New Report Documents State Policies to Advance Reproductive Freedom, Abortion Access

December 16, 2021
Contact: Kelly Novak, [email protected] 

Despite tremendous losses in 2021, states still passed a record number of laws to protect and advance reproductive health, rights, and justice

NEW YORK – Today the National Institute for Reproductive Health (NIRH) released its 2021 report, Gaining Ground: Reproductive Health, Rights, and Justice Legislation in the States, analyzing state bills to protect and expand reproductive freedom in the 50 states throughout 2021.

At the end of 2021, anti-abortion politicians appear to be on the cusp of fulfilling their decades-long crusade to eliminate federal protections for abortion rights. The Supreme Court’s pending decision in Dobbs v. Jackson Women’s Health Organization – a challenge to a Mississippi abortion ban – is expected to decide the fate of abortion access, and reveal if the Court is willing to give a green light to the roughly half the states that are poised to ban abortion.

Even against this dire backdrop, a record number of states have stepped up to protect and secure abortion access and make reproductive health care more accessible, equitable, and humane.

“This year, states exacerbated the patchwork of reproductive health access across the country, with some doubling down on measures to restrict and even attempt to ban abortion, while those committed to advancing access continued to shore up protections and roll back barriers to care,” said Andrea Miller, president of the National Institute for Reproductive Health. “NIRH is sounding the alarm that there has never been a more important time to take action to protect abortion access and expand reproductive health care for all, at the state and local level, everywhere we can.”

In 2021, state legislatures introduced at least 1,096 proactive health, rights, and justice pieces of legislation – believed to be the greatest number of proactive bills ever attempted. Thirty-six states and the District of Columbia enacted at least one proactive law to address reproductive health care, leading to the most proactive reproductive health, rights and justice policies (179) passed in a single year since NIRH began keeping track. The legislative trends align with NIRH’s core priorities to pass laws at the state and local levels that will protect and expand access to abortion, improve access to contraception, and address racial disparities in maternal health.

“In the coming months and years, we will need all hands on deck to keep advancing state laws that enhance reproductive health, rights, and justice,” Miller continued. “NIRH is committed to continuing to partner with advocates and lawmakers across the country to support policies that improve access to abortion, expand the availability of contraception, and work toward eliminating racial and economic disparities in health.”

Highlights from 2021 include:

  • In 2021, state legislatures introduced at least 1,096 proactive pieces of legislation to advance reproductive health, rights, and justice — believed to be the greatest number of proactive measures ever attempted. Thirty-six states and DC enacted at least one proactive law to address reproductive health care. The 179 bills enacted in 2021 surpasses the previous record, set in 2019.
  • Nine states enacted 13 laws to protect the right and expand access to abortion care, with one more expected to do so any day. These include:
    • Delaware removed abortion from its criminal code and eliminated the provisions of its law that treated abortion differently from other medical procedures.
    • New Mexico repealed a 1969 law that criminalized abortion, ensuring that the outdated law cannot be used to threaten New Mexico providers and their patients if abortion rights are further weakened or overturned.
    • Illinois repealed its parental involvement requirement for minors’ access to abortion care, making it the second state to roll back parental involvement laws (following Massachusetts in 2019). The Illinois bill is expected to be soon signed by the Governor – which will push the number of proactive abortion measures in 2021 to 14 laws in 10 states.
    • Virginia repealed a state law prohibiting the inclusion of abortion coverage in private health insurance plans.
    • Hawaii expanded access to abortion care by authorizing qualified advanced practice registered nurses to perform first-trimester abortions.
    • Connecticut prohibited crisis pregnancy centers from engaging in deceptive advertising that would mislead people seeking abortions.
  • Ten states overall passed laws to allow pharmacists to prescribe contraception and/or allow a one-year supply: Arkansas, Arizona, Colorado, Delaware, Illinois, Maryland, Nevada, North Carolina, Utah, Virginia.
  • Among the 31 states that enacted laws to increase access to pregnancy care, NIRH was especially proud to work with Connecticut partners to define doulas in statute and explore a state certification process; and with Rhode Island partners to pass a bill requiring private insurers to cover doula care and provide for Medicaid coverage for doula care through a budget item.
  • Several states passed legislation that will increase the availability of free menstrual products to students in public schools and universities, including Alabama, Arkansas, California, Colorado, Delaware, Illinois, Maryland, Nevada, Oregon, Rhode Island, and Washington.

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NIRH has been working for more than a decade to advance proactive reproductive health, rights, and justice laws at the state level — and documenting the progress around the country since 2014 to inform and inspire advocates and lawmakers to act. Gaining Ground canvasses proactive state-level policy across the areas of abortion, contraception, pregnancy, parenting, menstrual equity, sexuality education, and combating reproductive coercion, and NIRH looks forward to working with state advocates in 2022 to pass even more proactive legislation.



The National Institute for Reproductive Health (NIRH) works to protect and advance just and equitable access to reproductive health care. Our strategy is to go on the offensive to pass laws that safeguard reproductive freedom. NIRH builds coalitions, launches campaigns, and successfully advocates for policy change in partnership with state and local reproductive health, rights, and justice organizations and allied groups. We work together so that the fabric of reproductive freedom is harder to tear apart.