The National Institute for Reproductive Health’s 2017 End of Year Report, Gaining Ground: Proactive Reproductive Health and Rights Legislation in the States analyzes the ways in which states have counteracted the harmful aggressions of the federal government with a record number of proactive policies to advance reproductive health, rights, and justice.

The report tracks proactive legislation across seven categories: expanding access to abortion care, improving access to contraception; increasing access to pregnancy care; ensuring reproductive health care coverage for all (including for abortion and contraception); promoting comprehensive sexuality education for all young people; supporting parents and families; and prohibiting discrimination based on reproductive decisions or health status.

Highlights from 2017

• Securing access to abortion through state laws, to mitigate the hostility to abortion access at the federal level and concerns about the security of the protections of Roe v. Wade: Oregon enacted the Reproductive Equity Act ensuring coverage for a full range of reproductive health services; Illinois passed HB 40, restoring insurance coverage for abortion for residents who qualify for Medicaid or are state employees; Delaware passed Senate Bill 5, which repeals unconstitutional portions of the state’s pre-Roe abortion law and establishes clear protections for abortion access in the state; New York secured insurance coverage for abortion through governor’s regulations; and Hawaii enacted a law to mitigate the deceitful practices of “crisis pregnancy centers” seeking to prevent women from seeking abortions.
• Supporting affordable contraception in the face of federal efforts to dismantle the ACA and its guarantee of contraceptive coverage with no copay: California, Colorado, the District of Columbia, Hawaii, Maine, Maryland, Massachusetts, New York, Nevada, Oregon, Virginia, and Washington all enacted proactive measures to support their residents’ access to contraception through a variety of policy measures.
• “Red” states taking action to advance reproductive freedom: Arkansas adopted a resolution to extend Medicaid and Medicare services to pregnant immigrant women; Missouri introduced 28 proactive bills; Tennessee introduced 20 bills; and in Texas, advocates and legislators came together to introduce a record 78 proactive bills, of which 14 advanced and four became law.

Policy suggestions for 2018

For 2018, 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:

• Provide insurance coverage for the full range of reproductive health services, including contraception and abortion, prenatal care, postpartum care, and breastfeeding support and supplies. (See page 20 of Gaining Ground and Oregon House Bill 3391 for a legislative model.)
• Repeal laws that restrict access to abortion, including waiting periods, laws that ban insurance coverage for abortion, bans that criminalize women’s behavior during pregnancy, or bans on telemedicine for medication abortion. (See page 6 of Gaining Ground and Texas Senate Bill 1632 or Delaware Senate Bill 5 for legislative models.)
• Keep abortion patients and providers safe by working with law enforcement to provide training, information, resources, and accountability to ensure safety for all those who work in or access clinics. (See Wisconsin Senate Bill 568 for a legislative model.)
• Ensure that patients can choose their reproductive health care provider by prohibiting insurance plans from restricting access to providers, whether in or out of network. (See page 10 of Gaining Ground and California Senate Bill 743 for a legislative model.)
• Ensure that all patients can get the contraceptive option of their choice by allowing access to a 12-month supply of birth control and guaranteeing that insurance companies cover all forms of contraceptives without additional barriers. (See page 21 of Gaining Ground and Nevada Assembly Bill 249 for a legislative model.)
• Promote the health of incarcerated pregnant women by prohibiting shackling, and requiring prisons, jails, and prosecutors to meet a host of reforms for women who are pregnant. (See page 36 of Gaining Ground and 2014’s Massachusetts Senate Bill 2063 for one possible legislative model.)
• Protect the rights of pregnant and parenting students by allowing students to take sick leave without endangering their academic career, providing breastfeeding support and accommodations, and providing childcare for students with young children. (See page 32 of Gaining Ground and Maryland House Bill 616 for a legislative model.)