COVER

The reversal of Roe v. Wade will bring about a cascade of legal, health and social problems in Ohio.

By CityBeat Staff and Cleveland Scene Staff

Editor’s note: Some of the people and organizations quoted in this feature frame their abortion language around “women,” meaning a sex assigned at birth. But transgender men, intersex individuals, non-binary individuals and agender individuals also receive abortion care. We will continue to explore abortion issues that a ect all individuals in future stories.

In a landmark decision on June 24, the U.S. Supreme Court ruled to overturn Roe v. Wade, eliminating the federal protection of a patient’s right to decide to terminate a pregnancy.

In the decision on Dobbs v. Jackson Women’s Health Organization, Justice Samuel Alito follows the same language and logic he’d written in the leaked draft opinion that Politico published on May 2. In the current decision, Alito — part of a majority conservative court — writes that the U.S. Constitution does not explicitly spell out the right to an abortion, an unenumerated right. e decision in Dobbs reverses a nearly 50-year-old right granted by Roe v. Wade.

Justices Sonia Sotomayor, Elena Kagan and Stephen Breyer don’t mince words in their jointly written dissent.

“Whatever the exact scope of the coming laws, one result of today’s decision is certain: the curtailment of women’s rights, and of their status as free and equal citizens,” the three justices write. e decision has opened up the oodgates for restrictive state bills across the country — including in Ohio, which that night enacted a ban on abortions after six weeks of gestation. ese decisions also could open the door for reversing other rights, including further bodily autonomy, being able to marry someone of a different race or the same sex, or having consensual sexual activity or accessing birth control.

“No one should be con dent that this majority is done with its work. e right Roe and Casey recognized does not stand alone. To the contrary, the Court has linked it for decades to other settled freedoms involving bodily integrity, familial relationships, and procreation,” Sotomayor, Kagan and Breyer warn in their dissent.

Here’s Where Abortion Currently Stands in Ohio

What is an abortion?

e Cleveland Clinic de nes abortion using two separate methods for the procedure: medication abortion and surgical abortion. e clinic’s de nitions are as follows:

Medical abortions (nine weeks of pregnancy or less): A woman will take two di erent medicines (usually within a 48-hour period). e medication is given by a healthcare provider and is either taken in the provider’s o ce or at home (or a combination of both). Your healthcare provider will give you speci c instructions about how and when to take the medications.

Surgical abortions: In this type of abortion, a healthcare provider will surgically remove the embryo from the uterus. ese types of abortions require mild sedation, local anesthesia (numbing an area) or general anesthesia (fully asleep). Some other terms for surgical abortions are in-clinic abortions, aspiration abortions and dilation and curettage (D&C) abortions. Some reasons women have a surgical abortion are personal preference, too far along in pregnancy or a failed medical abortion.

At six weeks gestation, an embryo is not yet a

Protests against abortion bans are happening throughout Ohio. MARY LEBUS fetus and is about 3.5-6 millimeters, or roughly the size of a grain of rice. In comparison, a blood clot commonly passed during a typical menstrual period is about the size of a dime, or 17 millimeters.

What abortion services are currently legal in Ohio?

Prior to Dobbs, abortion was legal in Ohio until 20 weeks gestation; as of press time, it is only legal until just six weeks gestation. Lebanon, Ohio, is the only city in the state where abortion is outlawed, but there was no provider there when the procedure was banned in almost all cases in 2021.

How many abortions happen in Ohio?

Ohio Department of Health data for 2020 shows there were 151 cases of abortion care per 1,000 cases of live births. Abortion care, overall, has trended downward since 2000, with the exception of slight increases in 2012 and 2020, according to data released annually from ODH. e gestational time frame when a patient seeks abortion care also has steadily skewed earlier. ere were 20,605 legal cases of abortion care in Ohio in 2020, according to ODH. Of those cases, 62.3% happened before nine weeks gestation, and 25.4% happened between nine

and 12 weeks. at means 87.7% of cases of abortion care occurred within the rst trimester. Only about 10% of abortion care cases happened between weeks 13 and 18, and there were 441 cases involving pregnancies of 19 weeks or more.

