Abortion Access in Ohio's Changing Legislative Context, 2010-2018

Abstract

Objectives. To examine abortion utilization in Ohio from 2010 to 2018, a period when more than 15 abortion-related laws became effective.Methods. We evaluated changes in abortion rates and ratios examining gestation, geographic distribution, and abortion method in Ohio from 2010 to 2018. We used data from Ohio's Office of Vital Statistics, the Centers for Disease Control and Prevention's Abortion Surveillance Reports, the American Community Survey, and Ohio's Public Health Data Warehouse.Results. During 2010 through 2018, abortion rates declined similarly in Ohio, the Midwest, and the United States. In Ohio, the proportion of early first trimester abortions decreased; the proportion of abortions increased in nearly every later gestation category. Abortion ratios decreased sharply in most rural counties. When clinics closed, abortion ratios dropped in nearby counties.Conclusions. More Ohioans had abortions later in the first trimester, compared with national patterns, suggesting delays to care. Steeper decreases in abortion ratios in rural versus urban counties suggest geographic inequity in abortion access.Public Health Implications. Policies restricting abortion access in Ohio co-occur with delays to care and increasing geographic inequities. Restrictive policies do not improve reproductive health.

FIGURE 1—

Select Legislative and Clinic Changes and Number of Abortions per Year: Ohio, 2010–2018 Note. HB = House Bill; SB = Senate Bill. Dates are the years in which laws became effective. Total numbers of abortions in Ohio were obtained from the Ohio Department of Health’s “Induced Abortions in Ohio” report and include all abortions that took place in Ohio. The number of abortion clinics is the count as of June 1 of the given year. Abortion clinics were categorized on the basis of the type of abortions (surgical or medication only) they provided for most of that year. Several of more than 15 legislative changes from 2010 to 2018 are represented.

FIGURE 2—

Abortion Rate in Ohio, Midwestern States, and US Mandatory Reporting Areas: 2010–2016 Note. Midwestern states include Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin. Numbers of abortions were obtained from the Centers for Disease Control and Prevention’s Abortion Surveillance Reports and include all abortions that occurred in Ohio, the Midwest, and the United States. Numbers of women aged 15 to 49 years were obtained from US Census Bureau data, based on the American Community Survey.

FIGURE 3—

Distribution of Abortions by Gestation Categories in (a) Ohio and (b) the United States: 2010–2016 Note. Data are from the Centers for Disease Control and Prevention’s Abortion Surveillance Reports and include all abortions that occurred in Ohio and the United States.

FIGURE 4—

Ratios of Abortions per 1000 Live Births by County of Residence and Number of clinics in Ohio in (a) 2010 and (b) 2018 Note. Shading indicates ratio of abortions per 1000 live births per year by county of residence. The lighter shading of the county represents a lower abortion ratio (fewer abortions per 1000 live births). Green numbers indicate the number of clinics, both surgical and nonsurgical, open on June 1 of the given year. Counts of abortions by county were obtained from Ohio Department of Health’s “Induced Abortions in Ohio” report and live births were obtained from the Ohio Department of Health’s public health information warehouse. In 2010, Ohio had 15 surgical and medication and 1 medication-only abortion clinics. In 2018, Ohio had 8 surgical and medication and 3 medication-only abortion clinics.