There’s no denying it—2019 was a bleak year for reproductive rights. Nine states passed bills restricting abortion access. Alabama voted to ban abortions almost entirely, with states like Georgia, Kentucky, and Ohio prohibiting abortions from taking place after the first six weeks. The federal government, meanwhile, gave millions in Title X family planning funding to anti-abortion clinics, spurred on by the president’s use of strong anti-abortion rhetoric.
With these overwhelming setbacks to reproductive rights, it can be easy to miss motion in the opposite direction. That’s why the National Institute for Reproductive Health just released a new report called “Gaining Ground,” a comprehensive review of reproductive health legislation U.S. states introduced, passed through various parts of their legislatures, or enacted in 2019.
“When we’re looking at the federal government continuing to make heinous attacks on access to reproductive healthcare, it can feel very disempowering,” says NIRH president Andrea Miller. “We hope this report will remind people that they have tremendous potential and power to engage at the state and local level.”
As shown in the report, a record 944 bills aimed at protecting reproductive freedom were introduced in 2019 across 49 states as well as Washington, D.C. Across 38 states and D.C., 147 of those bills were enacted. That means at least one policy supporting reproductive freedom passed in three-quarters of U.S. states.
The report highlights additional record-breaking numbers, like nine states moving forward legislation to expand abortion rights. These states range from Nevada, which decriminalized self-managed abortions, and Maine, which will now require abortion coverage through Medicaid.
Nine states also expanded reproductive healthcare and rights for incarcerated people. Now, in Nebraska, Utah, and Arkansas, it will be illegal to shackle a person when they’re pregnant, in labor, and recovering postpartum, adding to the 29 states that already had similar laws in place. (Though at the same time, both Arkansas and Utah further restricted abortion access in 2019, prohibiting abortions after 18 weeks.)
New Jersey is in both of those groups of nine states, and also reformed its Medicaid program to offer pregnant women access to their chosen healthcare providers. Under former governor Chris Christie, Miller says, the state hadn’t been able “to move anything affirmative.” But last year, it became one of the most proactive states for addressing maternal and reproductive health.
Besides New Jersey, states like California, Illinois, and New York enacted the most policies toward reproductive rights in 2019. If you want to measure the most proactive states by number of bills introduced, however, Pennsylvania, Mississippi, Tennessee, Iowa, Arizona, and Michigian all make the list—some of which may be less expected due to their otherwise conservative policies.
NIRH’s report ends with recommendations for state and city advocates and elected officials to take on in 2020. These recommendations include codifying the right to choose in-state laws, decriminalizing the pursuit and management of one’s own abortion, and ensuring schools provide adequate support to pregnant students.
If Miller could only choose one of those recommendations for every U.S. state to adopt next year, she’d opt for legislation that ensures insurance coverage for the “full range of reproductive health services, including contraception and abortion, prenatal care, postpartum care, and breastfeeding support and supplies,” she says. “The ability to make sure that income is not a barrier to accessing care . . . if it were done in every single state, would be absolutely transformative for everyone.”
For its part, NIRH will continue to work next year with reproductive health advocates at both the state and municipal levels “in about half of the states,” Miller says, ranging from more conservative states like Georgia and Kentucky to left-leaning states like New York and Massachusetts. She believes the current momentum around abortion rights won’t let up. Particularly, she thinks we’ll see legislation move forward in Virginia, where the fall 2019 election put Democrats in control of both the state’s House and Senate.
But at the federal level, it’s a different story. Next year will bring with it the Supreme Court’s first hearing of an abortion case since the Trump administration appointed two conservative justices, Neil Gorsuch and Brett Kavanaugh, shifting the balance of the court rightwards. The case focuses on a Louisiana law, which currently vastly restricts the number of doctors in the state allowed to provide abortions.
“I expect that we’ll see this as part of the discourse in the electoral cycle,” says Miller, “and that elected officials and advocates are really clear about the attacks coming from the federal government, and from a number of states, and are building the capacity to make change.”