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In the past few years, states across the country have passed a record number of restrictions on abortion. Some of those laws are blocked by courts; others are making access to abortions more difficult, like in Ohio. Since 2011, half the state's clinics that perform abortion have closed. Any day now, a judge in Toledo could rule on whether another one must shut down. NPR's Jennifer Ludden has the first of several reports from a state with some of most sweeping abortion laws in the country.
JENNIFER LUDDEN, BYLINE: After 20 years trying to shame women out of an abortion, Pastor Dale Henkel suddenly has fewer places to make his case. Bundled against a frigid wind in Cleveland, he sticks giant photos in the ice - mangled fetuses, smiling babies. Henkel used to protest a doctor three doors down.
PASTOR DALE HENKEL: Murder Marty, as I refer to him. I was down there for at least 15 years until he got shut down.
LUDDEN: The doctor relocated to Michigan. Then Henkel would go to a clinic across town until it closed. Now Cleveland has just two clinics that perform abortion, including this beige and glass building where another woman approaches the door.
HENKEL: You know they're not choices, they're children. The ultimate crime against humanity's killing a defenseless unborn baby. Nobody in there cares about you.
UNIDENTIFIED WOMAN: Thank you for calling Preterm. How can I help you?
LUDDEN: Here at Preterm Clinic, executive director Chrisse France says the caseload is up 10 percent with all the closures.
CHRISSE FRANCE: We are more fully booked, and I think we have a harder time squeezing patients in if they're earlier in the pregnancy.
LUDDEN: In a bustling surgery center, women are coming from farther away. A mandated waiting period means they must come twice or stay overnight.
FRANCE: And that's tough for women who are working, you know, who may not have paid time off. They're very likely to have children. Children and transportation are often big issues.
LUDDEN: Some are even going out of state. Ohio restricts drugs that induce abortion early on, and it has confusing limits on the procedure after 20 weeks of pregnancy. Kellie Copeland of NARAL Pro Choice Ohio says that's prompted some clinics to just stop doing abortions then.
KELLIE COPELAND: We know that women who have pregnancy complications have to go to Pittsburgh often, someone who maybe later in pregnancy found out that there was a severe fetal anomaly.
LUDDEN: Then there's this new twist on an old law - all surgery centers in Ohio need a transfer agreement with a hospital in case of emergency. But now, clinics that perform abortion, and only those clinics, are barred from an agreement with a public hospital.
COPELAND: So clinics are in this catch-22 that really doesn't have anything to do with patient care.
LUDDEN: Abortion opponents say it keeps tax dollars from funding the procedure. The ban has shuttered at least one clinic and left others in legal limbo.
Not all the closings are tied to new laws; one shut after safety violations, another for business reasons. But NARAL's Copeland says the relentless barrage of restrictions has left providers feeling besieged. Still, she says even the toughest laws won't keep women from ending their pregnancies.
COPELAND: At no time in history, at nowhere around the globe did outlawing abortion mean that women stopped having them. What it meant was they became dangerous.
MIKE GONIDAKIS: Our goal ultimately is to live in a society where abortion is no longer even considered.
LUDDEN: Mike Gonidakis heads Ohio Right to Life, whose offices overlook the statehouse in Columbus. He's key architect of a strategy even opponents call brilliant. He calls his approach incremental and says it's driven by concern for civil rights.
GONIDAKIS: Every pregnant woman, regardless of her socioeconomic status, should be able to get the prenatal care she deserves, be able to have a real doctor and then have her child.
LUDDEN: Gonidakis says he aims to change the culture around abortion, and he's been so successful he says because he doesn't push too far.
GONIDAKIS: What happens in federal court if you overreach, you lose. And when you lose, you lose bad.
LUDDEN: This session, Ohio Right to Life is pushing a long list of new measures. One would ban abortion based on a diagnosis of Down syndrome. A so-called trigger law would ban virtually all abortions if the U.S. Supreme Court overturns Roe v. Wade.
REPRESENTATIVE KRISTINA ROEGNER: I think we as a society, we need to be looking at this issue.
LUDDEN: Representative Kristina Roegner keeps a framed copy of the Ten Commandments on her wall. When she first ran for office, she says constituents asked her about abortion more than anything else. Now, she's sponsoring a bill to ban the procedure at 20 weeks, based on the medically disputed assertion that fetuses feel pain then.
ROEGNER: Those are precious. They're beautiful, little lives that, you know, if left alone will develop into, you know, human beings, and they have rights, too.
AL GERHARDSTEIN: This is part of a bigger effort to rig the system against abortion providers.
LUDDEN: Al Gerhardstein is a civil rights attorney in Cincinnati.
GERHARDSTEIN: We have in Ohio laws that criminalize medical procedures that are unique to abortion. No other area of medicine has doctors fearing for criminal prosecution because they do the right thing for women, and that's wrong.
LUDDEN: His colleague, Jennifer Branch, is dismayed there hasn't been more of an outcry as Ohio's lost one abortion provider after another. Major cities are down to one clinic each. If more close...
JENNIFER BRANCH: My biggest concern is that there's going to be a young woman who dies from trying to self-abort, and that's what it's going to take to galvanize people.
LUDDEN: She and others continue to challenge Ohio's abortion laws. But so far, courts have allowed some of the toughest restrictions to stand. Jennifer Ludden, NPR News.
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