Destinee Marett was less than two years sober when she got pregnant. She already had three children, her first when she was 13 years old.
At the time, she was waitressing at a diner in Cleveland, surviving on tips alone. Employers in Ohio pay servers only $4.30 (£3.31) per hour, and between taxes and child support her check was often for nothing.
“I grew up fast, real fast,” said Marett, a former felon. This pregnancy was the “wrong time, wrong place kind of thing.”
She found out five weeks into the pregnancy, and had an abortion, as has been every woman’s constitutional right since the US supreme court legalized abortion nationally in the Roe v Wade decision in 1973.
This month, Ohio passed one of the strictest abortion bans in the world, a so-called “heartbeat bill” which would make the procedure illegal at about six weeks into gestation. The law bans abortion just as embryonic tissues begin to pulse, even though the chambers of the heart have yet to form at this early stage.
Conservative Christian lawmakers, who have supported the bills in 15 states across the country, hope the law – which is blatantly unconstitutional – will be challenged all the way up to the supreme court, giving the conservative-leaning, nine-member panel an opportunity to redefine a woman’s right to abortion.
Roe v Wade gave women in America the right to obtain an abortion until about 24 weeks into a pregnancy, when a fetus could potentially live outside the womb (a normal-term pregnancy is 40 weeks). Lawmakers in Ohio and elsewhere hope to challenge that standard by arguing that the detection of cardiac activity is a better limit.
Gynecologists have argued that the so-called “heartbeat bills” are misleading, because the pulsing tissues of a six-week-old embryo have not yet formed a heart.
“There’s nothing magical that happens when we can detect cardiac activity,” said Dr Jen Gunter, a prominent gynecologist. “There’s no perception of pain, there’s no soul, there’s nothing that you can say, ‘Well, wow,’ this could medically make me think differently about abortion.”
Women without access to abortion are more likely to try to self-induce abortion using herbs or unproven drugs, may self-inflict abdominal trauma, or remain with a violent partner. The Ohio law also forces victims of rape and incest, who discover they are pregnant later than six weeks into gestation, to carry a child to term.
“I’ve met so many women who’ve had to make choices between their cancer treatment and carrying a pregnancy,” said Janine Boyd, a Democratic Ohio state representative who opposed the law. “There’s things we know nothing about.”
Nevertheless, 11 more states are considering the bill and four more have passed it.
Although it is nationally considered a “purple” state, Ohio has led the way in a long series of abortion restrictions. It was the first state to introduce a ban on dilation and extraction procedures, which campaigners called “partial birth abortion”. Until recently, the six-week limit was promoted by fringe anti-abortion activists in Ohio, and was considered too severe, even for sympathetic Republican lawmakers.
“This bill is very extreme,” said Freda Levenson, a staff attorney with the American Civil Liberties Union of Ohio. “It does not even have an exception for rape or incest.”
Chrisse France, executive director of Preterm in Cleveland, Ohio, runs one of the last remaining independent, feminist abortion clinics in the country. There are only 14 across the United States. Preterm plans to sue Ohio with the help of the ACLU of Ohio to stop the law, one of several legal battles it’s fighting on this front.
Since the Ohio law passed, many clients are calling in a panic, asking whether abortion is still legal in Ohio (it is, for now, while the law is challenged in court).
Within Ohio, after the tear-flooded hearings on the bill in which Democrats offered amendment after amendment to halt its progress, many blamed an unlikely culprit for the bill: gerrymandering.
A Republican majority has held the Ohio house for the better part of a decade. A 2016 Republican sweep brought a supermajority in the house, and allowed the bill to move forward in the senate.
“I’ve been here the whole time this session and I definitely have some feelings,” said Kelley Freeman, an organizer with Naral Pro-Choice of Ohio, on the day the bill passed through the legislature. “A lot of it is disappointment, a lot of it is anger.”
Districts drawn to favor Republicans, said political scientist Paul Beck of University of Ohio, “magnifies the clout of the right-to-life community”, by encouraging a party base to elect ever more extreme candidates.
“For the last 10 to 12 years, there’s been a very powerful force in the right-to-life community, wanting to roll back Roe versus Wade and challenge gay marriage,” said Beck. Where once there was division on the bill, “the right-to-life community, as far as I can tell, came to be fairly united on the ‘heartbeat bill’ that passed.”
