Local Reproductive Freedom Index Series Local Reproductive Freedom Index, 2021

October 7, 2021
Expanding Abortion AccessEliminating Racial & Economic DisparitiesIncreasing Access to Contraception

We are in the midst of unprecedented attacks upon reproductive freedom from the courts and conservative states. Cities play a crucial role in ensuring that people can control their reproductive and sexual lives, choose whether and when to become parents, and get the support they need to raise their families.

The 2021 Local Index analyzes how local policy responded to and was impacted by the major events of 2019-2020 – the onset of the COVID-19 pandemic, uprisings for racial justice, and attacks upon voting, elections, and the fundamental pillars of democracy.

Read the press release summarizing the key findings and what they mean for the future.

City Profiles and Scorecard

The Local Index offers a snapshot of how localities have proactively risen to advance reproductive freedom. The Local Scorecards capture the policies and practices that 50 U.S. cities had in place as of December 31, 2020.

Explore the Scorecard

NIRH is committed to working with advocates and elected officials in every city to shore up and expand the vision and reality of reproductive freedom for their communities.


The roadmap is a proactive policy agenda to establish a city that truly advances reproductive freedom, across six separate focus areas. Below is a selection of possible policies to explore; for the full policy agenda, see the 2021 Local Index.

Protecting Abortion Access

Recommended policies ensure that access to abortion care is safe, affordable, and protected, integrated into the city’s health care system, and not stigmatized or criminalized.

  • Engage every relevant department in the city to implement and enforce policies and practices to prevent harassment and disruption at abortion clinics, including noise regulations, parking and traffic regulations, and anti-nuisance regulations.
  • Launch a public awareness campaign to ensure residents know about the safe and legal abortion care they can access in the city, and to educate residents on how to identify an AAPC.
  • Officially recognize March 10 as Abortion Provider Appreciation Day to celebrate the important work of local abortion providers and clinics.
Funding and Coverage for Reproductive Healthcare

We recommend that the city budget reflects the city’s values by providing funding to fully meet the need for high-quality, patient-centered reproductive health care and services, including abortion.

  • Allocate municipal dollars to the city’s local abortion funds, directly to local abortion providers, and/or topractical support funds that help people pay for costs associated with accessing abortion, such as travel, lodging, and childcare.
  • Mandate that insurance benefits for municipal employees cover comprehensive reproductive health care benefits, including abortion.
  • Offer trainings to reproductive health care providers and staff on how to provide care to populations with unique needs — including LGBTQIA-friendly care, teen-friendly care, and culturally responsive care — and on how to provide person-centered care to all patients.
Supporting Young People

The city should equip young people with the reproductive and sexual health information and services they need to make the best decisions for themselves regarding their health, relationships, families, and futures.

  • Provide pregnant and parenting youth with the services and accommodations they need to continue and complete their education in a non-stigmatizing environment, including resources for lactation, childcare, and a flexible absence policy.
  • Require schools to implement a K-12 comprehensive sexuality education program that meets the National Sexuality Education Standards. Comprehensive sexuality education includes lessons about consent, healthy relationships, and bodily autonomy, in addition to lessons about sexual and reproductive health.
  • Fund SBHCs that offer reproductive health care services, including contraception services and counseling and STI/HIV screening. Train SBHC staff on providing LGBTQIA-friendly reproductive health care.

Supporting Families

The city should support every resident’s right to create, raise, and support their families in a healthy, safe, and secure environment.

  • Require paid family leave for municipal employees, including those who work part time and for contractors working with the city.iv
  • Partner with local communities to identify potential harms in common beauty and hygiene products, such as nail salon products or skin lightening creams, and support strategies to reduce reliance on them, such as public education, regulation, or incentive programs.
  • Create a free local doula training program to increase opportunities for low-income people to become doulas, and subsidize doula care for low-income families at rates that ensure doulas earn a living wage.
Building healthy and just communities

The city is committed to health, economic security, safety, and autonomy for all people, inclusive of their many identities. Its initiatives and programs provide people with the support they need to engage with their community, plan their lives, and achieve their full potential.

