New Report Highlights Actions to Advance Abortion Access, Maternal Health at State Level

July 12, 2021
Contact: Kelly Novak, [email protected]

National Institute for Reproductive Health’s (NIRH) Annual Midyear Report Tracks Trends in Reproductive Freedom Legislation

NEW YORK – NIRH’s new 2021 Midyear Report: Gaining Ground details the movement within the states through June 1, 2021, to advance reproductive rights, health, and justice. In the first half of 2021, 49 states and the District of Columbia (D.C.) introduced 1,014 pieces of proactive legislation to protect and expand reproductive freedom — including access to abortion — and address many of the racial and economic disparities laid bare by the pandemic. Overall, 85 bills were fully enacted, including 11 bills to protect and expand abortion access.

“Against the backdrop of unprecedented threats to reproductive freedom – especially abortion access — NIRH knows that passing proactive policies at the state level is our best chance for pushing back and establishing lasting protections,” said Andrea Miller, president of NIRH. “This is absolutely the time to double down at the state and local levels, and together with our partners, NIRH is doing just that. NIRH is proud to have worked alongside partner organizations in several states to pass several of these bills.”

While in 2020, state legislatures ground to a halt at the height of the pandemic, this year they resumed their momentum from 2019, passing laws that will advance reproductive freedom in a number of different ways. Big trends so far this year track with NIRH’s core 2021 priorities for states to pass laws to protect and expand abortion access and address racial disparities in maternal health.

Several states removed barriers and expanded access to abortion care:

  • Colorado revised its restrictions on Medicaid coverage of abortion, although a constitutional ban on Medicaid coverage for most abortion care remains in place.
  • Connecticut prohibited crisis pregnancy centers from using deceptive advertising.
  • Hawaii authorized qualified advance practice registered nurses to perform first trimester abortions.
  • New Mexico repealed a 1969 law that criminalized abortion, which had been dormant since Roe v. Wade, ensuring that it cannot be used to threaten New Mexico providers and their patients if Roe v. Wade is further weakened or overturned.
  • Virginia repealed a state law that prohibited inclusion of abortion coverage in private health insurance plans. Virginia also reaffirmed its commitment to including abortion as part of comprehensive reproductive health care, commissioning a review of the health services that are provided to incarcerated pregnant people, including abortion.
  • Washington State extended its insurance coverage requirement for abortion and maternity care to student health plans.

Many states addressed racial disparities in maternal health:

  • Arizona, Indiana, Kentucky, North Dakota, New Mexico, Nevada, and Virginia all passed legislation establishing and/or enhancing the work of maternal health and mortality commissions, including efforts to directly address racial and ethnic disparities in care.
  • Several states passed legislation to expand access to a wider range of birthing-related providers: Arizona created a doula certification process, Connecticut defined doulas in statute and commissioned a study to determine whether the Department of Public Health should establish a state certification process, Maine required insurance coverage for certified midwife services, and Virginia built out a certification process for licensed midwives.
  • Maryland, Washington, and West Virginia all passed bills that expand public insurance coverage for a person who gives birth, up to one year after the birth of a child. Similar moves are underway in Illinois and Texas.

NIRH publishes research twice each year on the proactive legislation to protect and expand access to reproductive freedom in states across the country. In December, 2021, NIRH will release its eighth annual year-in-review report, detailing trends and lessons learned through the entirety of 2021, including updates on the laws and trends found here.


The National Institute for Reproductive Health (NIRH) is an advocacy group that works directly with state and local reproductive health, rights, and justice organizations and allied groups to protect and advance access to reproductive healthcare. For more than 40 years, NIRH has been partnering with communities to build coalitions, launch campaigns, and successfully advocate for policy change. NIRH’s strategy is to go on the offensive and focus on communities where change is needed, so the fabric of reproductive freedom becomes harder to tear apart.