New Report Finds 27 States and D.C. Enacted a Record 100 Laws to Protect and Expand Reproductive Freedom in 2018 — More than in Each of the Previous Four Years 

January 2, 2019
Contact: Marisa Rodriguez, [email protected], 956-607-9952

National Institute for Reproductive Health (NIRH) highlights advances for reproductive health and rights in 2018; offers policy recommendations for 2019

NIRH announces strategy and partnership with advocates in key states to pass legislation and advance policies to make abortion more accessible

New York – As the Trump-Pence administration and many anti-abortion state legislatures continued to attack reproductive rights and abortion access in 2018, advocates and legislators in almost every state that had a legislative session nonetheless sought to protect and advance reproductive freedom through hundreds of pieces of legislation – enacting the highest number of proactive bills since NIRH started keeping track. Last year, a record 100 laws to protect and expand reproductive freedom were passed in 27 states and the District of Columbia (D.C.), with a total of 44 states and D.C. introducing 422 affirmative bills. Gaining Ground: Proactive Reproductive Health and Rights Legislation in the States, NIRH’s fifth annual report on this subject, explores these advances for reproductive health, rights, and justice – and makes recommendations about how advocates and legislators can continue to advance reproductive freedom at the state level in 2019.

“States have the power to determine what access to reproductive health care looks within their borders, and last year, from California to Maine, advocates and legislators seized opportunities at the state level to pass legislation to increase access to abortion, contraception, supports for families, and other needed health care and services,” said Andrea Miller, president of the National Institute for Reproductive Health. “In 2014, 13 states passed 19 proactive reproductive rights and health bills. Just four years later, 27 states and D.C. passed a record 100 bills, including broad, overarching protections and advancements for reproductive health care access, as well as policies to address more specific barriers. With the Trump-Pence administration’s continued assaults on reproductive freedom, Roe v. Wade in serious jeopardy, and several states seeking to ban abortion and reduce access to reproductive health care, our new report shows how states are carrying proactive, positive momentum from 2018 into the year ahead. With big electoral victories in state legislatures and governorships, an increasing number of states are now primed to provide the last line of defense for a woman’s ability to control her body, life, and future.”

According to the report, significant trends in 2018 include:

  • Protecting and Expanding Abortion Access: Massachusetts decriminalized abortion, repealing the state’s century-old criminal abortion law; Washington enacted the Reproductive Parity Act, requiring any insurance plan that covers maternity care to also cover abortion services;  New York made advances on the Reproductive Health Act, which would decriminalize abortion, including self-managed abortion, and expand abortion access – and is set to pass it in 2019; New Mexico, Rhode Island, and West Virginia each introduced bills to repeal their own outdated and harmful pre-Roe v. Wade criminal abortion bans; Colorado, Hawaii, New Jersey, and Washington introduced bills to ensure coverage for the full range of reproductive health care, including abortion, for every resident; California’s legislature passed a bill that would have required each student health center at a public university to offer medication abortion, though its efforts to expand abortion access were thwarted by a veto from Governor Jerry Brown.
  • Improving Access to Contraception: Maryland and New Hampshire passed laws requiring insurance companies to cover a dispersal of 12 months of contraception at one time; Connecticut, Delaware, the District of Columbia, Maine, Rhode Island, and Washington passed laws that would guarantee no copay coverage for contraception – enshrining key protections of the Patient Protection and Affordable Care Act (ACA) into their state laws; and after seven years of advocacy and just one month into the start of the new legislative session, New Jersey’s new entirely pro-choice state government restored long-withheld and much-needed family planning funding.

  • Protecting Marginalized and Incarcerated Women: California, Delaware, Illinois, Louisiana, Maryland, New York, Rhode Island, Virginia, and Washington all passed legislation aimed at improving the reproductive health of incarcerated women in various ways. Connecticut, Kentucky, and Oklahoma passed comprehensive bills improving the lives and health of incarcerated women, banning several shackling practices, improving nutrition, and expanding access to substance abuse treatment. In a move that couples reproductive freedom with criminal justice reform, Tennessee enacted a law that prohibits courts from using any form of birth control, sterilization, or family planning services as a bargaining chip when sentencing offenders.

In addition to highlighting the trends seen in 2018, NIRH’s report also points to eight bold policy priorities that states should consider for 2019. With the continuing federal attacks – and the potential for Roe v. Wade to be gutted or overturned – NIRH recommends that state advocates and legislators focus on continued efforts to: safeguard a woman’s right to an abortion and ensure that abortion is not criminalized; enact legislation providing insurance coverage for the full range of reproductive health care; expand contraception access; protect patient safety; promote the reproductive health of incarcerated women; ensure that young pregnant women can take time off of school; and prevent the government from engaging in reproductive coercion.

In order to carry out strategies to protect and expand access to abortion and other reproductive health care, NIRH announced that it will deepen its work with partners in key states in 2019 to help make positive policy change where advances are more possible in the near future. NIRH will work with partners in states such as Connecticut, Colorado, Delaware, Massachusetts, New Jersey and New Mexico while continuing its long-standing work directly in New York to assess existing barriers to abortion care and to pass policies to ensure that abortion care is not a crime for healthcare providers or women, that everyone has insurance coverage for abortion and the full range of reproductive health care they need, and that states stand up and protect the right to abortion in the face of a hostile Supreme Court. These efforts complement NIRH’s ongoing work in roughly half the states annually, partnering with advocates and policymakers at the state and local level to advance reproductive health, rights, and justice.

“Over the last five years, a new trend has been developing of state advocates and supportive elected officials using their powers to push forward positive, proactive legislation that expands access to abortion, contraception, and the full range of reproductive health care – and the result is that the number of affirmative bills that became law has quintupled in just five years,” Miller said. “With the momentum from the midterm elections in many states and a renewed commitment to protecting rights and access in light of the threats from the Supreme Court, in 2019 we intend to work with even more states to ensure that their laws are as strong as they can possibly be to advance reproductive freedom.”


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 150 reproductive health, rights, and justice organizations in 39 states and 56 localities across the country.

At the national level, NIRH engages in groundbreaking public opinion research, proactive policy initiatives, and innovative advocacy campaigns to shape a new national conversation about reproductive freedom.