Ohio Abortion Laws May Have Caused Rise in Later Terminations as Women Struggle to Access Treatment Quickly

Laws that restrict access to abortions in Ohio may have sparked a rise in later-term terminations as women struggled to quickly access the procedure, researchers believe.

The authors of a paper published in the American Journal of Public Health looked at data collected between 2010 to 2018 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. The authors used this information to chart changes in abortion rates in the U.S., the Midwestern region and Ohio by gestation time, location, and whether patients were given drugs or a surgical procedure.

Abortions have become "increasingly regulated" in the U.S., the authors stated. In Ohio, more than 15 laws related to abortion came into effect between 2010 to 2018, affecting both patients and providers. For instance, abortions after 20 weeks of gestation are banned.

During the period of study, five of Ohio's 16 abortion clinics closed, and by 2018 the state had eight such facilities.

The abortion rate dropped nationally between 2010 and 2016, and Ohio had "slightly" lower rates than the U.S. overall, according to the study. This was reflected in other Midwestern states, "the majority of which had similarly restrictive abortion policies."

As most women have abortions due to unintended pregnancies, the researchers believe the decline is likely due to better access to and use of contraception, particularly birth control pills for adolescents.

The majority of abortions took place in the first trimester, both in Ohio and the U.S. overall, with approximately 10 percent happening after 14 weeks.

"However, pregnant Ohioans had procedures at relatively later gestation, and those living in rural areas had lower use of abortion compared with those living in urban areas, a disparity that increased with time alongside the closure of clinics," the authors wrote.

Between 2011 and 2016 women could only have a medical—rather than surgical abortion—up to 7 weeks into their pregnancy with four visits to a healthcare provider. This reduced access to earlier abortions, the team said. In contrast, other states followed an evidence-based protocol and set the barrier at 10 weeks and one visit. As a result of when having fewer drug-induced abortions, patients in Ohio "experienced higher costs and more clinic visits, side effects, and interventions," the authors found.

"Although all legal abortion in the United States is very safe, earlier abortions have even fewer risks for patients," the researchers said.

The research also showed that most abortion clinics were located in major cities, and the majority of counties didn't have one. Abortion ratios, or the proportion of terminations to live births, in Ohio were in general highest in the urban areas of Toldeo, Cleveland, Akron, Columbus, Dayton, and Cincinnati, the team noted.

Between 2010 to 2018, there was a 25 percent drop in the abortion ratio in Ohio, at 24 percent in urban and 32 percent in rural counties, respectively. "The lack of abortion clinics, and the decrease in abortion ratio, was most striking in the Appalachian region in southeastern Ohio," the authors said.

Rates may be lower in rural areas due to a lack of access or because of different attitudes to the procedure, "rather than simply because of declines in unintended pregnancy," the authors argued.

As the research was based on data of abortions that were carried out, the team was unable to quantify "how many people were forced to carry an unintended pregnancy to term."

Co-author Dr. Alison Norris, associate professor in the College of Public Health and College of Medicine at Ohio State University, told Newsweek: "We found that as lawmakers have restricted abortion access, Ohioans have experienced delayed care and increasing geographic inequities. Restrictive policies do not improve reproductive health. We hope lawmakers will draw on evidence about impacts on health when they make policy."

Norris said the study was limited partly because the team was unable to measure the impact of individual laws and regulations as many were passed in a short period of time.

"Abortion care is one of the safest medical procedures that we have" said Norris. "People benefit from quick access to abortion services when they choose to end a pregnancy. When people are delayed in accessing abortion, they may have increased costs, more travel time, and the need for more visits to the clinic."

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