Gaining Ground Series 2018 Report — Gaining Ground: Proactive Legislation in the States

January 2, 2019
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Increasing Access to ContraceptionEliminating Racial & Economic DisparitiesExpanding Abortion Access

The National Institute for Reproductive Health’s 2018 End of Year Report, Gaining Ground: Proactive Reproductive Health and Rights Legislation in the States analyzes state advocates’ and legislators’ work to advance reproductive health, rights, and justice through proactive policy throughout 2018  – enacting the highest number of proactive bills since NIRH started keeping track.

The 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 discrimination based on reproductive decisions or health status.


  • Protecting and Expanding Abortion Access: Massachusetts decriminalized abortion, repealing the state’s century-old criminal abortion law; 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— and is set to pass it in 2019; New Mexico, Rhode Island, and West Virginia each introduced bills to repeal their own outdated and harmful pre-Roe v. Wade criminal abortion bans; Washington enacted the Reproductive Parity Act, requiring any insurance plan that covers maternity care to also cover abortion services; 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; ConnecticutDelaware, the District of ColumbiaMaineRhode 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. ConnecticutKentucky, 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.

Policy suggestions for 2019

For 2019, NIRH suggests that advocates and policymakers consider the following bold policy ideas that have the potential to advance reproductive health and change the public conversation about reproductive health, rights, and justice:

  • Protect the right to decide when and whether to become a parent, including the right to decide to have an abortion, and repeal state laws that restrict rights and access, like waiting periods or bans on insurance coverage for abortion.
  • Improve the health of women and families, by enacting legislation providing insurance coverage for the full range of reproductive health care, including contraception and abortion, prenatal care, postpartum care, and breastfeeding support and supplies.
  • Ensure that no woman or other person who becomes pregnant will be investigated, prosecuted, or imprisoned for managing their own abortion by repealing laws that criminalize self-managed abortion and enacting legislation that makes it clear that no one can be prosecuted or jailed for ending their own pregnancy.
  • Expand access to the full range of contraceptive options by mandating that insurance companies cover all forms of contraception without additional barriers and by allowing patients to obtain a year’s worth of birth control with one prescription.
  • Keep abortion patients and providers safe by ensuring that employees, volunteers, or clients of reproductive health providers can request that their private, personal information — including where they live and information about their children — is kept off the internet and away from those who seek to harass and harm them.
  • Protect and promote the health of incarcerated pregnant women and other pregnant incarcerated people by prohibiting shackling during pregnancy, requiring prisons and jails to meet prenatal and postnatal health and nutrition standards, creating lactation and breastfeeding support programs for postpartum women, requiring courts and prosecutors to strongly consider alternatives to incarceration for anyone who is pregnant or lactating, and following through on all of those guarantees.
  • Support the ability of pregnant and parenting young people to stay in school by ensuring that pregnant students can take time off to get pregnancy care or abortion care; by requiring schools to help students catch up when they return; and providing young parents with sick days specifically to take care of sick children, without needing them to get a doctor’s note.
  • Ensure that no one’s reproductive decisions are coerced by the government by prohibiting any court or other state entity from making a benefit from the state contingent on agreeing to use contraception, be sterilized, or make any other decision about one’s reproductive life.
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