Ohio abortion law is now governed by a 2023 constitutional amendment that protects the right to end a pregnancy up to fetal viability, and after viability when the treating physician determines the procedure is needed to protect the patient’s life or health. The amendment, known as Issue 1, passed with 56.78% of the vote and added Article I, Section 22 to the Ohio Constitution. It has already led courts to block the state’s six-week ban, its 24-hour waiting period, and other restrictions that existed before November 2023. A handful of rules remain enforceable, including parental consent for minors and federal limits on Medicaid funding.
What the Constitution Now Protects
Section 22 gives every individual the right to make and carry out their own reproductive decisions. It names five protected categories: contraception, fertility treatment, continuing a pregnancy, miscarriage care, and abortion. The list uses “including but not limited to” language, so it is not a closed set.1Ohio Legislative Service Commission. Ohio Constitution Article I Section 22 – The Right to Reproductive Freedom with Protections for Health and Safety
The state cannot directly or indirectly burden, penalize, or discriminate against a person who exercises these rights, or against anyone who helps them, which brings doctors and clinic staff under the same protection as patients. If Ohio wants to regulate anything that touches reproductive decisions, it must prove two things: that the regulation uses the least restrictive means available, and that it advances the patient’s health according to widely accepted, evidence-based standards of care.1Ohio Legislative Service Commission. Ohio Constitution Article I Section 22 – The Right to Reproductive Freedom with Protections for Health and Safety
A rule driven by moral disapproval or a desire to limit access fails that test on its face. Section 22 is also self-executing, meaning it took effect the moment it was certified; the legislature did not need to pass anything to make it operative.1Ohio Legislative Service Commission. Ohio Constitution Article I Section 22 – The Right to Reproductive Freedom with Protections for Health and Safety
When the State Can Still Prohibit Abortion
Ohio may prohibit abortion after fetal viability, but the amendment defines viability in a way that leaves the call with the treating doctor rather than the legislature. Viability means “the point in a pregnancy when, in the professional judgment of the pregnant patient’s treating physician, the fetus has a significant likelihood of survival outside the uterus with reasonable measures,” determined case by case.1Ohio Legislative Service Commission. Ohio Constitution Article I Section 22 – The Right to Reproductive Freedom with Protections for Health and Safety
There is no fixed gestational cutoff in the constitutional text. A six-week ban, a 15-week ban, or any other rigid timeline cannot survive. The physician treating the patient decides whether viability has been reached based on that pregnancy’s facts.
Even after viability, the state cannot prohibit an abortion when the treating physician determines the procedure is necessary to protect the patient’s life or health. That exception has no second-opinion requirement, no committee review, and no waiting period attached. The doctor’s professional judgment is the standard.1Ohio Legislative Service Commission. Ohio Constitution Article I Section 22 – The Right to Reproductive Freedom with Protections for Health and Safety
Restrictions That No Longer Apply
Several pre-amendment laws have been blocked or struck down since Issue 1 passed.
The six-week “heartbeat” ban (Senate Bill 23), which had prohibited abortion once fetal cardiac activity could be detected, was permanently struck down by a Hamilton County judge. The First District Court of Appeals affirmed in January 2026 that the ban itself is unconstitutional, though it sent some ancillary provisions back for further review.
Ohio’s mandatory 24-hour waiting period, which forced patients to make two separate clinic trips, has been blocked by a preliminary injunction. A Franklin County judge found that the waiting period, the in-person visit requirement, and the state-mandated counseling script did not advance patient health. As of early 2026 that injunction remains in place, and those requirements are not being enforced.
A separate law requiring burial or cremation of embryonic and fetal tissue from procedural abortions (Senate Bill 27) has been permanently blocked, with the First District Court of Appeals upholding the trial court.
Litigation is still working through other pre-amendment restrictions. Rules that genuinely protect patient health through the least restrictive means may survive; rules that function as access barriers almost certainly will not.
