Amid Pandemic, States Continued to Pass Laws to Advance Reproductive Health, Rights and Justice in 2020

December 16, 2020
Contact: Kelly Novak, [email protected]

New report from National Institute for Reproductive Health (NIRH) highlights 2020 state legislation to protect access to abortion, contraception, pregnancy care, and more – and recommends policies for states to move in 2021

NEW YORK – A new report from the National Institute for Reproductive Health (NIRH) highlights how 44 states and the District of Columbia stepped up for reproductive freedom this year by enacting 74 bills that protect and advance reproductive health, rights, and justice – even in the midst the COVID-19 pandemic. NIRH worked to pass a number of these proactive policies, and its Gaining Ground: Proactive Reproductive Health and Rights Legislation in the States 2020 report is a review of all the proactive state legislation introduced, moved, or enacted to advance and protect reproductive freedom over the course of 2020. The report finds that states introduced a total of 608 bills in all and provides policy recommendations for state advocates and legislators to follow as they pick up this mantle in 2021.

“In a year in which the COVID-19 pandemic has upended lives across the country, never has the critical role of states in safeguarding our basic rights and expanding equitable access to reproductive health care and enhancing supports to parents and families been more evident,” said Andrea Miller, president of NIRH. “Amid the pandemic – and in some cases, because of it – states found ways to prioritize reproductive health, rights, and justice. With the looming threats posed by the Supreme Court, there are clear actions that states should take as soon as possible in 2021 to ensure that everyone has the right and ability to make decisions about their reproductive lives and access to the services and support they need to do so.”

In 2020, dozens of states around the country stepped up to advance the full spectrum of reproductive health care. Specifically, the Gaining Ground report tracks proactive legislation across six categories: expanding access to abortion care, improving access to contraception, increasing access to pregnancy care, promoting comprehensive sexuality education for all young people, supporting parents and families, and prohibiting interference with reproductive health care.

In recent years, states have significantly stepped up in introducing, moving, and passing legislation to protect and expand reproductive freedom. In 2014, when NIRH started tracking proactive legislation in the states, 32 states moved 70 such bills, enacting 30 of them. In 2019, 49 states and the District of Columbia introduced nearly 1,000 such bills, moved 365 of them, and enacted 147.

Trends from 2020 included:

  • There were fewer proactive bills regarding abortion in 2020 than in previous years (57 bills proposed, five enacted), yet with a new Supreme Court that is all but certain to roll back or eliminate federal constitutional protections for abortion care in mind, advocates and lawmakers continued to push forward on two key priorities: restoring and expanding access and safeguarding rights. Two new laws were enacted, in Virginia and the District of Columbia.
  • At the close of the year Massachusetts and New Jersey were urgently moving forward legislation to eliminate barriers to abortion and protect fundamental rights.
  • States also prioritized ensuring easier access to contraception in 2020. They focused on bills to ensure 12 months of birth control in one prescription, allow pharmacists to directly prescribe or provide oral contraception, and enshrine the ACA guarantee of contraception access in state law. In all, 77 bills were proposed, 11 of which were enacted.
  • The number of states to consider paid family and medical leave proposals (88 bills) increased from 2019 (75 bills). Despite the pandemic – or in some cases, spurred by it –

nine new paid family leave laws were enacted in eight states.

  • States also continued the trend of acting to combat the crisis of maternal mortality in states across the country, especially among Black women. Thirty-seven states considered policies to improve pregnancy health outcomes (167 bills, 20 enacted), with most focusing on reducing maternal mortality and addressing the significant Black maternal mortality rate. The proposed policies included new task forces to study maternal health, Medicaid expansion (38 bills), and policies to support access to midwives or doulas (28 bills).

In addition to analyzing 2020 policies, the Gaining Ground report offers specific policy recommendations for state lawmakers and advocates to move forward in 2021 — especially as some states are poised to roll back reproductive health care and the Supreme Court is stacked against it. NIRH points to policies that will enshrine protections in state laws, such as the right to access abortion and the ACA’s contraceptive coverage mandate, and policies that will make reproductive health care more accessible, given the turmoil caused by the pandemic.

“Governors, state legislators, and state policy represent our greatest hope for advancing abortion access and protecting reproductive freedom in 2021,” Miller said. “NIRH remains committed to pushing these efforts forward, and in 2021 we will be working closely with state advocates and elected officials across the country to ensure that their laws are as strong as they can be.”


NIRH works to protect and advance access to reproductive health care and build political power for reproductive freedom, primarily at the state and local levels. In addition to its Gaining Ground series, which documents highlights and recommendations for state level proactive policy to advance reproductive freedom, NIRH also produces the Local Reproductive Freedom Index that serves as both a snapshot and a roadmap for proactive reproductive health, rights, and justice practices and policies in cities and states across the country. In early December, NIRH released a companion report, Protecting Reproductive Freedom in Cities and Counties During the COVID-19 Pandemic: A Local Reproductive Freedom Index Special Report, citing the progress made by cities in 2020 to advance reproductive health, rights, and justice.