Ohio Gov. John Kasich, who on Tuesday jumped into the pool of GOP presidential candidates, has spearheaded a targeted effort against legal abortion access, leading to the closure of half of the state’s outpatient abortion clinics.

Ohio had 14 abortion clinics in 2013, two years into Kasich’s first term. But that summer, flanked by a group of all-male state officials, Kasich signed a two-year budget bill that included, among other anti-choice measures, stringent new licensing regulations for abortion clinics in the state.

Those regulations required that every clinic have a written agreement with a local, private hospital that says it will accept clinic patients in cases of emergency, or else apply for an exemption. The GOP’s anti-choice law explicitly states the agreement cannot be with a public hospital system.

Since the law went into effect in 2013, clinics have scrambled to comply, eight have closed or stopped providing abortion services since the start of that year, and several abortion care providers continue to fight legal battles to stay open. Many of the clinics sought but were unable to find private hospitals, a large portion of which are religiously affiliated in Ohio, that would write a transfer agreement.

The Cincinnati-area Lebanon Road Surgery Center, also known as Women’s Med, had its variance permit revoked by the state on what it contends were arbitrary terms. The state then revoked the clinic’s operating license altogether, on the grounds that it didn’t have a variance.

The Cincinnati metropolitan area now has one remaining abortion clinic. And that clinic, the Elizabeth Campbell Surgical Center, was hit with a citation in October for failing to have a transfer agreement. The clinic for years had an agreement with the University of Cincinnati Medical Center, but had to find a private hospital that would do the same.

When officials couldn’t find one, it applied for a variance permit instead. That variance had been pending with the Ohio Department of Health for more than a year when the clinic received the citation.

And this year, Kasich dealt a blow to abortion clinics using the state budget, this time signing two last-minute amendments to the 2015 budget that abortion access advocates say are designed to close two of the state’s clinics.

One of those clinics, called Capital Care Network (CCN), is the Toledo area’s only remaining abortion clinic. CCN originally had a transfer agreement with the University of Toledo Medical Center, but was forced to find a private hospital under the law. After searching in vain, CCN finally signed an agreement with a hospital 50 miles away in Ann Arbor, Michigan.

The state Department of Health then revoked the clinic’s license, saying the contract must be made with a “local” hospital. CCN challenged that decision in court and won in June, however, the court’s favorable decision was immediately appealed by the state.

Kasich days later signed the 2015-2017 budget, with an amendment added to define “local” for the purposes of the transfer agreements as at most 30 miles away.

The anti-choice push during Kasich’s tenure as governor has happened with help from not only the state legislature but also the state health board. In 2012 he appointed Mike Gonidakis, the president of the anti-choice group Ohio Right to Life, to the State Medical Board, a body in part responsible for the licensing of abortion clinics.

More recently, Kasich appointed Rick Hodges, formerly the executive director of the Ohio Turnpike and Infrastructure Commission, to be the new director of the Ohio Department of Health, despite public outcry that Hodges lacks the experience, required by law, for the job. The health department is responsible for setting and implementing statewide health policy and responding to public health crises in the state, among other things.

Hodges also served as a state lawmaker in the 1990s, during which time he sponsored at least three anti-choice bills, including one forcing minors give notice to their parents prior to getting an abortion.