  • Allocate municipal dollars for free menstrual hygiene products in all public places, including jails, prisons, juvenile detention centers, government buildings, schools, and shelters, or establish a public-private partnership with menstrual hygiene companies to ensure that people who need but cannot otherwise afford these products can easily access a sufficient and high-quality supply.
  • Implement programs and policies to increase democratic engagement and protect the right to vote locally, including campaign finance reform, ranked choice voting, easy access to voter registration, and transportation to the polls. Allow non-citizens and/or people under 18 the right to vote in municipal elections.
  • Pass an ordinance requiring that anyone who is incarcerated while pregnant has access to comprehensive reproductive health care, including abortion care, contraception, prenatal and postpartum care, doula support, and lactation accommodations. Ban shackling of pregnant people who are incarcerated while pregnant, in labor, or postpartum. Engage in training and oversight to ensure these policies are instituted and followed.
Proclaiming Local Values

The city establishes its social justice values, including its support for reproductive freedom, through resolutions and public statements. The city speaks out on local-, state-, and federal-level reproductive health, rights, and justice issues that impact its residents.

  • Pass a resolution or issue a proclamation opposing the deceptive practices of AAPCs and calling for an end to any state or federal funding they receive.
  • Pass a resolution or issue a proclamation declaring support for ballot initiatives or legislation on the state or federal level that protect abortion rights and/or advance abortion access. This includes calling on the state or the federal government to expand insurance coverage of abortion, pass the federal EACH Act and Women’s Health Protection Act, repeal state-level restrictions on abortion access, or affirm the right to an abortion in the state.
  • Pass a resolution or issue a proclamation declaring the city a safe and welcoming place for all to receive reproductive health care, including abortion.

Model City

The Model City provides a framework that all cities can strive to meet by using every tool possible to support the freedom and ability of each person to control their reproductive and sexual lives, foster thriving families, and destigmatize abortion and contraception.

Highlights of City Policies


Atlanta, GA

In October 2019, NIRH worked with advocates in the Amplify GA coalition and elected officials in the Atlanta City Council to establish a first-of-its-kind Reproductive Justice Commission in Atlanta, GA.

Free Menstrual Hygiene Products in Public Schools

Boston, MA

In Fall 2019, Boston Public Schools launched a pilot program to bring free menstrual supplies to students in public schools.


Austin & NYC

In 2019, NIRH helped Austin, TX, and New York, NY become the first cities in the country to directly fund abortion care through their municipal budgets.

Engaging Residents in Local Government

Birmingham, AL

In 2019, Birmingham started a program to make local policymaking more accessible to community members by bridging the distance between the community and their leaders.


Baltimore, MD

The Baltimore City Health Department distributed 500,000 diapers to city residents during the pandemic.

Housing Security for Young Parents

Denver, CO

Denver is home to the Florence Crittenton High School, offers pregnant and parenting young people curriculum to earn high school diploma or an Associate’s degree, and offers food, on-site daycare and services, and a comprehensive medical clinic, including dental care.


What is your research process?

We have a multi-round research process. NIRH staff conduct the first round of research independently, reviewing municipal websites including from the city and county government, local and state departments of health, departments of education or school districts, and other relevant government agencies and commissions, as well as publicly available information from local community-based organizations and local media. Then, we conduct phone and email interviews with people and organizations in the community, depending on their ability. This could include organizations in our partnership network, other community-based organizations, departments of health, school districts, and city and county officials in each of the cities. Then we share our initial draft of the scorecard with local advocates and the heads of city or county departments of health for review. Finally, drafts of the Local Scorecards are distributed to the mayor and heads of the city and county government. Final Local Scorecards are based on the sum of this work. 

How did you select these 34 policy indicators?

These indicators and the policies and principles of the Model City are based on NIRH’s expertise and values after more than a decade of local advocacy, that of our partner organizations, and the work of allied social justice movements. For indicators we did not have direct expertise in, we reached out to national experts for advice starting with the first edition of the report in 2017. This includes A Better BalanceAdvocates for YouthAll* Above AllBold FuturesCityMatCHFairVoteFight for $15National Latina Institute for Reproductive JusticeRepresentWomenSex Workers Outreach Project (SWOP) USA, and Sex Workers Outreach Project (SWOP) Behind Bars. The indicators have been refined over the years as we learned from our research and received feedback from our partner organizations and local advocates. 

Why are some indicators worth 2 points instead of 1?

NIRH takes several reasons into consideration when determining the value of an indicator. This includes the rarity of the policy – particularly the fact that, unfortunately, policies to support abortion access are relatively rare on the local level compared to other indicators we review. We also consider the difficulty it takes to pass a given policy, and its impact on reproductive freedom.  