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Norma McCorvey, pictured, was the real name of the woman known as “Jane Roe” in the landmark 1973 US supreme court case Roe v Wade, which established the right of American women to have abortions.
McCorvey became the plaintiff in 1970 after she met with two lawyers looking for a test case to challenge the abortion ban in Texas, where it was a crime unless a woman's life was at risk. Similar statutes were in place in nearly every other state at the time.
At the time, McCorvey was pregnant, unmarried, unemployed and unable to obtain an abortion legally or otherwise.
The case went to the supreme court, which handed down the watershed ruling that a woman's right to make her own medical decisions, including the choice to have an abortion, is protected under the 14th amendment.
McCorvey never had an abortion. Her case, which proceeded largely without her involvement, took too long to resolve, and she gave birth to a child that she placed for adoption.
Several years after the ruling, she publicly revealed her identity and became involved in the pro-abortion rights movement. But after a conversion to Christianity, she became an anti-abortion rights activist. Before she died in 2017, McCorvey had said it was her wish to see Roe v Wade overturned in her lifetime.
Lawmakers like Candice Keller reflect the change over 10 years. She runs a Christian pregnancy center which opposes abortion. She also opposes gay marriage, and is a Republican state representative for Ohio’s 53rd house district.
“Abortion is not the law in this country, neither is gay marriage. All these cases are case law,” said Keller, whose district is an almost entirely white suburb outside Cincinnati. “They can be challenged at any time, just like we are now challenging abortion.”
Abortion and gay marriage are, in fact, the law of the land – law made by the supreme court through decisions.
Lawmakers like Keller, elected in 2016 with Trump, are pushing such abortion bans alongside laws that chip away at newly won gay rights. Keller co-sponsored a bill called the “pastor protection act”, which the American Civil Liberties Union of Ohio said “may open to door to discrimination against LGBTQ people”.
“Just like we used to have slave states and free states, there will come a time when Ohio will become a life state, and states along the east coast you will be able to abort your child,” said Keller. States like Ohio, she said, will have “a culture of life”.
“Whether this ever leads to a tragedy, like it did before with our civil war, I can’t say,” she said. “That’s going to be something your generation, and your children’s generation, will have to deal with.”
The unified Republican affront to abortion in Ohio is reflected in the state’s long list of abortion restrictions.
Ohio requires minors to obtain parental consent, insists abortion clinics have contracts to transfer patients to local hospitals and forces women to wait 24 hours between a state-mandated counseling session and an abortion. The state dictates which information pamphlets women must receive before an abortion, and that doctors offer a sonogram or to let women listen to a fetal “heartbeat” before the procedure.
Anti-abortion advocates in Ohio have also successfully separated abortion providers from the medical establishment. Just 6% of Preterm’s patients obtain an abortion using health insurance – the rest pay $450 out of pocket (the fee is subsidized by donors). Secular hospitals often avoid the procedures except under special circumstances. Religious hospitals can refuse it altogether.
Women in Ohio can’t use Medicaid, a public health insurance program for the poor, to pay for an abortion. State employees can’t use their private insurance to pay for an abortion. Nor can women who buy private insurance through marketplaces, so-called Obamacare exchanges.
For Democratic Ohio house member Stephanie Howse, who represents the state’s poorest district, the law is a “distraction”.
“What you want to do is have control over someone else’s body,” said Howse. “Don’t you come over here trying to save my people,” said Howse. “We don’t need saving.”
Howse’s constituents, she said, “Don’t care. You know why? They’re trying to live life. This ain’t in their top five” worries and concerns. “They [are] focused on how they can break generational poverty.”
For now, Preterm is strategically planning for a future without abortion in Ohio.
“Get ready, because we’re going to be sending patients to New York,” said France. “We’re not talking tomorrow, but I would say it’s certainly a possibility.”
If it is allowed to go into effect, the law would also have a series of knock-on effects on women’s rights.
Here is just one: because of exemptions in marital rape laws in Ohio, a woman can be drugged and raped by her husband. If she discovered she was pregnant after the fetus has cardiac activity, the state could then force her to carry the pregnancy to term.
“Ohio became a much less safe state for women, and I have two daughters,” said Greta Johnson, a former prosecutor and state representative who tried to end the marital rape exemption. Democrats offered an amendment to close the loophole as the Republican supermajority pushed through the six-week law ban. It was rejected.
The situation, Johnson said, is “very sobering”.
Adrian Horton contributed to this report