The National Institute for Reproductive Health’s 2019 End of Year Report, Gaining Ground: Proactive Reproductive Health and Rights Legislation in the States analyzes advances in reproductive health, rights, and justice at the state level throughout 2019 – 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 interference with reproductive health care.

Key Findings in 2019

944 proactive reproductive health, rights, and justice bills were introduced in 49 states and the District of Columbia from January 1 – December 15, 2019. Of these, 147 bills were enacted.

More states than in any previous year enacted laws to protect and expand abortion access — nine states in all passed 15 bills.

The 2018 midterms brought new progressive pro-choice majorities to several state legislatures and a handful of new pro-choice governors. This created both the conditions and the expectation for proactive policy change in the 2019 legislative session. The result: states enacted some of the boldest reproductive health, rights, and justice laws of our generation.

Significant Trends of 2019

• Protecting and Expanding Abortion Access: More states than in any previous year passed laws to expand and protect abortion access. Illinois, New York, Rhode Island, and Vermont enacted laws that codify a fundamental right to make reproductive health care decisions, including the decision to have an abortion, and repealed old laws that had made abortion a crime. Nevada decriminalized self-managed abortion so that women do not risk prosecution for ending a pregnancy. California enacted a law requiring public universities to provide medication abortion at on-campus student health centers. Connecticut established a Council on Protecting Women’s Health to monitor and report on federal legislation that could impact women’s health care in the state. Maine enacted legislation that requires abortion coverage through Medicaid and allows advanced practice clinicians to provide abortion care within their scope of practice. New Jersey enacted an address confidentiality program that allows patients and pro­viders to request that their addresses be kept confidential and thus helping them stay safe in their homes.
• Advancing Reproductive Health Care and Rights for Incarcerated Women: Arkansas, Nebraska, Utah, and Virginia enacted laws to prohibit the shackling of women during pregnancy, labor and delivery, and postpartum recovery, totaling 32 states that now have such laws on the books. Arkansas went further to require prenatal nutrition and hygiene standards and access to prenatal and parenting classes. Texas enacted a comprehensive law that provides incarcerated women with information on prenatal care and parenting, promotes visitation between a mother and her child, and prohibits the solitary confinement of pregnant and postpartum women. Georgia, Maryland, and New Jersey enacted standalone policies to end solitary confinement. New Mexico enacted laws to support incarcerated women’s ability to parent by developing a breastfeeding and lactation policy and requiring courts to consider an individual’s pregnancy and lactation status when determining eligibility for release, bond, or time served.
• Improving Maternal Health Outcomes: Illinois, New Jersey, and New York passed legislation to reduce racial disparities among Black women and women of color by establishing maternity care standards and protocols and training health care providers and staff. A dozen states – Arkansas, Colorado, Idaho, Maryland, Nevada, New Jersey, New Mexico, New York, Oklahoma, Rhode Island, Virginia, and Washington – created or strengthened maternal mortality review commissions, triple the number that were created in 2018. Indiana, New Jersey, and Wyoming enacted legislation to reform their Medicaid programs so pregnant women can have access to the provider of their choice, as well as support from doulas throughout pregnancy.

Policy suggestions for 2020

• Protect the right to decide when and whether to become a parent, including the right to decide to have an abortion, by codifying that right in state law.
• Ensure that everyone who needs it can access abortion care, by repealing state laws that restrict rights and access, such as waiting periods or bans on insurance coverage for abortion.
• Ensure that no one 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.
• 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.
• Expand access to the full range of contraceptive options by mandating that insurance companies must 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 patients 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 women, transgender men, and other people who can become pregnant who are incarcerated by prohibiting shackling during pregnancy, requiring prisons and jails to meet prenatal and postnatal health and nutrition standards, creating lactation and breastfeeding support programs, 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 requiring 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 – such as a reduced sentence – contingent on agreeing to use contraception, be sterilized, or make any other decision about one’s reproductive life.