Cities – Even in the “Reddest” States – Step Up to Protect Reproductive Freedom Against Attacks from Trump Administration and State Legislatures, New Report Finds

October 21, 2019
Contact: Marisa Rodriguez, [email protected], 956-607-9952

National Institute for Reproductive Health’s Local Reproductive Freedom Index Analyzes Policies of 50 Major Cities, Offers Roadmap and Tools for Advocates and Policymakers

NEW YORK – The National Institute for Reproductive Health (NIRH) today released the second edition of the Local Reproductive Freedom Index, a first-of-its-kind initiative launched in 2017 to evaluate the reproductive health, rights, and justice policies of U.S. cities representing every region of the country. The report is a call to action outlining specific steps advocates and policymakers have taken to build stronger and healthier communities and charts a future course for cities to follow, especially as the White House and hostile state houses across the country continue to attack reproductive rights and undermine access to reproductive health care.

Since taking office, the Trump-Pence administration has emboldened anti-abortion extremists, spurring a spate of state-level laws intended to eliminate abortion access and eventually overturn Roe v. Wade. Meanwhile, the federal government has undermined the nation’s long-trusted Title X family planning program. Amidst the continued onslaught against reproductive health care, many cities have recognized both their responsibility and ability to advance reproductive freedom.

“Cities across the country are really stepping up to the plate, acting on an affirmative vision of what is both necessary and possible to protect and advance reproductive freedom,” said Andrea Miller, president of NIRH. “From reducing barriers to abortion care to ending discriminatory insurance practices to advancing democracy, U.S. cities are leading a national countermovement and showing communities everywhere the power and importance of electing local leaders who will use their positions of power to embrace reproductive freedom – especially in the face of growing attacks from the federal government and a number of state governments.”

NIRH analyzed the policies of 50 cities along 34 indicators, awarding each city zero to five stars based on the policies the city has in place, including access to abortion care, comprehensive sexuality education, and paid family leave. The report demonstrates that many bright spots exist – even in red states – and charts a road map for other cities to follow suit. Just two years after NIRH released its inaugural Local Index in 2017, which established a baseline of what can be done at the local level, cities across the country have embraced and expanded the vision of protecting reproductive freedom at the local level.

The Local Reproductive Freedom Index details action in cities, including in:

  • Columbus, OH: Having protected access to its abortion clinics in 2016, Columbus further expanded a pilot program to offer free menstrual hygiene products at all rec centers and homeless shelters and passed an ordinance that makes it illegal to deny someone services based on their immigration status. The city also adopted a resolution opposing changes to the Title X program.
  • Detroit, MI: The city of Detroit launched a network of teen-friendly reproductive health care providers offering contraception and STI testing and treatment. Detroit also passed an anti-discrimination resolution in 2017 officially opposing the Trump-Pence administration’s immigration policies.
  • Hartford, CT: After an anti-abortion pregnancy center opened just 20 feet from the entrance to the state’s only independent abortion provider, the City Council passed an ordinance requiring any anti-abortion pregnancy centers in the city to disclose whether they have a licensed medical provider on site providing or supervising medical services. That ordinance became the model for a statewide bill that has been introduced in the state legislature.
  • Portland, OR: The Portland Public Schools Board of Education allocated $25,000 in the FY 2018/19 budget to fund free menstrual products for the entire district.
  • Shelby County, TN: Although Tennessee preempts cities from raising the minimum wage, Shelby County raised the minimum wage for all county employees, including temporary workers.
  • Louis, MO: The St. Louis Board of Aldermen passed an ordinance in February 2017 to prohibit employers or landlords from discriminating against anyone based on their pregnancy status or reproductive health decisions, including abortion care.

Of the 50 U.S. cities analyzed in the Index, San Francisco was found to be best equipped to protect and advance reproductive freedom, followed closely by Chicago and New York; other national leaders include Boston, Los Angeles, Portland, Seattle, and Washington, D.C. A full breakdown of each city can be found at

While the Local Index tracks local policies on reproductive health, rights, and justice enacted through the end of 2018, advances at the city level accelerated in 2019. For example, NIRH worked with both Austin and New York City to use their city budgets to fund practical support services for abortion care and abortion care itself, respectively. Across the South, Charleston, WV; Charlotte, NC; and Jackson, MS, have enacted clinic safety ordinances to protect patients and providers at facilities providing abortion care. And from Atlanta to Portland, OR, cities across the country passed resolutions condemning state-level abortion bans.

“We know that real progress often starts at the local level – and now is the time for cities to stand tall and protect their residents against harmful actions by lawmakers in both state and federal government who are hostile to reproductive freedom,” Miller continued. “Whether a city has yet to act, or if it’s one of the highest-scoring cities in the Local Index, every municipality has a role to play to improve the lives of its residents and support their ability to make decisions about their reproductive lives – and the 2019 Local Index charts the course for how to do so.”

Since 2008, NIRH has provided more than $5 million in direct grants, and millions more in hands-on support, to 175 organizations in 43 states, including in 64 localities.

The launch of the Local Index will kick off today in Atlanta, Georgia, where NIRH President Andrea Miller will be joined by advocates, partners, community members, and lawmakers to highlight the importance of city leadership when it comes to ensuring residents’ reproductive freedom and uplift local achievements to protect reproductive health, rights, and justice.


The National Institute for Reproductive Health builds power at the state and local level to change public policy, galvanize public support, and normalize women’s decisions about abortion and contraception.

Using a partnership model, NIRH provides state and local advocates with strategic guidance, hands-on support, and funding to create national change from the ground up. We form strategic partnerships with a wide range of organizations to directly impact the reproductive health and lives of women across the country. Each year, NIRH works in at least 20 states and more than a dozen localities; to date, NIRH has partnered with more than 170 reproductive health, rights, and justice organizations in 43 states and 64 localities across the country.