Abortion Providers: Restrictions
Ohio imposes extra restrictions on abortion providers, despite the fact that all health-care providers already must comply with a variety of federal and state regulations governing health, safety, building and fire codes, and zoning requirements.
Restrictions on Where Abortion Services May Be Provided
Ohio places medically unnecessary restrictions on where abortion services may be provided.
Each clinic must have a written transfer agreement with a hospital located within 30 miles. Ohio Admin. Code § 3701-83-19(E); Ohio Rev. Code Ann. §3702.303 (Enacted 2013; Last Amended 2015). A federal appeals court held that this restriction is constitutional, even if it means that some clinics may not be able to operate. Women’s Med. Prof’l Corp. v. Baird, 438 F.3d 595 (6th Cir. 2006). Nothing requires hospitals to enter into such an agreement, nor is an exception made for rural areas. Ohio also prohibits a public hospital, including a state university hospital or state medical college hospital, from entering into a transfer agreement with an abortion provider. Ohio Rev. Code Ann. §3727.60 (Enacted 2013).
If an Ohio clinic is unable to get a transfer agreement with a local hospital, then the clinic can submit an application for an exception to the Ohio Department of Health. The Department of Health must rule on the application within 60 days, or it is considered denied. Ohio Rev. Code Ann. §3702.304 (Enacted 2013; Last Amended 2015). When the only two remaining abortion clinics in southwest Ohio were denied their respective variance requests, they filed suit against the state. A U.S. district court judge issued a temporary injunction, allowing the clinics to remain open while the case proceeds. Planned Parenthood Southwest Ohio Region and Women’s Med Group Professional Corporation v. Hodges, 1:15-cv-568 (Sept. 2015). As of June 2017, because a final decision in the case hinges in part to the constitutionality of the state’s Public Hospital Ban, the case was put on hold while awaiting the outcome of Capitol Care Network of Toledo v. State of Ohio Dept. of Health, No. 2016-1348 before the state supreme court. In February 2018, the state supreme court ruled against the Toledo clinic,which means that if the clinic cannot find another hospital to grant a transfer agreement, it will be forced to close.
Ohio has an unconstitutional and unenforceable requirement that all abortion services after the 14th week after the first day of the woman’s last menstrual period be provided in a hospital. Ohio Admin. Code § 3701-47-01(E), 3701-47-02(A) ("Immediate post-abortion care shall be provided in a hospital.").
The U.S. Supreme Court held that a second-trimester hospitalization requirement unconstitutionally burdens a woman’s right to choose. Akron v. Akron Ctr. for Reprod. Health, 462 U.S. 416 (1983).
Restrictions on Who May Provide Abortion Services
Ohio prohibits certain qualified health-care professionals from providing abortion services.
Only a physician certified by the state medical board to practice medicine or surgery may provide abortion care. Ohio Rev. Code Ann. § 2919.11 (Enacted 1974), Ohio Rev. Code Ann. § 4731.41 (Original Statute Enacted 1868; Recodified 1953; Last Amended 1998).
Ohio has a post-viability abortion ban that states that no abortion may be provided after viability unless two physicians certify in writing that it is necessary to preserve the woman’s life or to prevent a "serious risk of the substantial and irreversible impairment of a major bodily function" of the woman. These risks may not include any reason related to a woman’s mental health or the diagnosis that the pregnant woman will engage in conduct that would result in her death or a substantial and irreversible impairment of a major bodily function.
The physician must use the method most likely to result in fetal survival unless, based on the physician’s good faith and reasonable medical judgment, it poses a "significantly greater risk" of the woman’s death or "a serious risk of the substantial and irreversible impairment of a major bodily function" than other available methods; a second physician must attend; the procedure must be provided in a health-care facility with access to neonatal services for premature infants; and a fetus of at least 24 weeks gestational age is rebuttably presumed to be viable. A physician providing abortion care after 20 weeks gestational age must perform extensive viability testing; failure to do so is a fourth degree misdemeanor punishable by a prison term of no more than 30 days and a fine of as much as $250. Provision of abortion care in violation of any of the other elements of this law is a fourth degree felony punishable by a prison term of six to 18 months and a fine of up to $5,000. Ohio Rev. Code Ann. §§ 2919.16 (Enacted 1995, Last Amended 2011), 2919.17 (Enacted 1995, Last Amended 2011), 2307.52 (Enacted 1995, Last Amended 2011).
A court declared an earlier version of this law unconstitutional because it was not severable from a pre-viability abortion ban that unduly burdens a woman’s right to choose, and permanently enjoined the law. Women’s Med. Prof’l Corp. v. Voinovich, 130 F.3d 187 (6th Cir. 1997), cert. denied, 523 U.S. 1036 (1998).
