Denise, a registered nurse at the Northeast Ohio Women’s Center in Cuyahoga Falls, looks at the ultrasound of a patient who is three days past Ohio’s new six-week legal limit to have an abortion. (photo by Karen Schiely)
A nurse presses a gelled probe into a young woman’s stomach, squinting at the staticky gray image on the screen. The 22-year-old holds her breath and stares at the ceiling.
“Unfortunately, you’re at six weeks and three days, so we can't help you."
She’s three days too late.
The woman sits up and looks straight ahead emotionlessly, avoiding eye contact with the nurse, who hands her a half-sheet of paper with numbers for out-of-state clinics that could perform an abortion.
Suddenly, she begins to sob.
The woman, who visited the Northeast Ohio Women’s Center in Cuyahoga Falls on Monday afternoon, is one of many across the state whose unplanned pregnancies are further complicated by Ohio’s recent passage of the so-called “heartbeat law,” which outlaws abortion after fetal cardiac activity can be detected, typically around six weeks of gestation, except when the mother's life is at risk.
The measure became effective immediately on Friday evening, just hours after the U.S. Supreme Court decision that overturned Roe v. Wade, a landmark case in 1973 that ruled a state law banning abortion was unconstitutional.
Abortion clinic adapting rapidly to accommodate new law
Dr. David Burkons, who runs the abortion clinic at 2127 State Road, says though he anticipated the law’s passage, the state moved weeks quicker than he and other abortion-rights advocates expected.
Burkons and his staff had to adapt overnight. New policies are in constant evolution now, with much confusion among staff and patients.
“The problem is the law isn’t clear,” Burkons says. “Nobody knows the answers to a lot of these questions that are coming up.”
Burkons’ strategy has always been to get patients early, but they’ve recently ramped up efforts by encouraging patients to come in as soon as they think they may be pregnant. He used to tell women to wait a few days, because if they came in too early, he might not see anything on the ultrasound.
He says in the last few days, they've gotten an influx of women who are not even pregnant but scared because of missed periods and concern over securing an abortion.
Under previous Ohio law, abortions could be performed up to 20 weeks post-fertilization, usually about 22 weeks after the last menstrual period.
At the Northeast Ohio Women’s Clinic, which is one of six remaining surgical clinics in the state, patients have the option of having a procedure or a medical abortion via oral pills. After about nine and a half weeks, surgery was the only option.
As of Friday, the clinic had performed about 1,800 abortions, 650 of which were surgical. Now, because of the six-week cutoff, pills are an option for any patient. Surgical abortions are still available, but Burkons expects a major drop-off in operations.
The pills have a higher failure rate, about 2% to 7% according to Burkons, but to each patient, “it’s all or nothing,” so some may opt for the surgical abortion instead.
In the case of medical abortions, Burkons previously only prescribed two doses to patients who were over eight weeks pregnant, but now, due to time constraints, he gives each person two doses.
“Usually, if the pill doesn’t work, we just have them come back a week or two later and try again,” Burkons says. “That’s not really an option anymore.”
‘Time is an issue now’: Early detection and action
In many cases, people don’t even realize they’re pregnant at six weeks.
Those who catch their pregnancies in time feel lucky.
“I was really nervous with everything going on about whether I was going to be able to do this or not,” says a 34-year-old woman at the clinic Monday. She and the other patients are not being identified to respect their privacy and safety.
The woman is already the mother of two young children and says she and their father cannot care for another child. She plans to take the pills, which block hormones to the fetus and force uterine contractions to terminate the pregnancy.
“Time is an issue now with the new heartbeat bill,” a nurse tells her after her ultrasound. The woman considers when her schedule allows her two days of rest, during which she will experience bleeding and cramping induced by the pills. The clinic’s new policy is to take a new ultrasound every 48 hours if the patient does not schedule their abortion within that time frame.
“What about Wednesday?”
The nurse scrolls through her calendar on her phone, calculating the days until her six-week mark.
“Yes, that should work,” the nurse says. “If you change your mind, that’s OK, just call us and let us know. But if you’re going to do this, it’s going to have to be soon because again, time is really important now.”
“This was a really hard decision for me,” the woman tells the Beacon Journal as she waits to get her blood drawn. “I’ve always been pro-choice, but never thought I could do it myself until my circumstances changed. I’m just glad I have this option because in a couple more days, I wouldn’t.”