What kind of abortion care is used in Ohio?

About 47% of abortion treatments were carried out using mifepristone, commonly known as the “abortion pill,” according to ODH. e number of patients receiving mifepristone (as opposed to using methods like curettage or dilation with evacuation) has seen a steep increase since 2015, when only 4% of patients were prescribed the pill.

Who seeks abortion care in Ohio?

2020 data from ODH shows that 59.2% of patients were ages 20-29 and 28.9% were in their thirties. Black patients accounted for 48.1% of abortion care patients, with 43.8% listed as white. A majority of patients — 81.8% — had never been married. Patients were likely to already have children, with 24.3% having one child and 38.4% having two or more children.

What kind of abortion care will be available in Ohio now that Roe v. Wade is overturned?

e 2019 “Heartbeat Bill” passed by the Ohio legislature limits a patient’s right to terminate a pregnancy after the detection of a "fetal heartbeat," sporadic electrical utters which occur after about six weeks and before many people even know they’re pregnant (medical experts say this is not an actual heartbeat). ere are few allowances for a person to get an abortion after six weeks, and there are no exceptions for rape or incest. Doctors who perform abortions can be charged with a fth-degree felony. Previously under an injunction, that bill became state law the evening Dobbs and Roe were decided.

Ohio Republicans also are prioritizing bills like House Bill 598, which would eliminate access to abortion care almost entirely. It would only permit an abortion in narrow medical cases, o ering loose language that makes medical exemptions hazy. Multiple physicians would need to determine that the procedure is “necessary to prevent the pregnant individual’s death or a serious risk of the substantial and irreversible impairment of a major bodily function.” A doctor can get around some of the hoops in the case of an emergency, but the bill doesn’t de ne what quali es as an emergency.

HB 598 uses language that does not align with terminology de ned by medical professionals. Cleveland Clinic’s de nition of abortion refers to the removal of an embryo, whereas HB 598 refers to the organism developed from the point of fertilization as “an unborn child.”

Nonetheless, Ohio Gov. Mike DeWine has said he would sign the legislation.

Will there be repercussions for those who perform or seek abortion care in Ohio?

Abortion care won’t just be inaccessible but criminal under Ohio's new and potential laws. ose caught performing abortion care could face felony charges, hefty nes and jail time — up to $10,000 and 25 years in prison under House Bill 598. Likewise, “promoting” abortion services would also be a misdemeanor, and a physician could lose their license. For now, Ohio’s bills provide legal immunity to a patient; only those performing abortion procedures would be liable, but patients would be able to sue providers in a wrongful death cause of action. Other bills could be developed that criminalize more participants, including patients.

What do Ohio voters think of abortion access?

A Pew Research Center study nds 48% of Ohioans approve of abortion care access in all or most cases. About 61% of Americans nationwide approve of abortion care. With Roe v. Wade overturned, individual states have the power to set their own rules about not just abortion, but also bodily autonomy and privacy. e outcome will create vast swaths of land where abortion care is inaccessible, forcing patients to travel great distances for care. Ohioans would need to travel to states like Illinois, New York or Maryland.

Are abortions legal in Kentucky?

e decision on Dobbs has e ectively and immediately banned abortion care in the state of Kentucky. e Commonwealth’s 2019 “trigger” law bans abortions except in order to prevent the death of or “the serious, permanent impairment of a life-sustaining organ” of a pregnant person. It does not provide exceptions in cases of rape or incest. Kentucky’s law also states that any person who performs an abortion or provides relevant medication can be charged with a Class D felony, which is punishable by up to ve years in prison.

People in Kentucky who want an abortion can travel to Ohio while abortion care is still accessible in the Buckeye state (for now). Ohio Department of Health data from 2020 shows that 5.7% of abortions in Ohio were for people from out of state. —Madeline Fening

Selected Characteristics of Resident Induced Abortions in Ohio, 2020

Source: Ohio Department of Health

More Legal Rights in Ohio and Beyond Are on the Chopping Block with the Fall of Roe v. Wade

As the United States wraps up Pride month and Juneteenth celebrations, there are questions about how the U.S. Supreme Court’s decision on abortion may a ect additional human and legal rights.