NARAL Pro-Choice America supports the legal framework established in Roe v. Wade. Regarding the right to abortion in the third trimester, Roe allows for restrictions on post-viability abortion so long as they contain adequate exceptions to protect the woman’s life and health. However, many states have bans with inadequate exceptions, no exceptions at all, or define viability as occurring at a particular point in pregnancy. A state may not prohibit abortion prior to viability, which is that point at which a fetus is capable of "meaningful life" outside a woman’s body. Roe v. Wade, 410 U.S. 113, 163 (1973). Because viability is a point that varies with each pregnancy, states may not declare that it occurs at a particular gestational age. NARAL Pro-Choice America opposes Ohio’s post-viability restriction because the health exception is dangerously narrow.
Abortion Bans Throughout Pregnancy: Procedure Ban
Ohio bans a safe abortion procedure.
While a lower court held that Ohio’s 2000 ban on abortion procedures is unconstitutionally vague and has an impermissibly narrow exception to protect women’s health, an appellate court overturned that decision and allowed enforcement of the law. Women’s Med. Prof’l Corp. v. Taft, 162 F. Supp. 2d 929 (S.D. Ohio 2001), rev’d, Women’s Prof’l Med. Corp. v. Taft, 353 F.3d 436 (6th Cir. 2003).
The U.S. Supreme Court previously held that a ban that has no exception to protect a woman’s health and that bans more than one procedure places an undue burden on a woman’s right to choose and is unconstitutional. Stenberg v. Carhart, 530 U.S. 914 (2000).
Ohio’s ban makes any abortion procedure that falls within a specific definition a felony, unless the procedure is necessary, in the physician’s reasonable medical judgment, to preserve the life or health of a woman endangered by a "serious risk of the substantial and irreversible impairment of a major bodily function." Ohio Rev. Code. Ann. § 2919.151(B) (Enacted 2000). A "serious risk of the substantial and irreversible impairment of a major bodily function" is defined as "any medically diagnosed condition that so complicates a pregnancy as to directly or indirectly cause the substantial and irreversible impairment of a major bodily function." Ohio Rev. Code. Ann. § 2919.151(A)(5) (Enacted 2000). The Sixth Circuit is the only circuit in the country to have upheld such a dangerously narrow health exception.
This law does not prohibit the suction curettage, the suction aspiration, or the dilation and evacuation abortion procedures. The woman, the "father" of the fetus if it was not conceived by rape, and the parent of the woman if she is under 18 may obtain monetary relief in a civil action. Ohio Rev. Code Ann. §§ 2305.114 (Enacted 2000), 2307.53 (Enacted 2000), 2919.151 (Enacted 2000).
In addition, a court held that Ohio’s original ban on "dilation and extraction" abortion is unconstitutional and has permanently enjoined it. Women’s Med. Prof’l Corp. v. Voinovich, 130 F.3d 187 (6th Cir. 1997), cert. denied, 523 U.S. 1036 (1998). This law was repealed. Ohio Rev. Code Ann. § 2919.15 (Enacted 1995; Repealed 2000).
There is also a Federal Abortion Ban, which applies nationwide regardless of state law. The federal ban prohibits certain second-trimester abortion procedures and has no exception for a woman’s health. In April 2007, the U.S. Supreme Court upheld the ban, making it the first time since Roe v. Wade that the court has upheld a ban on a previability abortion procedure.
Reasons-Based Ban: Fetal Anomaly
Ohio enacted a law that would ban abortion if sought for reasons of fetal anomaly – either a positive test result or a prenatal diagnosis of Down syndrome, or "any other reason to believe" the fetus has Down syndrome. Any provider who provides such an abortion in violation of this law shall be guilty of a felony, and may have their medical license revoked. The provider is also subject to civil action. Additionally, the provider must report that they have no knowledge that the woman is seeking abortion care for the reason of fetal anomaly. H.B.214, 132nd Gen. Assem. (2017).
The law has been temporarily enjoined. Preterm — Cleveland v. Himes, 1:18-cv-109 (2018).
Abortion Bans Throughout Pregnancy: Procedure Ban
Ohio outlaws the use of a D&E (dilation and evacuation) procedure unless it is necessary to save the woman’s life. The bill also includes a narrow and inadequate exception for a woman’s health. The D&E procedure is the most commonly used method for second-trimester abortion. Its illegality would cause women to have to undergo more invasive and potentially more dangerous procedures. A physician providing care in violation of this law is guilty of a felony. S.B. 145, 132nd Gen. Assem. (Ohio 2018).
