Demonstrating Resilience: 2025 Proactive State Legislative Trends

Movements for civil rights have been essential to securing and expanding protections for historically marginalized communities, and reproductive freedom is no exception. The first year of the second Trump administration encompassed escalating attacks on reproductive health care across all levels of government, which is certain to continue in 2026. Against this backdrop, a resilient movement of advocates and policymakers across the states is working to expand access to the full range of reproductive health care and advance Birth Justice.

In 2025, state advocates and policymakers hit the ground running to shore up protections for reproductive freedom. In response to federal attacks, at least five states enacted unprecedented legislation to mandate hospitals to provide emergency pregnancy care, including abortion. Efforts to expand interstate shield and data privacy protections for patients, providers, and helpers continued with states building upon existing protections to enact first-in-kind legislation permitting providers’ names to be removed from abortion and gender-affirming medication prescription labels. While Congressional Republicans worked to decimate Medicaid, states also acted to broaden insurance coverage with a particular focus on covering doula care and birth centers, recognizing the significance of culturally congruent care as essential to Birth Justice. 

NIRH works in deep partnership with state and local advocates to advance proactive policy solutions and shares this trend brief to highlight replicable models and inform strategy across the field. As the movement prepares for the second year under a hostile federal administration, advocates and lawmakers can continue working to bolster protections and expand access to reproductive health care both within and across state borders. This report provides an overview of legislation enacted by states to secure reproductive freedom under the law. State lawmakers and advocates can use it to identify opportunities in their state to advance reproductive freedom and bodily autonomy.