Jen Dye, director for the Nathaniel R. Jones Center for Race, Gender, and Social Justice at the University of Cincinnati College of Law, says overturning Roe v. Wade could open a door to other forms of oppression.

“Roe was actually decided on this whole idea of the right to privacy, and even though on its face it was about abortion, really the court decided that the issue was about the right to privacy,” Dye says. “It’s kind of like if somebody shouted, ‘Fire!’ in a crowded building, the issue would be freedom of speech, but on its face it’s if somebody can shout, ‘Fire!’ in a crowded building.” e right to privacy is an unenumerated right, Dye explains, which means it’s not explicitly stated in the U.S. Constitution.

“It’s well-established in a lot of case law and precedent that it is something we can imply and infer that we all have, even if it’s not explicitly stated,” she says.

In the Dobbs/Roe decision, Alito cites other rights that Americans have enjoyed that are also unenumerated rights: • e right to obtain contraceptives (Griswold v. Connecticut, 1965) • e right to interracial marriage (Loving v. Virginia, 1967) • e right to engage in private, consensual sexual acts (Lawrence v. Texas, 2003) • e right to same-sex marriage (Obergefell v. Hodges, 2015)

“ ere’s an erosion there,” Dye says. “Alito in his [then] draft opinion clearly lays out the groundwork to overturn anything that isn’t explicitly stated in the Constitution.”

In the June 24 Dobbs opinion, Alito writes, “ e Constitution makes no reference to abortion, and no such right is implicitly protected by any constitutional provision.” He writes that other unenumerated rights are di erent from abortion rights because they do not involve the moral question of life, but he also says rights that are not explicitly stated in the Constitution must be “deeply rooted in the nation’s history and traditions.”

Dye says other unenumerated rights like interracial and same-sex marriage or sexual privacy are relatively new and apply to citizens that the country’s founders hadn't considered when drafting the document.

“ ose responsible for the original Constitution, including the 14th Amendment, did not perceive women as equals and did not recognize women’s rights,” Sotomayor, Kagan and Breyer write in their Dobbs dissent. “When the majority says that we must read our foundational charter as viewed at the time of rati cation (except that we may also check it against the Dark Ages), it consigns women to second-class citizenship.”

Dye expands on that idea.

“I mean, the Constitution was written in the late 1700s,” she says. “At that time period, it was white men who owned property who counted. ey were the only people who could vote, they were the ones who were considered citizens, if you were a person of color, you weren’t even considered human — you were property. Women, while you were considered human, you were still someone’s property. If we say we want to go back to what the Constitution was written as, that’s what the Constitution was written as.”

Approval of interracial marriage is far from “deeply-rooted” in our nation’s history, for example, with Loving v. Virginia decided in 1967. And yet, Alabama only narrowly voted to legalize interracial marriage in 2000, and national Gallup polling in 2002 showed 29% of Americans still opposed interracial marriage.

Loving served as precedent for samesex marriage rights that were nally passed in 2015 through Obergefell. Since then, Ohio Republicans have proposed their own “Don’t Say Gay” legislation similar to Florida’s, which prohibits schools from mentioning queer gender identity or sexual orientation, along with other laws that chip at LGBTQ+ rights.

And Ohio already is passing laws that signal homophobic and transphobic priorities. e recently passed House Bill 151 bans trans youth from participating in school sports, requiring controversial gender-veri cation exams on children. e legislature approved the bill 56-28.

Additionally, multiple states are waging wars on birth control as they craft their own trigger bans on abortion care, including Missouri, Idaho and Louisiana.

In his concurring Dobbs opinion, Justice Clarence omas writes that additional rights-granting cases should be re-examined.

Dye warns that ongoing culture wars may give way to new laws that ignite old battles, and threatening the right to privacy by overturning Roe would give lawmakers the tools to get started now.

“Some people are saying, ‘Oh that’s alarmist,’ but it wasn’t too long ago when people were saying it’s alarmist to think they’d overturn Roe,” Dye says.

Maya McKenzie, media coordinator for Planned Parenthood Ohio, also is worried about the implications for the LGBTQ+ community.