This law has been temporarily enjoined as litigation continues in federal court. Planned Parenthood Sw. Ohio Region v. Yost, 375 F. Supp. 3d 848 (S.D. Ohio 2019), reconsideration denied, No. 1:19-CV-00118, 2020 WL 40143 (S.D. Ohio Jan. 2, 2020).
Abortion Bans Throughout Pregnancy: Ban by Week
Ohio outlaws abortion after 20 weeks, without an adequate exception to protect women’s health, in cases of rape or incest, or for cases of fetal anomaly. Ohio’s law makes abortion after 20 weeks a felony, unless necessary to preserve the woman’s life or to avert serious risk of substantial and irreversible impairment of a major bodily function. There is an explicit prohibition against an exception for the woman’s mental health. Physicians in violation of the law would be subject to up to imprisonment and/or fines up to $5,000, and disciplinary action which may include license revocation.
In addition, the law allows the woman or the father of the pregnancy to bring a civil suit for damages against the physician. The state also establishes in the state treasury, the Ohio pain-capable unborn child protection act litigation fund to be used to pay for litigation around enforcement of these restrictions. It also allows "any person, or the representative of the estate of any person, who sustains injury, death, or loss to person or property" related to the abortion to file for injunctive relief blocking the abortion provider from providing future abortion care after 20 weeks. Ohio, S.B.127, 131st G.A., 2016.
Abortion Bans Throughout Pregnancy: Ban by Week
In 2019, Ohio passed an unconstitutional and unenforceable ban that outlaws and criminalizes abortion procedures as early as 6 weeks without an adequate exception to protect women’s health.* The ban only allows an exception in the case of a medical emergency.
The law requires physicians to perform an ultrasound to determine whether there is a detectable fetal heartbeat, and bans abortion if a heartbeat is detected. The law provides that any person who violates the ban is guilty of a felony of the fifth degree. OH ST § 2919.193 (enacted 2019).
*This law has been enjoined while litigation on the law continue. Preterm-Cleveland, et al., v Yost, 394 F.Supp.3d 796 (2019).
Ohio provides that a woman may not obtain an abortion until at least 24 hours after a physician informs her verbally, individually, in person, and in a private setting, of: (1) the nature of the procedure and its medical risks; (2) the probable gestational age of the fetus; and (3) the medical risks associated with carrying the pregnancy to term.
The law further provides that at least 24 hours prior to an abortion, a physician or physician’s agent, in person, by telephone, by certified mail, or by regular mail evidenced by a certificate of mailing, must provide the woman with the name of the physician who is scheduled to provide the abortion and give her state-prepared materials that must include: (1) a description of the probable anatomical and physiological characteristics of the fetus at two-week gestational increments for the first 16 weeks and at four-week gestational increments for the remainder of the pregnancy, including the possibility of viability; (2) a comprehensive list of public and private agencies and services, including adoption agencies, available to assist her through pregnancy, upon childbirth, and while the child is dependent; (3) information about medical assistance benefits available for prenatal care, childbirth, and neonatal care; and (4) information about the support obligations of the "father." Ohio Rev. Code Ann. § 2317.56 (Enacted 1991; Last Amended 1998).
In 2019, Ohio expanded their biased counseling requirements to require pregnant women to sign a form acknowledging that they have received information from the person intending to perform the abortion that "the unborn human individual the pregnant woman is carrying has a fetal heartbeat and that the pregnant woman is aware of the statistical probability of bringing the unborn human individual the pregnant woman is carrying to term." OH ST § 2919.194. This provision of the law is temporarily enjoined while litigation continues. Preterm-Cleveland, et al., v Yost, 394 F.Supp.3d 796 (S.D. Ohio 2019).
In 1998, upon agreement of the parties, a court issued a preliminary injunction prohibiting the enforcement of this law, allowing a previous version to remain in effect. Cincinnati Women’s Services v. Taft, No. 1:98-CV-289 (S.D. Ohio Apr. 29, 1998) (agreed order granting injunction). In 2005 the court lifted the injunction and found the mandatory-delay provision of the statute constitutional. Cincinnati Women’s Servs. v. Taft, 466 F.Supp.2d 934 (S.D. Ohio Sept. 8, 2005). The appellate court upheld the lower court decision allowing the law to remain in effect. Cincinnati Women’s Servs. v. Taft, 468 F.3d 361 (6th Cir. 2006).
Notably, the more recent law mandates that a woman who chooses abortion must make two trips to the provider. Cincinnati Women’s Services v. Voinovich 468 F.3d 361 (6th Cir. Oct. 4, 2005).
