The case of a 10-year-old rape victim forced to travel from her home in Ohio to Indiana for an abortion outlawed in her state sparked international outrage, magnifying the far-reaching, myriad impacts of eliminating access to abortion care.
Ohio outlaws abortion after six weeks of pregnancy, with no exceptions for pregnancies from rape or incest. That law went into effect hours after the US Supreme Court struck down the constitutional right to an abortion on 24 June.
On 6 July, Republican Governor Mike DeWine called the case a “horrible, horrible tragedy” – but he did not mention the abortion ban, named the “Human Rights Protection Act”, which he signed into law one day after it passed the Republican-led legislature in 2019. At the bill’s signing, the governor said “government’s role should be to protect life from the beginning to the end.”
Three days after the Supreme Court ruling, Dr Caitlin Bernard, an obstetrician-gynecologist in Indiana, received a call from a colleague in Ohio seeking help for their 10-year-old patient. She was six weeks pregnant.
“She is not alone,” Dr Bernard toldThe Independent.
“This is, unfortunately, the real-life consequences of the abortion ban,” she said. “All states have people who are pregnant who need abortion care, in the most extreme circumstances and in the most common circumstances, and everyone deserves to have access to comprehensive reproductive healthcare in a state in which they live.”
On 25 July, state lawmakers in Indiana will convene for a special legislative session, under direction of the state’s Republican anti-abortion Governor Eric Holcomb, to potentially consider more restrictions on abortion.
Abortion is legal in the state, but it is among the first in the rush to criminalise care after the Supreme Court overturned Roe v Wade last month, ending half a century of constitutional protections for abortion rights and handing the decision back to individual states.
“We do expect them to have a very severe ban, based on what we’re hearing out of the state house, that could include very few exceptions, including potentially not an exception for rape, as was the case in Ohio,” Dr Bernard told The Independent.
“What that means for my patients is what we’re seeing already … People who can will travel, sometimes [thousands] of miles to receive access to safe, legal abortion care in another state,” she said. “What we know is that those who are not able to overcome all of the challenges [to access care] and all of the barriers will turn to other methods, including self-managed abortion. And that is something that we don’t want people to have to do. We want them to be able to access safe, legal care in the place that they live.”
Ohio is among 10 states – including Alabama, Arkansas, Florida, Kentucky, Louisiana, Missouri, Oklahoma, South Dakota, Tennessee and Texas – that do not provide any exceptions for abortions from pregnancies resulting from rape or incest under their state laws governing abortion care.
Following the Supreme Court decision in Dobbs v Jackson Women’s Health Organization on 24 June, state-level restrictions and “trigger” laws that previously were considered unconstitutional under Roe were enacted in states across the US.
State legislators now are moving quickly to consider new legislation to severely restrict or outlaw abortion access entirely without the constitutionally protected right to an abortion preempting state law.
Ohio’s law prohibits abortions past six weeks of pregnancy, before many patients know they are pregnant, or roughly two weeks after a missed period.
After a judge allowed the law to go into effect, “immediately people were scrambling” in neighbouring Indiana, Dr Bernard told The Independent.
“People who had care scheduled in Ohio were scrambling to find somewhere to send their patients. Patients were scrambling to figure out where they would be able to get to when how much it would cost. And we took those calls immediately,” she said. “And luckily in many cases, we were able to get care for them and have increased access in the state to meet those demands. But of course we also don’t know exactly how long that’s going to be.”
Providers and advocates in Idaho, Mississippi, North Dakota and Wyoming – four states that have rape or incest exceptions in their anti-abortion laws – have warned that while those laws do allow people to end pregnancies under some circumstances, it will likely be easier to assist their patients’ travel to another state than it would be to clear the extremely narrow state-level obstacles to legal care. And in states like Mississippi, where the last remaining abortion clinic closed on 7 July, it may be difficult to find a provider willing to navigate those restrictions.
Indiana’s existing restrictions on abortion care include waiting periods, mandatory state-directed counseling and ultrasounds, bans on certain health insurance coverage, and bans on telemedicine appointments to access medication abortion, the most common form of abortion care, using a two-drug regimen that can be taken from the comfort of a patient’s home, in most cases.
Nearly 67 per cent of all terminated pregnancies in the state in 2020 occurred within six to eight weeks of gestation. Medication abortion is approved by the Food and Drug Administration for use up to 10 weeks. Roughly 55 per cent of all abortions in the state that year were medication abortions.
The state’s Targeted Regulation of Abortion Providers laws, or TRAP laws, require providers to have so-called admitting privileges at local hospitals and other onerous regulations for provider offices, like room sizes.
Complying with restrictions is “incredibly stressful for providers and for healthcare organizations,” according to Dr Bernard.
“There has been a lot of stigma against organizations and health care providers who do provide abortion care in the state such that we feel threatened both physically and from our employment standpoint, and that is limiting the number of providers in the state,” she said. “That means decreasing access [and] decreasing the number of physicians and healthcare clinics that are able to provide abortion care.”
Some patients may have to drive several hours away to Illinois, among a handful of states that have protected legal access to abortion care, according to Dr Bernard.
“I might as well be talking about another planet when I offer them the option of going to Chicago,” she said, pointing to burdensome travel costs for many patients. “For many people, that is just not feasible.”
Last year, roughly 25 per cent of abortion patients in Indiana traveled out of state for care, according to the Hoosier Abortion Access Study, which reviewed abortion patients from June 2021 through May 2022.
Most of those patients said that the costs made it difficult to buy groceries, pay rent and childcare. Roughly 83 per cent of people seeking an abortion in the state were similarly burdened, according to the study.
“I think we hear a lot from the ‘right to life’ movement right now, saying, ‘Well, now we have to support women.’ And the question is, ‘well, where has that support been this entire time?’ Not just in their access to abortion … but the support of them and their children with housing and food support and paid family leave and universal health care and access to mental health and substance abuse treatment,” Dr Bernard said.
“It’s really stunning, the hypocrisy.”