“It obviously extends beyond the right to choose whether or not you would have an abortion,” McKenzie says. “But LGBTQ+ people, including transgender men and non-binary people, they can and do have abortions, just like anyone else.”

Maria Bruno, public policy director at Equality Ohio, testi ed against HB 598, the state’s latest abortion ban bill, saying it would be a disaster for LGBTQ+ Ohioans.

“At rst glance, abortion rights might seem like a distinct legal issue from LGBTQ+ rights,” Bruno testi es in her opposition. “But LGBTQ+ people need this healthcare, and LGBTQ+ rights and abortion rights are tightly entwined together through case law precedent. Picking and choosing when legal precedent matters — and which foundational constitutional rights deserve preservation and which don’t — is a recipe for disaster.”

Dye says other human rights decisions could be forced back to the states and that it will be on voters to mobilize to maintain previously protected rights — even though many states like Ohio have been gerrymandered under Republican power.

“ ose local and state elections are going to be that much more important in terms of policy of where you live,” Dye says. “It’s a lot easier to get state legislation through because state legislator terms are shorter.” —Madeline Fening

Resident Induced Abortions, Ohio, 1977–2020

Ohio’s District Maps, Ballot Seats Continue to Shape Abortion Laws Within the State

As noted previously, many Ohioans and most Americans want abortion care to remain in place. But the likelihood of an all-out ban on procedures in the Buckeye State is practically certain as Ohio lawmakers consider next steps after the U.S. Supreme Court overturned Roe v. Wade. Here, conservative political games will enable that to happen. e push by Ohio Republicans to ban the procedure has been almost e ortless. A statewide ban on abortion care after six weeks gestation already has gone into e ect since the U.S. Supreme Court overturned Roe. Two “trigger” bills outlawing abortion care (except in vaguely outlined emergency cases) also are poised to pass.

“I think a realistic person would say there is almost no constituency in Ohio for an abortion ban, and yet that is by far the most likely policy outcome we’re looking at,” says David Niven, a University of Cincinnati political science professor who researches gerrymandering and has testi ed as an expert witness in court cases on the subject.

“ ere’s only one reason why Ohio has a legislature to the right of Mississippi, and that’s because the maps were drawn to make it that way,” he says. “ e maps we’ve been living under for the last 10 years are roughly the second-most gerrymandered in the country.”

Ohioans will pick new state lawmakers on Aug. 2 using district maps that the Ohio Supreme Court has repeatedly rejected as unconstitutional for unfairly favoring Republicans. Niven says the U.S. Supreme Court is shifting the decision on abortion care to the states without considering how redistricting is moving policy outcomes away from what voters actually want.

“I don’t think ‘Catch-22’ is a strong enough phrase,” Niven says.

Nonetheless, the rejected, unconstitutional maps are expected to stay in place for the November general election, when voters will decide who sits in the governor’s seat. Democrat Nan Whaley, who is facing o against Republican incumbant DeWine, says there is a lot she would be able do as governor to resist a ban on abortion care.

“ e governor’s o ce in Ohio is about the fourth-most powerful in the country, not only because of line items, but because of appointments and the work they can do on access around public health. ere’s no singular position more powerful, regardless of what the legislature does, than the governor’s seat for this issue,” Whaley says.

In order to stop the passage of a ban, Whaley would need real veto power, which is something a Republican-packed House and Senate would prevent. e Ohio Senate is made up of 25 Republicans and eight Democrats, with 17 seats on the upcoming ballot. Currently, there are 64 Republicans in the Ohio House and 35 Democrats. While all their seats are on the ballot, the odds of Democrats taking enough new seats to prevent a three- fths vote overruling a Whaley veto is slim, Niven says.

“Democrats are not going to come close to a majority. e best case scenario is they win enough votes to stop the legislature from overriding a theoretical Nan Whaley veto. But the odds don’t really favor that as an outcome,” Niven says. ere are additional o ces on the ballot beyond the legislature that could a ect the way a ban on abortion care is felt in Ohio.

