The clock is ticking for the Cincinnati branch of Planned Parenthood, the only abortion clinic in Ohio’s most populated city.
On 29 September, a new law passed by the Republican-controlled Ohio legislature will kick into effect, triggering a legal countdown that will force the facility to close within 60 days, barring a state reprieve.
Should the clinic be shut down, it would make Cincinnati, with its 2.2 million people, the largest metropolitan area in the United States without any access to surgical abortions.
The nearest facility, the Women’s Med Center in Dayton, is under similar threat. If that were to close, too, women seeking terminations would have to make the 500-mile journey to Cleveland.
“Women who live here would be left with no easy or even reasonable access to safe legal abortion,” the chief executive of Planned Parenthood in south-west Ohio, Jerry Lawson, told the Guardian.
“For low-income women, the bulk of our patients, the extra travel and cost would be daunting and many could find themselves carrying pregnancy to term when they didn’t want to.”
The threat is not academic. Over the past four years the strongly conservative Ohio legislature has led a series of restrictive measures on abortion facilities, gradually limiting provision by placing incremental hurdles in its path.
The number of clinics in the state has plummeted from 17 to nine. A further three clinics – Cincinnati and Dayton among them – are in imminent danger of closing.
The withering of abortion provisions in the state has happened under the watch of Governor John Kasich, who since he came into office in 2011 has signed no fewer than 16 anti-abortion measures into law.
Despite the position he has staked out in his presidential campaign as the moderate face of the Republican party – in contrast to the anti-immigration antics of Donald Trump or the Tea Party rhetoric of Ted Cruz – Kasich’s record in Ohio puts him at the frontline of the rightwing war on abortion.
Other Republican presidential candidates have been competing ferociously to sound the most extreme in their anti-abortion posturing. While Kasich has remained relatively quiet on the subject, the influence of his thinking can be seen in the harsh reality of women’s healthcare in Ohio today.
Kasich has consistently declined to use his veto-wielding powers to prevent incremental anti-abortion measures from being slipped into budget bills by Republican lawmakers. Typical of those moves was a 2013 measure, HB 59, that prevented public hospitals from entering into agreements with abortion clinics.
After Kasich allowed the measure to be enacted as a line item within the budget bill, his spokesman said: “The governor is pro-life, and we believe these are reasonable policies to help protect human life.”
A laboratory for the new-look anti-abortion movement
In Cincinnati, Lawson sees the increasingly hostile legal environment towards abortion providers, not just in Ohio but across the heartlands of America, as part of a conscious political strategy that has switched the focus of the anti-abortion movement from picketing clinics to legislating on the floor of state assemblies.
“The leaders of the movement realised they had exhausted the effectiveness of the strategies they had been using – demonstrations outside clinics, rallies, and so on – and came up with a new strategy to impede abortions through incremental legislation,” he said.
The atmosphere is particularly chilly as it emanates from the statehouse in Columbus. When the legislature reconvenes this month, it is expected to pass and send to Kasich’s desk for signature a restrictive new bill that would prevent physicians from performing abortions on women seeking to terminate pregnancies after a prenatal Down syndrome diagnosis.
“We face a difficult environment in Ohio because the legislature is very conservative so when someone puts forward a new restriction there is an assumption it will pass,” Lawson said.
Kasich’s administration has publicly admitted to having conceived this incremental strategy, which has made Ohio something of a laboratory for the new-look anti-abortion movement – and may yet put him in an awkward spot on the campaign trail.
Mike Gonidakis, a prominent pro-life advocate whom Kasich appointed to the Ohio state medical board in 2012, has said: “Ohio has a history of advancing commonsense pro-life initiatives. We believe in the incremental approach: one step at a time, advancing legislation that will withstand court scrutiny.”
‘When one thing fails to work, they try something else’
Clinics like Planned Parenthood’s center in Cincinnati are the target of the new assault. The facility, which has been in operation since 1929 and was burned to the ground by an anti-abortion extremist in the 1980s, employs about 110 people, who provide a range of women’s health services including birth control, cervical Pap smears, HIV and pregnancy testing.
