By Lisa Bernard-Kuhn ;

As more abortion clinics close in Ohio, few hospitals are willing to perform the procedure under any circumstance.

In 2012, fewer than 1 percent of the 25,000 abortions performed in Ohio occurred at a hospital.

State law prohibits public hospitals from performing abortions or entering into transfer agreements for care after one is performed. Even most private hospitals have bans on elective abortions or strict guidelines for when the procedure can be performed.

Some hospitals allow for abortions deemed to be medically necessary. Increasingly, though, that means only in the most dire circumstances, as when the life of an expectant mother is threatened.

Few hospitals in Southwest Ohio will perform an abortion due to a genetic anomaly of a fetus, said Dr. Roslyn Kade, medical director at Planned Parenthood of Southwest Ohio.

“The hospitals used to induce all of those patients. That is something that has changed very recently,” she said. “Even if the pregnancy is not viable, these women have to go to (full) term or get referred, because they likely won’t terminate the pregnancy in the hospital now.”

Officials at the Christ Hospital, Mercy Health, TriHealth and St. Elizabeth Health in Northern Kentucky all confirmed that they will not perform elective abortions. UC Health did not return emails or calls on the issue.

Mercy Health makes “ethical decisions consistent with Catholic tradition based on sound clinical information provided by physicians and other caregivers,” said Nanette Bentley, a spokeswoman for the group that is the largest hospital operator in the region. Mercy is owned by Downtown-based Catholic Health Partners, the largest health system in Ohio.

“However, issues can occur in a pregnancy that can be life-threatening to the fetus or the mother or both,” said Bentley. “We may treat a severe condition to save a mother’s life, which may end the pregnancy, if we cannot safely postpone lifesaving treatment until the unborn child is viable. Our Ethical and Religious Directives support this approach.”

TriHealth, which operates four hospitals including Good Samaritan in University Heights, Bethesda North in Montgomery, TriHealth Evendale and Bethesda Butler in Hamilton, follows a similar protocol.

“Operations, treatments and medications that have as their direct purpose the cure of a pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they result in the death of an unborn child,” said Joe Kelley, a spokesman for the health system.

In Northern Kentucky, under no circumstances are abortions performed at any St. Elizabeth Healthcare facility, officials said.

“We believe in the sanctity of all life and follow the ethical and religious directives for Catholic health services,” said Guy Karrick, a spokesman for the health system. “Therefore, elective abortions are not performed at St. Elizabeth Healthcare facilities. However, St. Elizabeth is ready to offer compassionate physical, psychological and spiritual care to those persons who have suffered from the trauma of abortion.”

Number of abortion clinics dwindles with changing laws

Ohio law requires abortion clinics, and all surgical outpatient facilities, to maintain a patient-transfer agreement with a hospital in the event of emergencies. But the state last year passed a law that prohibits public hospitals from forming such agreements.

Meanwhile, few private hospitals, and none locally, will sign on to them.

That leaves abortion clinic operators such as Planned Parenthood of Southwest Ohio and the embattled Women’s Med Center in Sharonville at the mercy of Ohio’s health department to grant variances to the law.

Ohio had 14 abortion clinics at the start of 2013. That number could soon dwindle to seven as a result of restrictions. In January, the Women’s Med Center was ordered by the health department to close because it had not requested approval of the addition of two backup doctors in 2012 who had “credentialing and disciplinary issues.” Hamilton County Common Pleas Court Judge Jerome Metz ruled that the clinic could remain open while its owners appeal.

If the Cincinnati-area clinics were to close, Greater Cincinnati would become the largest metropolitan area in America without an abortion clinic, according to an Enquirer analysis cross-referencing U.S. Census data and abortion providers.

“That would really put women at risk,” said Kade. “Women will seek illegal abortion providers. It’s not going away. Women have always sought abortion services.”

Before the Roe v. Wade case that legalized abortions, Kade said “one entire floor of the ob-gyn pavilion at University Hospital was constantly full of women sick and dying from illegal abortions.”

Without access to legal abortions, women seeking them and hospitals face a “pretty untenable” situation, she said.

“If our hospitals don’t want to take transfer agreements from providers where the people are well trained and really competent, how are they going to manage seeing patients from people who aren’t trained?” Kade said.

Paula Westwood, executive director of Right to Life of Greater Cincinnati, disagrees.

“The bottom line is abortion is not health care and pregnancy is not a disease,” she said, adding that requiring transfer agreements is not an “undue burden” for abortion clinics.

“All ambulatory surgical facilities in the state are required to have transfer agreements, and the only ones that have ever received a variance are abortion clinics,” she said. “They should follow the guidelines as every other facility does and is require to do.”

New regulations criticized as ‘cumulative burdens’

Before its patient-transfer agreement ended with UC Health last year, Planned Parenthood of Southwest Ohio applied for the special variance to allow its Elizabeth Campbell Surgical Center in Mount Auburn to continue to operate. That request is still pending.

“We can’t predict what the wait-time will be,” Jerry Lawson, CEO of Planned Parenthood of Southwest Ohio, which operates seven health centers across the region. “We think we have a very solid request.”

It’s rare, Lawson said, that patients are transferred to a hospital from the Mount Auburn center. “We see just one or two a year,” he said, adding that no hospital in the region can turn a patient away who arrives in their emergency room.

“Patients get taken care of whether there is a transfer agreement or not,” he said. “This transfer agreement issue, it’s really just about putting a clamp-down on abortions.”

Ohio’s abortion restrictions tie for eighth in the nation in their breadth, according to an analysis of state laws by the Guttmacher Institute, a research group that advocates for abortion rights. Legislatures in 22 states passed a total of 70 abortion restrictions last year – the second-most in any year – and Ohio kept pace. Republicans included five anti-abortion provisions in the spending plan signed into law in June.

With each new restriction in Ohio, the barrier to abortion gets stronger, said Dawn Johnsen, a law professor at Indiana University whose specialties include abortion rights.

“These are cumulative burdens,” she said. ?