Under the Trump administration, reproductive rights have seen a steady degredation, the most recent of which went into effect on September 18. A new rule prohibits healthcare providers that receive Title X funding for reproductive care services from referring patients to abortion providers, which means that organizations now must decide whether to continue to offer those services or lose federal funding (Planned Parenthood chose to forgo the federal dollars).
As the administration has made changes on the federal level, some states have joined in: Rewire News, a nonprofit outlet focusing on reproductive justice, reported in May 2019 that at least 16 states had introduced “heartbeat bans,” or laws that prohibit abortion as early as six weeks into a woman’s pregnancy (when you can detect a fetal heartbeat).
Andrea Miller, president of the National Institute for Reproductive Health, started her work in the field in the late 1980s, “at a time when there were extraordinary attacks happening at the state level against access to reproductive healthcare and particularly abortion,” she says. “That may sound frighteningly similar to the current state of affairs, but much to my dismay, the potential threat and tenor is even more harsh and disturbing now than when I started this work.”
But the NIRH sees lots of potential for change, particularly beginning at the city level. The organization just released its 2019 Local Reproductive Freedom Index, a study that looked at the policies of 50 U.S. cities as of December 31, 2018, and rated those cities based on a set of 34 “indicators.” Those indicators ranged from initiatives directly tied to abortion access, like local protections for abortion clinics, to more tangentially health-related areas, like paid sick leave and a $15 minimum wage.
“The reality is that these are all really interconnected,” says Miller. “We really do recognize, as I believe cities do, that how we treat families, how we address the needs of our communities, whether people are able to have a sustainable income and take care of themselves and their families when they are unwell . . . all of these are intimately linked to the fundamentals of reproductive healthcare.”
Each city in the index got a grade between zero and five stars. The highest score went to San Francisco, which got a 4.5 and has enacted policies supporting abortion clinics and discouraging discrimination in areas like employment and housing. New York City and Chicago score right below San Francisco, with four stars each, while Boston; Los Angeles; Portland (Oregon); Seattle; and Washington, D.C. follow with 3.5 stars each.
The lowest score, 0.5 stars, went to Billings, Montana. El Paso, Texas; Las Vegas; and Omaha, Nebraska each got one star. Cities in Southern and Midwestern states (like Arizona and Utah) ranked among the lowest, while coastal cities tended to fair better. The average score across the cities was 2.3 stars.
Higher scoring cities tended to be larger and “have a lot more resources to work with,” Miller points out. Many of them have been supporting and implementing various antidiscrimination policies for years. “But I really think it would be a huge mistake to undersell what’s possible and what has been accomplished in smaller cities,” Miller adds, “particularly cities that are in the Midwest and the South—they are really stepping up quite remarkably.”
Columbus, Ohio, is one example. At the time the NIRH published its first (and only) Local Reproductive Freedom Index in 2017, Columbus had already established a protective zone around its abortion clinics that prevents protesters from interacting with women as they walk in. Still, the city increased its score in this year’s index.
“They added an initiative that helps to ensure . . . free menstrual hygiene products in recreation centers and homeless shelters,” Miller says. The city also passed a 2018 resolution in opposition to the Trump administration’s ruling prohibiting organizations like Planned Parenthood from receiving Title X funding. Meanwhile, Ohio has been attempting to enact the “heartbeat ban,” but was blocked by a federal judge in July.
Ultimately, the point of the index is to serve as a tool for advocates, elected officials, and other leaders to help advance reproductive rights. That’s a big part of why the NIRH is launching its index in Atlanta. “There’s an extraordinary group of both advocates and elected official allies there,” Miller says.
The NIRH has put more than $5 million in grants toward 175 organizations working toward increased reproductive freedom in the U.S. since 2008. “We hope that people will use the Local Reproductive Freedom Index to take a close look at their own communities,” Miller says, “and use it as an inspiration and a set of guideposts for what could be possible.”