The previous version of the law is substantially similar except it requires the physician to inform the woman of the nature of the proposed procedure and its medical risks; the probable gestational age of the fetus; and the medical risks associated with carrying the pregnancy to term verbally or by other non-written means of communication rather than verbally, individually, in person, and in a private setting. A court held that this previous version – which was construed subsequently by the Ohio attorney general to require only one visit to the provider – was constitutional. Preterm Cleveland v. Voinovich, 627 N.E.2d 570 (Ohio Ct. App. 1993), appeal dismissed, 624 N.E.2d 194 (Ohio 1993); Ohio Op. Att’y Gen. No. 94-094 (Dec. 30, 1994).
Ohio requires a woman seeking an abortion to wait at least 24 hours between the time she receives biased-counseling materials and when she can get the procedure. Because she must receive those materials in person, it creates a two-trip requirement. Ohio Rev. Code Ann. § 2317.56 (Enacted 1991; Last Amended 1998).
In 1998, upon agreement of the parties, a court issued a preliminary injunction prohibiting the enforcement of this law, allowing a previous version to remain in effect. Cincinnati Women’s Services v. Taft, No. 1:98-CV-289 (S.D. Ohio Apr. 29, 1998) (agreed order granting injunction). In 2005 the court lifted the injunction and found the mandatory-delay provision of the statute constitutional. Cincinnati Women’s Servs. v. Taft, 466 F.Supp.2d 934 (S.D. Ohio Sept. 8, 2005). The appellate court upheld the lower court decision allowing the law to remain in effect. Cincinnati Women’s Servs. v. Taft, 468 F.3d 361 (6th Cir. 2006). Notably, the most recent law mandates that a woman who chooses abortion must make two trips to the provider. Cincinnati Women’s Services v. Voinovich 468 F.3d 361 (6th Cir. Oct. 4, 2005).
Insurance Coverage for Abortion
Prohibits Abortion Coverage in the Insurance Exchange
Does Ohio expressly prohibit plans in its state exchange from covering abortion services?
Yes. Health-insurance policies offered in the state health-insurance exchange may not include abortion coverage, with exceptions only to save a woman’s life or if the pregnancy is the result of rape or incest. Nothing in the law prohibits the purchase of abortion coverage outside the exchange through an optional rider for which an additional premium is paid. However, insurers are not required to offer such riders and there is no evidence that such separate policies exist. (Even if they did exist, offering women the "option" to pay for separate abortion coverage is a false promise because no one plans for an unplanned pregnancy.) Ohio Rev. Code Ann. § 3901.87 (Enacted 2011).
Prohibits Abortion Coverage for Public Employees
Does Ohio expressly prohibit insurance plans for public employees from covering abortion services?
Yes. Health-insurance policies purchased by the state for state and municipal employees may not include abortion coverage, with exceptions only to save a woman’s life or if the pregnancy is the result of rape or incest reported to a law-enforcement agency. Abortion coverage may be obtained only through an optional rider for which an additional premium is paid. However, insurers are not required to offer such riders and there is no evidence that such separate policies exist. (Even if they did exist, offering women the "option" to pay for separate abortion coverage is a false promise because no one plans for an unplanned pregnancy.) Ohio Rev. Code Ann. § 9.04 (Enacted 1998; Last Amended 2011).
Abortion Coverage for Low-Income People
Restricts Low-Income Women’s Access to Abortion
Ohio prohibits public funding for abortion for women eligible for state medical assistance for general health care unless: (1) the procedure is necessary to preserve the life of a woman endangered by a physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself; (2) the pregnancy is the result of rape and the crime is reported to a law-enforcement agency prior to the abortion unless the physician certifies that the woman is physically unable to comply; or (3) the pregnancy is the result of incest reported to a law-enforcement agency or to a county children services agency prior to the abortion unless the physician certifies that the woman is physically unable to comply. Ohio Admin. Code § 5101:3-17-01; Ohio Dep’t of Job and Family Servs., Ohio Medicaid Provider Handbook, Physician Servs., 5101:3-17-01 (Rev. Mar. 5, 2005) at; Ohio Dep’t of Job and Family Servs., Physician Servs., 5101:3-17-01 Appendix A, Abortion Certificate Form, JFS 03197 (Rev. Mar. 2005).
Young People & Abortion
Ohio law restricts young women’s access to abortion.
Is the law enforceable? Yes. The U.S. Supreme Court held that an earlier version of this law is constitutional. Ohio v. Akron Ctr. for Reprod. Health, 497 U.S. 502 (1990). In addition, a court held the 1998 amendments to this constitutional, but on appeal, the single-petition rule was found unconstitutional. Cincinnati Women’s Services, Inc. v. Taft, 468 F.3d 361 (6th Cir. 2006).
