By: Mary FioRito, October 3, 2023
Ohio’s Issue 1 ballot initiative, on which voters will decide on Nov. 7, is already contentious enough. The proposed constitutional amendment would enshrine a right to abortion in Ohio’s state constitution and remove virtually every safeguard, including required parental involvement in a minor’s abortion. But now, a television ad featuring a couple who traveled to another state for a late-second-trimester abortion after receiving an adverse prenatal diagnosis has further fanned the flames — and caused immense confusion.
The details are heartbreaking: After a long struggle with infertility and spending thousands of dollars on IVF treatments, Beth and Kyle Long were expecting their first child, a little girl, whom they nicknamed “Star” — because in her earliest ultrasound image, she looked like a little, twinkling star. Beth Long’s pregnancy proceeded normally until, at 18 weeks, Star was diagnosed with a rare condition, a fetal malformation called limb body wall complex, sometimes referred to generally in medical literature as “body stalk anomaly.”
In body stalk anomaly, the abdominal wall does not develop, allowing the unborn child’s internal organs to form outside of the abdominal cavity, remaining attached directly to the placenta. The condition is so severe that the baby almost always dies while in utero, or in the perinatal period (the first four weeks following birth) — although there are a few documented cases of long-term survival.
In the ad in which the Longs are featured, Beth Long states, “An abortion was our only option.” Her husband then notes, “But the government here in Ohio took that decision away from us.”
It’s attention-grabbing for sure. But it is also untrue that the current Ohio abortion law prohibits abortion under the circumstances faced by the Longs.
The “heartbeat” abortion law in Ohio, which is what the ad implies was responsible, did not explicitly prohibit Beth Long’s abortion. As an extensive CNN report on the couple’s plight explicitly acknowledges, “[Beth Long’s] doctor explained … it was legal for them to have the abortion” they wanted. Beth’s doctor even made arrangements for a doctor in nearby Columbus to do the “complicated and risky” procedure, and they signed the forms necessary to begin the 24-hour waiting period that was required by Ohio law.
The reason the Longs didn’t undergo the abortion in Ohio? Their health insurance provider refused to cover it.
“There are numerous provisions in Ohio’s statutory scheme that function as a kind of state ‘Hyde Amendment’ to protect Ohio’s public grants and tax funding from paying for elective abortions. This includes the statute regulating state funds ‘for nontherapeutic abortion benefits,’” according to Rachel Citak, a civil rights and constitutional law attorney licensed in Ohio.
Citak noted that since Beth Long was a state of Ohio employee, her healthcare coverage was subject to the limitations of a 2011 statute restricting public funds for use in abortions. Because abortion is an elective procedure, it is not funded through insurance policies for public employees unless a pregnant woman’s life is endangered, or in cases of rape or incest.
Body stalk anomaly is not considered a life-threatening condition to the mother and does not generally pose serious risks to the mother’s health. “It’s all very patient specific,” Dr. Christina Francis, a board-certified obstetrician/gynecologist who practices in Indiana, told me. “For any anomalies that cause a large head circumference or enlargement of the baby’s body to an extent the mother cannot deliver vaginally, you would likely need to make a vertical incision on the uterus for a cesarean section during delivery,” she noted. “But those are done all the time, and are managed in such a way so as to make every effort to safeguard the mother’s future fertility and overall reproductive health. In cases like this, you would address any risk factors in the same way you would in any normal pregnancy.”
Perinatal hospice, a specialized program that provides minimal medical intervention and comfort care for babies who are born dying, might also have provided additional closure and comfort to the Longs.
“A couple who is given an adverse prenatal diagnosis obviously experiences a wide range of emotions,” said Dr. Colleen A. Malloy, a neonatologist at Lurie Children’s Hospital in Chicago. There is, of course, shock and disbelief. There is often concern that a baby might suffer pain or discomfort. However, the care for infants born with life-limiting conditions has been greatly improved with the help of families and providers. It’s important that the time the parents have in these circumstances is made as peaceful as possible, with consideration of the family’s wishes and concerns.”
Rather than waiting for their daughter to pass away naturally, either in utero (which occurs often for babies with body stalk anomaly) or shortly after birth — both circumstances in which their insurance would have covered their medical costs — the Longs opted instead to travel to nearby Pennsylvania for an abortion procedure.
To be sure, the Longs’ choice was a heart-wrenching one. But it was not one that was necessitated by Ohio’s abortion law, but rather by insurance coverage restrictions on elective procedures. Insurance provisions that restrict public funds for use in elective abortions are supported by a majority of people, both in Ohio and throughout the country.
Mary Hallan FioRito is an attorney and a fellow at the Ethics and Public Policy Center in Washington, D.C. She writes from Chicago.