Rep. Je Crossman is challenging incumbent Dave Yost for Ohio’s attorney general position. He says that in order to give Democrats a chance at districts in a way that would be constitutional under the Ohio Supreme Court — and, in turn, give them a shot at in uencing or preserving abortion care access — the attorney general needs to hold the redistricting commission’s feet to the re. Crossman led a criminal dereliction of duty complaint against the Republican-led commission on May 26, a lead he wants Yost to follow.

“ e attorney general should be joining in saying these folks are acting in contempt, because that’s exactly what’s happening,” Crossman says. “We’re being ruled, not governed.” (Yost did not respond to our requests for comment).

No matter what district maps are or aren’t in place for Ohio — or even if they continue to be deemed unconstitutional — the special election to vote on the legislature is scheduled for Aug. 2. e deadline to register to vote in the special election is July 5. e deadline to register for the November general election is Oct. 11. —Madeline Fening

Statewide Abortion Bans Will Lead to Bleeding, Infection, Even Death in Ohio, Experts Say

Dr. David Burkons remembers how his classmates got abortion care when he attended e Ohio State University in Columbus in the 1960s.

“ ere was some corner down on Cleveland Avenue,” Burkons says. “You showed up there and a car came by, you got in, you gave him the money, he takes you to have an abortion, you came back.”

By the time he graduated from medical school in 1973, the U.S. Supreme Court had just issued its decision on Roe v. Wade, legalizing abortion care nationally. Burkons has since delivered babies and terminated pregnancies, serving the choices of patients no matter their decision. Now, with the court overturning Roe 50 years later, Burkons worries about how Ohioans will access abortion care.

“ ere are going to be some deaths involved with this. ere will be very serious consequences,” Burkons says.

Burkons says that rather than people slipping into a car to be whisked to a secret abortion site, people will order pills online to end a pregnancy from outof-state, both through legal channels and from black-market sellers.

“ e internet has changed everything,” Burkons says.

Most people — about 47% in Ohio and 54% in the United States — who end a pregnancy do so with a series of prescribed pills, data shows. e rst pill usually prescribed is mifepristone (brand name Mifeprex), while the second pill, misoprostol (brand name Cytotec), is taken 24-48 hours later.

Burkons, who runs several abortion clinics in Cleveland and Toledo, says about 75% of the abortion care he provides is via the pill.

at timing will be compromised if patients are forced to nd pills to terminate their own pregnancies online, Burkons says. e abortion pill currently is only an option during the rst 10 weeks of pregnancy. Burkons says that

Protesters against the U.S. Supreme Court's Dobbs/Roe v. Wade decision and Ohio's abortion ban gather in Cincinnati. MARY LEBUS

Already-Disadvantaged Ohioans Are Poised to Disproportionately Su er from an Abortion Ban

In April, the Ohio Policy Evaluation Network (OPEN) found that Ohioans seeking a surgical abortion would have to travel up to 339 miles if the legislature were to institute a statewide ban (medical — or pill-based — abortions also are an option). e driving expenses associated with the additional travel could add as much as $400 to an already costly procedure.

Abortion is sought predominantly by patients of limited means, according to recent research. OPEN says that roughly 75% of people seeking abortions in 2021 were classi ed either as poor or low-income, or those making up to 200% of the federally designated poverty line. ese patients, advocates say, will disproportionately su er when abortions are made more burdensome and remote.

“Even under existing law, paying for an abortion is a huge impediment,” says Freda Levenson, legal director with the ACLU of Ohio. “It’s not only the cost of travel and childcare to think about, but the lost wages. Low-wage workers aren’t getting paid for time o work.”

According to the Guttmacher Institute, only 16 states — the nearest being New York, Maryland and Illinois — and the District of Columbia have laws that protect abortion as of press time. Because some states require a 24-hour waiting period between an initial appointment and an abortion procedure, travel costs for anyone not living near state lines likely would include a hotel stay.

“Remember that many Ohioans, even those working full-time and above minimum wage, still struggle to pay for basic living expenses,” Levenson says. “Forty percent of Americans aren’t able to cover a hypothetical emergency expense of $400, using cash on hand or their savings. e struggles that lowincome Ohioans face are only going to get more di cult as access becomes scarcer.”

