Norris, Alison H.

Objectives. To assess the impact of Ohio’s abortion policy changes on abortion provision following Dobbs v Jackson Women’s Health Organization. Methods. We analyzed quantitative and write-in responses from an ongoing survey of 6 abortion facilities in Ohio for 3 time periods: January‒June 2022 (pre- Dobbs), July‒September 2022 (6-week ban in effect), and October 2022‒June 2023 (post- Dobbs, ban blocked). We disaggregated counts by method, gestation, and state of residence. Results. Following Dobbs, Ohio banned abortions after detection of embryonic cardiac activity, and monthly abortion provision decreased 56%. Several months after the ban was lifted, monthly abortion means exceeded pre- Dobbs means. The percentage of patients from out of state increased over time. Conclusions. The post- Dobbs enactment of a restrictive abortion ban drastically reduced availability of reproductive health care in Ohio. Nevertheless, Ohio remained an important destination for patients from surrounding states with abortion restrictions. Public Health Implications. Gestational bans decrease access to necessary health care; instead, states like Ohio should work to eliminate barriers to abortion care to support the health and well-being of people in their own and surrounding states. ( Am J Public Health. 2024;114(10):1034–1042. https://doi.org/10.2105/AJPH.2024.307775 )

AbstractIntroductionDuring early stages of COVID‐19 in the United States, government representatives in Kentucky, Ohio, and West Virginia restricted or threatened to restrict abortion care under elective surgery bans. We examined how abortion utilization changed in these states.MethodologyWe examined COVID‐19 abortion‐related state policies implemented in March and April 2020 using publicly available sources. We analyzed data on abortions by method and gestation and experiences of facility staff, using a survey of 14 facilities. We assessed abortions that took place in February–June 2020 and February–June 2021.ResultsIn February–June 2020 the monthly average abortion count was 1916; 863 (45%) were medication abortions and 229 (12%) were ≥14 weeks gestation. Of 1959 abortions performed across all three states in April 2020, 1319 (67%) were medication abortions and 231 (12%) were ≥14 weeks gestation. The shift toward medication abortion that took place in April 2020 was not observed in April 2021. Although the total abortion count in the three‐state region remained steady, West Virginia had the greatest decline in total abortions, Ohio experienced a shift from instrumentation to medication abortions, and Kentucky saw little change. Staff reported increased stress from concerns over health and safety and increased scrutiny by the state and anti‐abortion protesters.DiscussionAlthough abortion provision continued in this region, policy changes restricting abortion in Ohio and West Virginia resulted in a decrease in first trimester instrumentation abortions, an overall shift toward medication abortion care, and an increase in stress among facility staff during the early phase of COVID‐19.

This study examines an underexplored source of medical uncertainty: the political context of care. Since 2011, Ohio has passed over 16 abortion-restrictive laws. We know little about how this legislation affects reproductive health care outside of abortion clinics. Drawing on focus groups and interviews with genetic counselors and obstetrician-gynecologists, we examine how abortion legislation impacts their work. We find that interpretation and implementation of legislation is not straightforward and varies by institution and region of the state. An ever-changing legislative landscape combined with uneven implementation of restrictions into policy produces uncertainty in reproductive health care. We also found uncertainty about the legal consequences of abortion in restrictive contexts, with obstetrician-gynecologists reporting greater concerns given their proximity to care provision. We argue that uncertainty can result in stricter interpretations of regulations than necessitated by the law, thereby amplifying the impacts of an already restrictive context for abortion care.