Dr. David Burkons graduated from medical school and began practicing obstetrics and gynecology in 1973, the same year the Supreme Court issued its landmark abortion decision in Roe v. Wade.
Burkons liked delivering babies. But he is also committed to serving all his patients, including those who choose abortions.
On a recent day a 30-something woman comes to the clinic. She is six weeks pregnant. Her birth control failed her, she says. Burkons greets the woman warmly as she comes to the clinic for the second round of the medical abortion process, a two-dose drug regimen to end a pregnancy.
"We're going to give you this," Burkons says, handing the woman the pills.
"And what are these two?" asks the woman, who requested anonymity.
"These are the misoprostol pills," Burkons says.
On this day a steady stream of women visit Burkons' clinic for medical abortions.
Since the Roe v. Wade decision, Ohio has been a trendsetter in passing restrictions on abortion. So it is especially unusual that in a small Ohio town, an hour south of Cleveland, a new clinic that performs abortions opened its doors last year.
Burkons wanted the clinic to be personable, with minimal wait times.
Initially in his new clinic, he could only administer the pills that induce medical abortion. But this summer, after 18 months of state inspections, rejections and — finally — acceptance, he began performing surgical abortions as well.
For any woman wanting to take these pills, Ohio requires more clinic visits than medically necessary, and it makes their use illegal after seven weeks of pregnancy. In many other states that restriction comes at nine weeks of pregnancy.
Ohio's laws are examples of how seemingly narrow rules can significantly curtail abortion. Mike Gonidakis, who leads Ohio Right to Life, says broader bills that propose stopping abortion entirely rarely get approval. "We believe in an incremental approach to both the legislative side as well as the changing [of] hearts and minds," Gonidakis says.
Another Ohio law, similar to one in Texas, requires doctors at clinics that perform abortions to have admitting privileges at local hospitals, in case of an emergency. These laws allow hospitals to grant specific doctors access to their facilities, but hospitals aren't required to grant the privileges. The U.S. Supreme Court may take up the Texas case in the fall.
Ohio has also proposed legislation that would make it illegal to end a pregnancy if the reason for the abortion is that the fetus has Down syndrome.
Lee Strang, an attorney and professor at the University of Toledo's law school, says the incremental approach to rolling back abortion seems to be working across the country.
"At some point in the mid- to late '70s, pro-life people recognized that they were in for the long haul," he says. "Instead of trying to overturn Roe, at least immediately, they tried to incrementally undermine Roe through the judicial appointment process, and then through state and federal statutory restrictions on abortion."
The Guttmacher Institute, a nonprofit that supports abortion rights, also tracks restrictions. In 2013 alone, the institute says, 22 states, including Ohio, enacted 70 provisions restricting access to abortion.
Jessie Hill, an attorney and professor at Case Western Reserve University's school of law, sits on the board of a clinic called Preterm that provides abortion services. She said various legal provisions under the public radar have been used to restrict abortions for years.
"It's hard for people to see how any one of these things in isolation impacts abortion access," Hill says. "But when they add up, they can really constitute a major burden."
Burkons says his work is very rewarding and that virtually all the women he treats are relieved and grateful.
"Nobody grows up saying, 'I'm planning on having an abortion,' " Burkons says. "And they just assume that if it does happen, someone will be here."
The clinic faced pent-up demand when Burkons started offering surgical abortions. He performed 16 of the procedures in three days.
About half of Ohio's clinics that perform abortions have closed since 2010. Counting the clinic Burkons operates, there are now nine in the state.
This story is part of NPR's reporting partnership with WCPN-Ideastream and Kaiser Health News.
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