The National Institute for Reproductive Health’s 2020 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 2020.

Gaining Ground: Proactive Reproductive Health and Rights Legislation in the States, 2020 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 2020

In the seven years since NIRH has produced this report, states have vastly increased their introduction and passage of laws that advance reproductive health and rights — including abortion care. In fact, 2019 saw nearly 1,000 proactive laws introduced, with a record nine laws to protect and advance abortion access enacted. Due to the pandemic’s interference with state legislative sessions this year, there were fewer bills overall introduced.

• The number of states to consider paid family and medical leave proposals (88 bills) increased from 2019. Despite the pandemic – or in some cases, spurred by it — nine new paid family leave laws were enacted in eight states.
• In 2020, there were fewer proactive bills regarding abortion than in previous years (57 bills proposed, five enacted), due to interrupted legislative sessions in many states. Yet with a new Supreme Court that is all but certain to roll back or eliminate federal constitutional protections for abortion care in mind, advocates and lawmakers continued to push forward on two key priorities: restoring and expanding access and safeguarding rights.
• New abortion laws that were enacted include the Reproductive Health Protection Act (RHPA) in Virginia, which repealed decades of restrictions that made abortion care harder o access in the state. mandated counseling, an ultrasound, and a mandatory 24-hour delay.
• At the close of the year Massachusetts and New Jersey were urgently moving forward legislation to eliminate barriers and protect rights.
• States also prioritized ensuring easier access to contraception in 2020 by focusing on bills to ensure 12 months of birth control in one prescription, allow pharmacists to directly prescribe or provide oral contraception, and enshrine the ACA guarantee of contraception access in state law. In all, 77 bills were proposed, 11 of which were enacted.
• States also continued the trend of acting to combat the crisis of maternal mortality in states across the country, especially among Black women. In all, 37 states considered policies to improve pregnancy health outcomes (166 bills, 20 enacted), with most focusing on reducing maternal mortality and addressing the significant Black maternal mortality rate.

Policy suggestions for 2021

Some of the most important moves that legislators can make in 2021 include enshrining the right to abortion in state law, inoculating against a rollback of those rights from the Supreme Court, and making reproductive health care more accessible given all the constraints of the pandemic.

• Abortion: Any policy that makes abortion more accessible during this exceptionally challenging time will contribute to broader access thereafter. States can repeal specific barriers to abortion care, making it easier to offer telehealth for abortion care, or allowing qualified health care professionals to provide abortion care rather than limiting that care to physicians only.
• Contraception: Allowing patients to get a year’s worth of contraception at one time may be the most promising policy to consider for 2021 and has the potential to address many of the most significant barriers imposed both by COVID-19 and by larger socioeconomic considerations. Enshrining the contraception mandate of the ACA into state law should also be a priority.
• Pregnancy: States should require at least one year of Medicaid coverage postpartum and allow all birthing patients to have a partner, doula, or other person with them in the labor and delivery room.
• Parenting: State lawmakers must continue to pass paid leave laws and should think carefully about how to balance society’s ongoing needs for education, childcare, and employment.
• Young people: As schools continue to offer virtual and distance learning, schools should evaluate how to safely teach their existing curricula and state legislatures to carefully consider whether new policies are needed to ensure that every student receives age-appropriate, culturally competent, comprehensive sexuality education.
• Preventing discrimination/incarcerated people: Policies that prevent pregnant individuals from being incarcerated in the first place — such as alternatives-to-incarceration programs — should potentially be first to be considered. States can base their standards for pregnancy-related care in detention settings on the new recommendations from the National Commission on Correctional Health Care and ACOG.