Has anything else changed about these indicators this year?
  • We modified when a city can be scored as “Preempted” for “Funding for abortion”: In 2019, Austin, TX set an innovative example by funding practical support for abortion care, such as travel and lodging, even though state law preempted funding for abortion procedures. Because Austin demonstrated that cities can allocate funding to facilitate abortion access even if their state has a similar preemption, NIRH changed our guidelines. Previously, we marked a city as “Preempted” when only funding for abortion procedures was banned; this year, cities were marked as “Preempted” only if both funding for the procedure and practical support were preempted by state law.   
  • Cities need to act on “Advancing democracy” during the review year to receive points: Because this indicator was a new addition to the Local Index in the second edition of the report, in 2019, NIRH awarded points for any policy to advance democracy that was in place through December 31, 2018. For the third edition of the report and all subsequent editions, NIRH only awarded cities points for actions taken during the period of review (January 1, 2019 – December 31, 2020). This is a recognition of the many actions that cities can take to advance and protect democracy, which requires constant vigilance and responsiveness to new challenges. 
  • We added “Percentage of budget spent on policing” to the Local Index: This new addition reflects the percentage of its overall budget that the city spends on policing, although it may not be complete because there are often many sources of funding in a budget that feed into police departments and policing. NIRH chose to add this indicator to the 2021 Local Index in response to the calls to action of the uprisings of 2020, sparked by the murder of George Floyd and in response to centuries of systemic racism, most specifically, anti-Black racism. The uprisings highlighted how cities and counties spend large portions of their budgets on policing, to the detriment of communities of color, while spending significantly less on social services and community resources. Advocates and officials are encouraged to use this information to think about how funding could be reallocated from police departments to reimagine public safety and invest in solutions that align with our values — like those in the “Funding and Coverage for Reproductive Health Care” section of the Local Index. NIRH acknowledges the Vera Institute of Justice as an important source of information on the percentage of city budgets spent on policing, and the Chicago Abortion Fund and the re.ad.just Coalition as advocates who encouraged NIRH to include this indicator. 
  • We changed “Supportive breastfeeding policies” to “Supportive lactation policies”: NIRH has updated our 2021 indicator to use the more gender-inclusive terms of “lactation” and “chestfeeding” in alignment with the recommendations of the Academy of Breastfeeding Medicine. “Lactation” and “chestfeeding” are intended to include parents who lactate but do not identify with the gendered term “breastfeeding.” NIRH acknowledges the re.ad.just Coalition as advocates who encouraged NIRH to make this language shift.  
Do you evaluate cities and counties at the same time?

Our research process “defaults” to city policy, so we first check if the city has any policies or programs in place that meet our metrics. If they do, then we stop the research there. If we can’t find anything on a city level, we then research county-level policies and will also give points there. County-level policies are marked on the scorecard with an asterisk (*).  

Why did you remove teen pregnancy and parenting?

Young people who are pregnant or parenting often face stigma and shame from their families, schools, communities, and government. Data related to teen pregnancies and births are often used to reinforce that stigma, rather than focusing on the resources that families, schools, communities, and governments can provide young people to enable them to make the decisions about their sexual and reproductive lives that are best for them. We made the determination that the indicators in “Supporting Young People” better reflected how a city is doing when it comes to supporting young people who wish to prevent pregnancy, who are pregnant, and who are already parents, without stigmatizing their actions or their families. NIRH acknowledges the leadership of Bold FuturesNational Latina Institute for Reproductive Justice, and the re.ad.just Coalition for changing the framework of the conversation on young people and pregnant, and educating NIRH on the importance of removing this indicator.  

What about preemption?

If an indicator is preempted by state policy, we remove the points for that indicator from the denominator and do not give any points in the numerator, so that it doesn’t impact the final score. NIRH considers a policy to be preempted if a state bans a municipality from taking action on that issue (such as restricting cities from setting their own minimum wage), or if a state passes a policy comprehensive enough that it does not require a city to take further action (such as a statewide comprehensive sexuality education mandate).  

What if my city or county isn’t included in the Local Index?

We have tools for you! You can use our Self-Scoring Tool to do your own research on your city’s indicators and create a Scorecard. And you can also use the Model City and Roadmap as a framework for building a policy agenda for your city.  

How can I contribute to NIRH’s research/have the opportunity to review scorecard for my city next year?

Send us an email at [email protected] and we’ll add you to our research database! We will begin our research process in early 2023.  

I think you made a mistake in your research!

We know we aren’t perfect – conducting original research of 50 cities and counties is hard. We welcome the opportunity to review our research with you and, if necessary, to correct our findings. If you think there might be a mistake, please email [email protected] with the subject line “Proposed Correction for [CITY].” 

Additional Tools

Local Index Self-Scoring Tool and Directions for Use

Local Policy Recommendations for Responding to TX SB 8

Protecting Reproductive Freedom in Cities and Counties During the COVID-19 Pandemic

Declaring Abortion Provider Appreciation Day in Your Community: A Proclamation Toolkit

Tools for Local Advocates & Policymakers

Download this Resource