On November 7, 2023, approximately 56.6 percent of voters in Ohio approved Issue 1, a ballot initiative for a constitutional amendment that codifies the legal status of abortion in Ohio’s state constitution. Ohio is now one of seven states where voters have supported abortion rights on the ballot, signaling a direct rejection of the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization to overturn Roe v. Wade and eliminate the federal constitutional right to abortion in the United States.
The Ohio constitutional amendment ensures, “Every individual has a right to make and carry out one’s own reproductive decisions … on contraception, fertility treatment, continuing one’s own pregnancy, miscarriage care, and abortion.” The amendment makes two additional clarifications: 1) The state cannot interfere with these rights unless it uses “the least restrictive means to advance the individual’s health,” and 2) abortion may be prohibited after fetal viability as long as it doesn’t interfere with a patient’s life or health.
These results are especially significant given anti-abortion Republican state lawmakers’ attempt to stop this ballot initiative before it even passed. Earlier this year, they placed a measure on Ohio’s August special election ballot that would have raised the requirement of voter support to amend the state constitution from more than 50 percent to 60 percent, making it more difficult for Issue 1 to pass. Voters resoundingly rejected this attempt by Republican lawmakers to circumvent democratic norms, paving the way for Issue 1 to pass.
Codifying protections on abortion rights in Ohio’s state constitution is important given the post-Dobbs waves of legislative and legal challenges to abortion. As of publication, abortion in Ohio is legal up until 22 weeks of pregnancy. However, hours after Roe was overturned, Ohio began to enforce a 2019 ban on abortion after six weeks, which was then blocked through multiple levels of litigation.
As this column details, the benefits of Ohio’s ballot initiative are far-reaching: In addition to proving the resounding success of abortion ballot initiatives in the wake of Dobbs, these election results also matter in the greater context of abortion care and maternal health in Ohio.
Ohio currently leads the nation in the greatest number of women affected by shortages and lack of access to maternity care in the United States.
This issue is particularly pressing for Ohioans: Ohio currently leads the nation in the greatest number of women affected by shortages and lack of access to maternity care in the United States. Post-Dobbs, in 2022, a total of more than 97,000 women in Ohio were affected by these reductions. Limited maternity care widens the gap in racial disparities in maternal and infant mortality, creates more obstacles for women to obtain care, and can ultimately force women to carry their pregnancies to term.
And make no mistake, women who need maternal health care—which includes abortion care—are dying in Ohio. Maternal health and abortion care are inextricably linked, confirming that abortion should be viewed as one aspect on the spectrum of holistic maternity care. Multiple studies have confirmed that states with policies that restrict abortion access correlate with higher maternal mortality rates—“the number of pregnancy-related deaths for every 100,000 live births.” Notably, the United States has the highest maternal mortality rate among developed countries, and Ohio is no exception to what has become a shocking American norm. Between 2018 and 2021, Ohio’s maternal mortality rate was 23.8 deaths per 100,000 live births, which is slightly higher than the national average at 23.5 deaths per 100,000 live births.*
Ohio’s ballot measure particularly affects women of color in the state
Black women and other women of color are dying at disproportionate rates in Ohio because of inadequate maternal health care, and these rates are in turn amplified by structural and racial bias.
In 2019, the maternal mortality rate for Black women in Ohio was more than five times the overall rate. Nearly 60 Black women died in Ohio for every 100,000 live births, a large increase from the 1999 number of 29.3 and a maternal mortality rate far in excess of every other racial or ethnic group. Moreover, deaths for American Indians and Alaskan Natives were nearly 4.5 times higher in 2019 than in 1999, jumping from a rate of 2.6 to 11.5—the largest increase of any racial or ethnic group in Ohio during that time period.
Existing racial and ethnic disparities in maternal mortality are exacerbated in states with policies that restrict abortion access. Longitudinal research shows that women who are denied abortion care are more likely to experience poorer health outcomes; this means that restrictions on abortion access are also overwhelmingly likely to worsen morbidity rates, or the rate at which disease or illness occurs in a population. What’s more, more than 80 percent of maternal deaths due to pregnancy complications are completely preventable, signaling that there are deep unmet needs in maternal health care.
Ohio is also not an exception to the national trend indicating that restrictions on abortion access increase the likelihood of infant deaths. As of 2021, Ohio’s infant mortality rate is already higher than the U.S. average—with 7.06 infant deaths per 1,000 live births compared with the national average of 5.44 infant deaths per 1,000 live births.
Ohioans have spoken. Ensuring protections for abortion rights in the state’s constitution will have a substantial impact on women’s health. And just as putting abortion on the ballot served as a rallying cry for voters to vote early and turn out in record numbers, this election should also serve as a push to prioritize and address the large crisis on maternal health outcomes in Ohio.
* Note: The full, detailed study from the Centers for Disease Control and Prevention is on file with the authors.