Travel costs, childcare costs — 60% of those seeking abortions are already parents, according to the Guttmacher Institute — and foregone wages are all on top of the cost of the procedure itself.

Maggie Scotece, interim executive director of statewide abortion fund Women Have Options Ohio (WHO), says that at their earliest and cheapest, rst-trimester surgical abortions cost roughly $500-$600 and get more expensive every two weeks of gestation.

“By the third trimester, we’re talking thousands of dollars,” Scotece says. “And most insurance policies don’t cover abortions, so these procedures are paid for out of pocket.”

As of press time, abortion-inducing drugs also are available as alternatives to surgical procedures. However, legal and medical experts predict that Ohio will attempt to restrict those with Roe v. Wade’s fall, despite federal laws that permit mail-order medications.

Scotece says that WHO is often a “fund of last resort” that works with local abortion funds and other providers to ensure that patients have all their nancial bases covered before traveling to get an abortion. She describes one instance in which a woman’s car broke down on her way home from a procedure and was forced to spend an extra night in a hotel, pay for her car repair and miss an additional day of work.

“For a single parent like her, one lost day of wages can be life or death,” Scotece says, adding that WHO case navigators helped the woman not only cover the cost of the hotel and car, but also paid the lost wages.

Women Have Options serves anyone traveling to or from Ohio for abortion care. While Ohio has enacted dozens of restrictions in recent years, it still has a few abortion clinics. Six are full-service surgical centers: three in the Cleveland area and one each in Columbus, Dayton and Cincinnati. ere are three additional clinics that only provide abortion medication in Columbus, Cleveland and Toledo.

Scotece notes that there has been an in ux of patients traveling to Ohio from Kentucky for abortion care and says that there are likely to be additional ripple e ects of a ban, including rising costs and restrictions associated with miscarriages and infertility. And while disadvantaged Ohioans will su er the e ects of a statewide ban disproportionately, many other people will be a ected.

“I think a lot of people are unaware of just how common abortion is,” Scotece says. “One in four women have abortions, and so when people think it doesn’t impact them or their families, it absolutely does. e higher and higher costs of abortion care will become really untenable.” —Sam Allard

after nine weeks and six days, patients risk heavier cases of bleeding, cramping and other complications that could require medical attention.

Burkons notes that while pregnancy tests can be used very early, most people don’t even know they are pregnant until after their rst missed period, which can be well beyond six weeks. Patients must wait for pills to ship from out of state or overseas, which may not be safe to work before reaching Ohio’s six-week abortion ban that just went into place — or for the even stricter laws in the pipeline.

Burkons doesn’t like those odds.

“I think what’s going to happen is people will nd out they’re pregnant. ey’ll nd these sites, they’ll order the pills, the pills will come, and it’s going to take a week or two to get the pills, so they’re already going to be further along and it’s going to be a much higher chance they’re going to have problems. And there’s going to be no one for them to call,” Burkons says.

Patients who take the right abortion pills within the rst ten weeks are likely to have a successful experience, Burkons says, but the uncertainty of how far along a pregnancy might be coupled with the delay of shipping the meds is still only part of the risk. Making sure you’re getting the right pills online is Burkons’ next fear.

“What you’re going to see are a lot

If abortion pills are limited in supply, there will be a higher rate of incomplete abortions, putting patients at major risk for medical emergencies and — depending on new laws that may crop up — criminal charges.

of websites — some are going to be legitimate, some are not going to be legitimate,” Burkons says. “If you go on to the internet now and look up ‘abortion,’ you get these crisis pregnancy centers that have very professional and misleading websites that are there to confuse women and keep them from having abortions. I guarantee you these antichoice people are going to be putting up websites like that, and if people get any medication, it’s probably going to be Smarties [candy] or something.”

Burkons says that even if a patient can’t get their hands on both misoprostol and mifepristone, taking just misoprostol could work in some cases — but the two drugs are most e ective together. If the pills are limited in supply, Burkons says there will be a higher rate of incomplete abortions, putting patients at major risk for medical emergencies and — depending on new laws that may crop up — criminal charges.