Burkons says the heartbeat law, which he repeatedly condemns as “just politics,” may actually have unintended consequences for anti-abortion lawmakers. He says he’s already seeing more people choose to get abortions who might otherwise not have if given more time.
“I used to tell people if they were unsure, wait a few days or even a few weeks,” Burkons says. “Now, there’s just no time to decide, so a lot more women are going to be getting abortions.”
Some will travel to other states for abortions
Throughout the day, the copy machine whirs, feeding sheets of paper into the tray. The printed flyers bear the names and numbers of clinics across state lines, as well as organizations that will help fund travel.
A medical assistant slides one across the table to a woman who just arrived at the clinic. She is 12 weeks pregnant.
The woman has no idea about the state’s recent ban and is immediately furious.
“The world is so (expletive) up,” she says. “These men have no idea what it takes to be a woman or raise a child. They have no right to tell us what to do with our bodies.”
She’s 24 and already has a 2-year-old child. She says the father is violent, striking both her and her daughter on previous occasions.
“He’s evil,” she says. “I can’t bring his baby into this world. It wouldn’t be safe for anyone involved.”
The paper lists clinics as close as Pittsburgh and Detroit, all the way to Atlanta, Georgia. Those states have at minimum an 18-week cutoff.
The woman says she plans to drive to Michigan with her dad as soon as possible but has logistical concerns. Her father works full time and she has a daughter she can’t leave behind, so she’ll need to bring another person to watch her while her dad drives her to and from the procedure.
“I’m going to do this, but I need to have people with me who I can trust,” she says.
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For some women, those trips will not be possible. Between the cost of gas, lodging, meals and other expenses, many will be priced out. That doesn't even account for the cost of the abortion itself, which is $700 at the Northeast Ohio Women’s Center.
“The real trouble will be for poor and rural women,” Burkons says. “They’re probably the ones who need it the most, because supporting a child is expensive, but some of them will be unable to travel and leave the state.”
Anti-abortion protests continue
On the sidewalk outside, anti-abortion protesters prop up signs with graphic images condemning abortion as “murder” and “sin.”
The protesters harass a Beacon Journal reporter on her way into the clinic, stepping off the sidewalks and approaching her car in the clinic’s parking lot, which is private property. The clinic’s escort ushers the reporter in, telling a woman she is trespassing and they’ve called the cops. She does not back off.
“Abortion is an injustice against a vulnerable population who cannot defend or speak for themselves,” Cuyahoga Falls resident and nurse Rita Vitale says to a male Beacon Journal reporter. Vitale is a longtime protester of the clinic. “And we reasoning adults need to stand up for the injustice against human beings.”
Soon, a counterprotest brews on the sidewalk.
A woman drives up and parks near Vitale and other anti-abortion protesters. She does not give her name, but hands them a card identifying herself as a volunteer clinic escort from the Northeast Ohio Pro-Choice Action organization.
“You are accusing me of coming in here and getting an abortion,” the woman says to them. “I just parked my car here, and you got in my face and told me not to get an abortion. Excuse me, it’s not your body. It’s my body. I’m allowed to do whatever I want with my body.”
The woman says she had been abused as a teen and had an abortion. The male protester, who gives only his first name, Scott, says she is “pro death.”
“Abortion means death. Abortion means to abort, to terminate. That’s what it means, to stop," Scott says.
Other abortion-rights protesters show up throughout the day to show their support for the clinic, holding signs that say, “Keep Abortion Legal" and "Forced birth = Violence."
What comes next for abortion providers in Ohio?
Burkons plans to be here until the very end of abortion in Ohio, which he expects to come in the next six to eight months.
In the meantime, he says, he will continue to work with lawyers to accommodate patients within the law.
He is considering getting licensed in Pennsylvania and Michigan and opening clinics there, where he could refer clients from the area for abortions.
Logistics and legal restrictions are murky. What if, for example, a doctor prescribes pills in Pennsylvania but a patient takes them in Ohio and terminates the pregnancy there?
“You really hate to feel like you’re letting them down, but there’s only so much we can do,” he says. “I’m not going to put myself or my staff in legal jeopardy, but this is important work and we will try whatever we can.”
Jim Mackinnon contributed to this report outside the clinic. Originally published in the Akron Beacon Journal on June 28, 2022.