Restrictions Still in Effect
Parental Consent for Minors
Under Ohio Revised Code 2919.121, no one may perform an abortion on a minor unless the physician has obtained written consent from both the minor and at least one parent, guardian, or custodian.2Ohio Legislative Service Commission. Ohio Code 2919.121 – Unlawful Abortion Upon Minor
A minor who cannot or does not want to involve a parent can petition the juvenile court for a judicial bypass. A hearing must happen within five days. The court looks at the minor’s emotional development, maturity, and understanding of the procedure and its alternatives. If the judge finds the minor is sufficiently mature to consent, or that the abortion is in the minor’s best interest, the court can authorize the procedure without parental involvement.2Ohio Legislative Service Commission. Ohio Code 2919.121 – Unlawful Abortion Upon Minor
Emancipated minors are treated as adults under the statute and need only provide their own informed written consent. Whether the consent requirement itself will face a Section 22 challenge is an open question, but as of 2026 it remains enforceable.
Licensing and Professional Oversight
The Ohio Department of Health still oversees clinic licensing and facility standards, and the State Medical Board of Ohio retains authority over physician conduct. Section 22 does not prevent the state from maintaining general healthcare quality standards; that is the kind of patient-health-focused regulation the amendment contemplates.
Medication Abortion and Telehealth
Medication abortion using mifepristone and misoprostol is available through roughly the first 10 to 11 weeks of pregnancy. At the federal level, the Supreme Court ruled in 2024 that mifepristone can continue to be prescribed through telehealth and delivered by mail, preserving the FDA’s relaxed access rules. Certified prescribers and pharmacies may dispense the medication, though Risk Evaluation and Mitigation Strategy requirements still apply, including pharmacy certification, signed patient agreements, and trackable shipping.
A 2021 Ohio law banning medication abortion by telehealth has been placed on hold by the courts. Planned Parenthood of Greater Ohio announced in early 2026 that it plans to provide telehealth abortion services. A bill in the Ohio House would require in-person visits before prescribing certain abortion medications, but for now telehealth remains a lawful channel for Ohio residents.
Emergency Care Under Federal Law
Federal law adds a separate layer on top of Ohio’s constitutional protections. Under the Emergency Medical Treatment and Active Labor Act, any hospital that participates in Medicare must provide stabilizing treatment to a patient who arrives with an emergency medical condition. The statute defines an emergency condition as one where the absence of immediate attention could reasonably be expected to put the patient’s health in serious jeopardy, cause serious impairment to bodily functions, or cause serious dysfunction of any organ.3Office of the Law Revision Counsel. 42 U.S. Code 1395dd – Examination and Treatment for Emergency Medical Conditions and Women in Labor
EMTALA does not use the word “abortion,” but when an abortion is the medically necessary stabilizing treatment, such as for an ectopic pregnancy, severe hemorrhaging, or preeclampsia, hospitals are legally required to provide it. That obligation runs with Medicare participation and cannot be overridden by state law. Hospitals that refuse stabilizing care face potential loss of Medicare funding and civil liability.
Paying for Abortion Care
The federal Hyde Amendment prohibits the use of federal Medicaid funds for abortion except in three narrow situations: when the pregnancy results from rape, when it results from incest, or when the abortion is necessary to save the patient’s life.4Congress.gov. The Hyde Amendment – An Overview Ohio does not go beyond those minimums. Ohio Medicaid will not cover elective abortions outside those three exceptions.
For patients paying out of pocket, costs vary with the type of procedure and the stage of pregnancy. A first-trimester medication or surgical abortion in Ohio generally costs around $750. Procedures between 13 and 15 weeks typically run $900 to $1,050. Those closer to 20 weeks can reach $1,500 or more. Lab work, blood tests, and follow-up care add to the total. Some clinics offer sliding-scale fees, and nonprofit abortion funds operate in Ohio to help patients who cannot afford the full cost.
Private insurance coverage depends on the plan. Ohio does not prohibit private insurers from covering abortion, but not all plans include it. Verify coverage directly with your insurer before scheduling.
What Section 22 Does Not Cover
The amendment protects individual decisions from state interference. It does not create a right to have the government fund or provide abortion services. It does not require private employers to cover abortion in their health plans. And it does not stop the legislature from passing new regulations, so long as those regulations clear the least-restrictive-means test and rest on evidence-based patient health standards.
Section 22 also does nothing to change the geography of care. Most Ohio abortion providers are concentrated in the largest cities, and patients in rural areas may need to travel or rely on telehealth. A constitutional right on paper does not resolve the practical and financial barriers that still shape access.