“Infection, massive hemorrhage, that sort of stu ,” Burkons says. “ ey’re going to be bleeding and need to go to the emergency room.”

We talked to an emergency room nurse during a Planned Parenthood rally in Cincinnati in May. She didn’t want to disclose her name for fear of reprimand from her employer.

“We don’t receive training for this at all,” the nurse says. “ ey’re putting their bodies at risk, their lives at risk.”

She adds that current emergency room sta have almost entirely worked in a world in which abortion care is accessible. Now, she says, they must prepare for patients who are managing medication abortions without the assistance of a doctor and receiving surgical abortions in non-medical environments.

“ ey’re not going to be able to give information on what’s been done to them,” she says. “We’re talking permanent bodily harm. Infection. Death.”

Whether or not Ohioans will be able to legally order medical abortion pills through the mail remains a legal gray area. Burkons says that because Ohio can’t prosecute doctors from outside state lines, it’s just a matter of time before lawmakers go directly after the patients seeking to stop or terminate their own pregnancies.

“ e anti-choice people always say they’re not after the women. ey call me the criminal,” Burkons says. “But my parking lot is full and I don’t advertise. People seek us out. When there’s no physicians in the state to prosecute because all this is coming from out of state, you know they’re going to go after the women.”

Burkons fears that potential trouble from doctors or the law will keep some patients away from emergency rooms. He advises those searching for abortion pills online to try ordering from a website with a customer support phone number to speak to a doctor or nurse.

He also emphasizes that misoprostol and mifepristone are overwhelmingly safe and e ective, but patients who are on blood thinners or are anemic should be careful, as they could lose a dangerous amount of blood.

Burkons adds that even people who aren’t pregnant have been ordering abortion pills.

“ ey have a long expiration period,” Burkons says. “Women are very smart people. ey’re going to nd a way.” —Madeline Fening

With an Abortion Ban in Place, Ohio’s Attempts to Court Large Companies May Stall

In recent months, Ohio has put on a full-press campaign through JobsOhio, the state’s quasi-public economic development agency, to lure companies to the state. e $50 million ad campaign has been deployed in Texas, New York, and other states with messages touting Ohio’s businessfriendly zero-percent corporate tax rate and cheap cost of living.

While major relocation or expansion decisions made by national corporations and large businesses often hinge not on broad reputational strokes of a state (Ohio’s leaders have long fought the idea that the state is “ yover country,” for example) but on the ability to hire workers and extract extravagant subsidies (such as Ohio giving Intel $2.1 billion in incentives to build its new chip hub in Columbus), low taxes and a ordable cost of living certainly play a role in courting business.

Abortion rights might be a new carrot in those races or — in Ohio’s case — a checkmark against a state.

Some large companies in Ohio and other conservative states like Texas and Florida already have been solicited by New Jersey Gov. Phil Murphy to relocate to a state that will protect access to abortion care.

“ e overturning of a woman’s right to bodily autonomy — and the chilling e ect this decision will have on your ability to attract and retain top female talent by being located in a state which has refused to recognize women’s reproductive freedom — cannot be ignored,” Murphy said in a June letter, which was rst reported by NPR. e call to move corporations to states without abortion restrictions will get louder, experts say.

“ e abortion restrictions are one part of a larger state culture that is not friendly or is hostile toward women, and so attracting top talent, women and families, it’s going to be really hard for some of the businesses in these states,” Nicole Mason, CEO of the Institute for Women’s Policy Research, told Fortune in May.

In the Supreme Court’s 1992 decision for Planned Parenthood v. Casey, the majority decision noted, “ e ability of women to participate equally in the economic and social life of the nation has been facilitated by their ability to control their reproductive lives.”

An abortion ban in Ohio will directly and negatively impact that ability, experts say. In May, economic analysis rm Scioto Analysis released a survey showing that 22 of 24 economists interviewed agree abortion bans in Ohio would have a detrimental e ect on the workforce.

“ e empirical evidence is very clear about the negative impact of unplanned pregnancies on women’s educational attainment, especially when support services are unavailable or una ordable,” Dr. Fadhel Kaboub, an associate professor of economics at Denison University, said in the report.