Who is considered a minor? A young woman under the age of 18 who is not married, not in the armed services, not employed or financially independent, or who is not otherwise independent from the care and control of her parents.
What is required – parental consent or parental notice? Consent.
Who must give consent? One parent.
Are there other trusted adults who may be notified instead? No.
What is the process for obtaining consent? A young woman may not obtain an abortion unless the attending physician secures the written consent of one parent.
May the parental mandate be waived if a young woman is a victim of rape or incest? No.
May the parental mandate be waived if a young woman is a victim of child abuse? No.
May the parental mandate be waived if a young woman’s health is threatened? No. However, any person alleged to violate any provision of the law because of "immediate threat of serious risk to the life or physical health" of the young woman from her pregnancy necessitating an immediate abortion may raise it as an affirmative defense in any criminal, civil, or administrative hearing.
May the parental mandate be waived under any other circumstances? Yes, the young woman may try to obtain permission from a judge.
If a young woman must obtain permission from a judge, what is the process? The minor may obtain an abortion without parental consent by securing a court order stating that she is sufficiently mature and well informed enough to make her own decision or that an abortion is in her best interests. At the hearing, the judge is required to hear evidence relating to the emotional development, maturity, intellect, and understanding of the young woman, and specifically inquire about the young woman’s understanding of the possible physical and emotional complications of abortion and who she would contact if she experienced complications after the procedure. The court must find clear and convincing evidence that the young woman is sufficiently mature and well-enough informed to make the decision.
Are there other significant requirements under the law? No.
Has a court considered the constitutionality of this law? Yes. The United States Supreme Court held that an earlier version of this law is constitutional. Ohio v. Akron Ctr. for Reprod. Health, 497 U.S. 502 (1990). In addition, a court held that amendments to this law that were enacted in 1998 are constitutional. Cincinnati Women’s Services, Inc. v. Taft, 468 F.3d 361 (6th Cir. 2006).
Other information about the law: An unemancipated young woman under 18 may only attempt to undergo the judicial-bypass procedure once during a pregnancy, even if, for example, her bypass is denied but then her circumstances change or new evidence is discovered. Ohio Rev. Code Ann. § 2919.121 (Enacted 1998). A court had previously declared this and other amendments to this law constitutional, but upon appeal, this single-petition rule was found unconstitutional Cincinnati Women’s Servs. v. Taft, 466 F.Supp.2d 934 (S.D. Ohio 2005); Cincinnati Women’s Servs. v. Taft, 468 F.3d 361(6th Cir. 2006).
Ohio Rev. Code Ann. §§ 2151.85 (Enacted 1985), 2505.073 (Enacted 1985), 2919.12 (Enacted 1974; Last Amended 1995), 2919.121 (Enacted 1998; Last Amended 2011), .122 (Enacted 1998).
Insurance Coverage & Contraception
No state measure.
Contraception Coverage for Low-Income People
No state measure.
No state measure.
Other Important Issues
No state measure.
Refusals & Guarantees
Refusals of Medical Care
ABORTION REFUSAL CLAUSE
Ohio allows certain individuals or entities to refuse to provide abortion services.
To whom does the refusal clause apply? Individuals and hospitals.
What does the refusal clause allow? Allows individuals to refuse to participate in medical procedures that result in an abortion. Allows hospitals to refuse to permit abortion. The refusal to participate or permit may not be a basis for civil liability, disciplinary action, or other recriminatory action. A claim for civil damages may be brought for violation of the provision protecting individuals.
Does the law require the refusing entity to notify the persons affected? No.
Are there circumstances under which a refusal clause may not be exercised? No.
Does the law require the refusing individual or entity to provide medically and factually accurate information or provide a referral for abortion services? No.
Does the law provide a mechanism for women to otherwise obtain specific reproductive-health services, information, or referrals if an individual and/or entity exercises a refusal clause? No.
Ohio Rev. Code Ann. § 4731.91 (Enacted 1974).
Counseling & Referral Bans
Counseling & Referral Ban
The health department may not award grants for women’s health services that will be used for abortion services, counseling or referrals, except in a medical emergency. A family-planning program receiving such funds must be organized so that any provision of abortion services is physically and financially separate from the provision of other services. Ohio Rev. Code. Ann. § 3701.046 (Enacted 2006); Ohio Admin. Code § 3701-68-01(B).
The health department may not use funds appropriated for genetics services to counsel or refer for abortion services, except in a medical emergency. Ohio Rev. Code. Ann. §3701.511 (Enacted 2007).