It also carries out about 3,000 abortions each year.
Since Kasich has been in the governor’s office, abortion clinics have come under ever tighter regulation in a series of incremental attacks.
“When one thing fails to work, they try something else,” Lawson said.
The legislature has used bureaucratic red tape to construct hurdles that threaten the clinics with closure – a process known as “targeted regulation of abortion providers”, or Trap.
First, the state imposed a requirement that all abortion clinics enter into “written transfer agreements” with local hospitals, so that any woman falling into medical difficulties during an abortion could be admitted for emergency treatment.
There is no practical medical purpose for the imposition of such an agreement. Hospitals are legally obliged to treat any person coming to them for emergency help through the emergency room. Of 14,000 abortions completed successfully over the past five years, Planned Parenthood in Cincinnati has only had to transfer three women who experienced problems.
Planned Parenthood duly entered into a “written transfer agreement” with the University of Cincinnati Medical Center. The next wave of attack came in the summer of 2013, when Republican legislators moved the goalposts again. They passed a line item in the budget bill that banned public hospitals such as the university medical center entering into written transfer agreements specifically with abortion providers.
That in effect stripped Planned Parenthood of its license to operate. The clinic sought to stay open by finding an alternative route to meet the transfer requirements, known in the jargon as a “variance request”.
It found some local doctors prepared to take care of any patient who fell into difficulties during an abortion. That in itself was no easy feat, given the history of harassment against doctors participating in abortions – in Dayton, doctors working with the Women’s Med Center have had their photographs pasted alongside images of aborted fetuses on the side of trucks parked outside their hospitals and homes.
High stakes with an immediate shutdown looming
In the latest legislative gambit, the Republican group introduced the new 60-day clock. Before the measure was passed in June, women’s health advocates engaged in intensive lobbying of Kasich, urging him to line-item veto the move. He declined to act.
Under the measure, Planned Parenthood in Cincinnati will automatically have its request for a “variance” declined if the state fails to approve it within 60 days of the law coming into effect. The decision rests with the Ohio department of health – an agency under Kasich’s control.
The 60-day deadline will fall on 28 November. The stakes are high. With no approval for its “variance request” the clinic would immediately lose its license and just as instantly be forced to shut down.
As Lawson points out, the department of health’s track record in this area does not provide grounds for optimism.
“The last time we had a ‘variance request’ considered by the Ohio health department it took them not 60 days but 14 months to respond, and only then after we had taken them to court,” he said.
Planned Parenthood of Cincinnati is now so close to oblivion, it has decided to resist. Together with the Women’s Med Center in Dayton, it has filed a lawsuit in the US district court for the southern district of Ohio that challenges all the recent Republican laws, on grounds that they violate the constitutional right to an abortion laid out in the 1973 supreme court ruling Roe vs Wade.
“We felt we couldn’t just sit and do nothing and run up against this deadline when all of a sudden we would cease to exist,” Lawson said. “We have accommodated where we could, but they kept on getting tougher and tougher with us and we’re now at the point where we just won’t be able to survive unless we push back.”
Further challenges lie ahead, with two bills pending in the Ohio legislature that could further damage the clinic’s chances of survival.
One piece of legislation would make it illegal for a doctor to perform an abortion when the stated reason is to avoid giving birth to a baby with Down’s syndrome. Pro-life lobbyists hope Kasich will sign it by Thanksgiving .
The second rides the wave of the recent furore over secretly filmed videos that showed a Planned Parenthood doctor discussing post-abortion foetal tissue donations. The bill demands the defunding of the whole organisation, despite the fact that no such foetal tissue donations occur in Ohio.
How Kasich responds to the debate over these new measures in his own backyard will have far-reaching implications for women’s health in his state. (The governor’s office and presidential campaign did not immediately respond to requests for comment for this article.)
But his position could also have ramifications for Kasich’s pitch to be seen as the prominent “moderate” candidate in a Republican presidential field hovering above many hard-right laboratories of democracy across the country.
guardian.co.uk © Guardian News and Media 2015