“Economic research overwhelmingly indicates that abortion rights greatly a ect the educational level, career opportunities, earning and wealth enhancement potential for women,” added Dr. Diane Monaco, an assistant professor of economics at Heidelberg University. “Abortion rights advantages are especially profound for historically marginalized women as well.”

A disproportionate burden will be carried by those least able to carry it, says Mikaela Smith, a research scientist with the Ohio Policy Evaluation Network at Ohio State University.

“Research re ects similar patterns of decreased access to abortion and other reproductive healthcare services among rural residents, suggesting that burdens associated with abortion restrictions will be felt particularly hard by those living in rural areas,” Smith says. “Given that we know that a lack of nancial resources is one of the primary reasons people seek an abortion and that being denied an abortion is associated with poorer economic outcomes, losing access to abortion — particularly among rural folks as well as people of color and those experiencing nancial burdens more broadly — will surely result in negative economic impacts at both the individual and community levels.”

Recent studies by the Institute For Women’s Policy Research back that up, showing that in 2020, statewide abortion restrictions caused $4.5 billion in economic losses. e vast majority of that hefty gure was shouldered by Ohio women ages 15-44, who experienced reduced earning levels and a higher number of job changes. ey also lost opportunities for future earnings due to time away from work when they were forced to carry pregnancies to term and care for children. ese losses could increase even further as a statewide abortion ban will keep more women out of the workforce, creating a loss of productivity, talent and wages that could have been taxed and spent back out into the state economy.

An Ohio abortion ban also may mean higher costs for taxpayers, given the data on abortion patient demographics and the impact that not being able to attain one has on the individual’s nances. Ohio residents could be on the hook for contributing to more public assistance, as funds from Women, Infants and Children (WIC) or Temporary Assistance to Needy Families (TANF) will be used by those dealing with the economic rami cations of full-term pregnancies and children.

Incoming businesses and investments to the state could also be a ected, including high-pro le sectors like the lm industry. A-list lms like Carol and Captain America: e Winter Soldier were lmed in Cincinnati and Cleveland, respectively, and Ohio routinely is a beacon for other major lms. Business has been growing, too, thanks in part to a generous state tax credit program. e Greater Cleveland Film Commission last year cited a study by Olsberg SPI, an international consultancy agency, that found the Ohio lm industry has created $1.2 billion in economic impact since 2009 and has created 6,192 “full-time equivalent jobs.”

But professional organizations such as the Writers Guild of America are already urging members to avoid states that enact abortion bans now.

“We call on our employers to consider the laws of each state when choosing production locations to ensure that our members will never be denied full access to reproductive healthcare,” the WGA said in a statement in early May (the Greater Cleveland Film Commission didn’t respond to a request for comment).

Nationally, some large corporations have begun to step in, o ering extra time o and nancial bene ts to employees who need to travel out-of-state for an abortion, and Cincinnati announced June 27 that it's rewriting its healthcare policy, as well. But that may not be enough to keep Ohio workers — or businesses — from moving to locations with fewer health restrictions.

“Eight in 10 college-educated knowledge workers — top talent — view access to abortion and reproductive health care as part of gender equity in the workplace, no more, no less,” says Jen Stark, senior director for corporate strategy at the Tara Health Foundation, in an interview with Voice Of America. “Employers that want to attract top talent into states that have social policies that don’t align with their values will have to do more to make up for this.”

Ohio's abortion ban could put more people who can get pregnant out of work. MARY LEBUS

In 2020, statewide abortion restrictions caused $4.5 billion in economic losses, with the vast majority shouldered by Ohio women ages 15-44, who experienced reduced earning levels, a higher number of job changes, and lost opportunities for future earnings due to time away from work when they were forced to carry pregnancies to term and care for children.

—Gennifer Harding-Gosnell and Vince Grzegorek

is feature is a collaborative e ort by reporters and editors at CityBeat in Cincinnati and Cleveland Scene in Cleveland, including Sam Allard, Allison Babka, Madeline Fening, Vince Grzegorek, Gennifer Harding-Gosnell, Maggy McDonel, Ashley Moor and Maija Zummo.