempts religious organizations from the requirement that health plans cover contraceptive services, creating obstacles for female employees at those organizations (HRSA). Furthermore, there are still women in Ohio who are uninsured. Ohio falls far below the national average for meeting the need for publicly funded contraceptive services. Although the need for publicly funded contraceptive services increased by three percent between 2010 and 2013, the percent of need met by publicly funded contraceptive providers decreased from 22% to 15% in the same time period (Frost, Frohwirth, Zolna, 2013). These numbers indicate that there are still many women who are in need of contraceptive services, facing barriers to control over their bodies.
Health Crisis for Black and Hispanic Women
The compiled data and statistics in this report illustrate a reproductive health crisis for Black and Hispanic women in Ohio. The unique challenges Black and Hispanic women face span across the spectrum of reproductive needs and issues, starting at a very young age. The teen birth rate has decreased across the board for all young women and girls in Ohio over the past decade, however the teen birth rate remains substantially higher for Black and Hispanic teens. In 2013 the teen birth rate (defined as births per 1,000 females age 15 to 19) was 49 for Black teens, 43 for Hispanic teens and 22 for white teens (National Kids Count, 2014). This disparity in teen birth rates demonstrates a resource gap for young Black and Hispanic teens that impacts their ability to advance in their education, careers, and communities.
During and after pregnancy Black and Hispanic women in Ohio face additional obstacles, which are adding to the health crisis for these communities. Access to adequate and affordable prenatal care is essential to continuing a healthy pregnancy and assisting women in controlling their reproductive lives. According to Amnesty International 19.3% of women of color in Ohio in 2010 did not receive prenatal care or their prenatal care was delayed (Amnesty International, 2010). For the same year, 12.2% of all women in Ohio (including white women) did not receive or delayed prenatal care (Amnesty International, 2010). Unfortunately, the 2010 numbers are the most recent data tracking the accessibility of prenatal based on race and ethnicity. The available statistics thus suggest that it is more difficult for women of color in Ohio to obtain the same level of prenatal care as white women. Black infants consistently have the highest rates of low birth weights in Ohio, potentially due in part to the racial disparity in prenatal care access. For example, 13.3% of Black infants born in 2013 in Ohio had a low birth weight compared to 7.4% of the white infants, who consistently have the lowest rate of low birth weights (National Kids Count, 2014).
The trend of Black women and Black infants facing disproportionate issues in pregnancy and after delivery continues with infant mortality rates. Unfortunately, Ohio is known for having particularly high infant mortality rates in the United States, nationally ranked 44th (United Health Foundation, 2016). However for Black infants the rate is double the state average. In 2014 the infant mortality rate for white infants was 5.3 while for black infants it was 14.3 (Ohio Department of Health, 2015). The disparity in these numbers reveals a clear and devastating health inequality between white residents and Black residents in Ohio. While there are numerous and complex causes for this difference, it is evident that comprehensive policy reform is necessary to address this reproductive health crisis for Black infants in particular.
Reproductive health does not begin and end with pregnancy and delivery but rather includes broader health issues, such as cancer and sexually transmitted infections. The reproductive health inequities for Black and Hispanic women are found in these areas as well. According to the Ohio Cancer Incidence Surveillance System, “Hispanic women have more than twice the risk of developing cervical cancer compared to non-Hispanic white women, and African American women have 1.5 times the risk of non-Hispanic white women” (OCISS, 2014). The differences in these risks indicates potential barriers to screening and treatment that Hispanic and Black women face that white women do not. The HIV infection rates in Ohio also indicate unique reproductive health dangers for Black and Hispanic women. In 2014 the diagnosis of HIV infection rate, defined as occurrence of infection per 100,000 females, was 0.9 for white women, while for Hispanic women it was 4.6 and for Black women it was 10.9 (Ohio Department of Health, 2015). Although the rate of HIV infection diagnosis for Black women has decreased, it is consistently substantially higher than the rate for women of other racial and ethnic backgrounds. These numbers are troubling because they illustrate that Black women in Ohio are facing larger threats to their reproductive health and wellbeing. The causes of these threats to Black and Hispanic women’s reproductive safety are multifaceted, however it is clear that Ohio must allocate more resources to address the needs of these women.
Although there are some positive trends in the state of choice for Ohio, there needs to be extensive policy change to grapple with the large obstacles and problems that women, particularly Black and Hispanic women, in Ohio face. This report covers more issues than abortion rights, contraception access and the unique health crisis for Black and Hispanic women highlighted above. The insufficient response from law enforcement to domestic violence and sexual assault, the push toward abstinence-only sexual education in schools, lack of state funding to support the foster care system, the fact that very few employees have access to paid family leave and the invisible reproductive struggle of women and girls in prison are all important features negatively impacting the state of choice in Ohio. The findings from this extensive search for data on choice in Ohio reveal many overlapping issues that should be investigated further. This report intends to create one consolidated resource that can be used as a base line to track some of these issues in years to come, as well as providing a comprehensive look at choice and reproductive health, based upon currently available data. Policies need to address, and in some cases, such as abortion, entirely change in order to improve the state of choice from its current dire condition.