t he majority of people in the United States support comprehensive reproductive health care, including abortion.* As laid out throughout this report, this support for reproductive freedom is intimately connected to other issues that intersect to impact people’s lives: economic justice, protections for immigrant communities, equal rights for the LGBTQ community, police reform, and protecting democracy and the right to vote.

While limited resources and often entrenched power structures may make cities imperfect vehicles for addressing all social ills, their nonetheless powerful impact on individuals’ day-to-day lives is too often unrecognized and unseen. Indeed, the innovative policies and programs that move this country towards achieving reproductive freedom are being developed, tested, and proven in cities every day. In this moment of great division and dysfunction at the federal level and in many states, cities can become the safe havens individuals and families need to lead full and healthy sexual and reproductive lives.

This report outlines successes and achievable guideposts that point toward a positive trajectory for cities across the country. And beyond the purview of this report, there are many other reasons for hope: community-based organizations are filling gaps in the safety net and pushing government to do more; individuals elected and appointed to public office are boldly pushing forward new ideas; and community members across the country are taking time out of their days to testify, protest, and dream up new visions for their cities. Advocates are pushing local government to redistribute resources, closely examine long-held practices and assumptions, and transform their institutions to align with the values of social justice, equity, and progress.

Our cities are bastions of possibility, and they have the ability to achieve great heights, improving the lives of their residents and all who come to cities to access care.


NIRH would like to thank the many individuals who contributed to this report, including Aharisi Bonner, Lauren Coy, Emily Kadar, Jenny Dodson Mistry, Daniela Moreira, Adria Orr, Allegra Stewart, Big Red Abacus, and the Center for Advancing Innovative Policy (CAIP). We would also like to thank the national organizations that lent us their expertise, including A Better Balance, CityMatCH, Fair Vote, Represent Women, Sex Workers Outreach Project (SWOP) USA, and Sex Workers Outreach Project (SWOP) Behind Bars. NIRH received support from the following organizations in establishing our framework in 2017 and their resources continue to inform this edition of the Local Index:  Advocates for Youth, All* Above All, the Fight for $15, and the National Latina Institute for Reproductive Health. Finally, we applaud the work of local leaders, advocates, and community members who have worked tirelessly for decades to create the thriving cities we were inspired to learn about throughout the course of this research. That especially includes the following organizations, who generously provided assistance and expertise in researching this report.


  • AIDS Alabama
  • Yellowhammer Fund


  • Arizona Family Health Partnership
  • Reproductive Equity Arizona


  • ACLU of Northern California
  • California Coalition for Reproductive Freedom
  • County of Santa Clara Public Health Department
  • Planned Parenthood Mar Monte
  • San Francisco Department of Public Health


  • Denver Public Health
  • NARAL Pro-Choice Colorado


  • Health Equity Solutions Inc.


  • Access Reproductive Healthcare-Southeast (ARC-Southeast)
  • Amplify GA


  • ACLU of Illinois
  • Chicago Department of Public Health
  • ci3 at the University of Chicago
  • EverThrive Illinois


  • Kentucky Health Justice Network
  • Planned Parenthood Advocates of Indiana and Kentucky


  • NARAL Pro-Choice Maryland


  • City of Boston
  • Boston Public Health Commission
  • Planned Parenthood Advocacy Fund of Massachusetts, Inc.


  • Michigan Organization on Adolescent Sexual Health (MOASH)
  • Planned Parenthood of Michigan


  • Hennepin County Public Health
  • NARAL Pro-Choice Minnesota
  • Planned Parenthood North Central States
  • St. Paul-Ramsey County Public Health Department


  • Converge: Partners in Access
  • Mississippi Reproductive Freedom Fund


  • City of St. Louis Department of Health
  • Hope Clinic for Women
  • NARAL Pro-Choice Missouri


  • Forward Montana
  • Planned Parenthood of Montana


  • Douglas County Health Department
  • Women’s Fund of Omaha


  • America Votes Nevada

New Jersey

  • New Jersey Public Policy Perspective
  • Planned Parenthood Action Fund of New Jersey
  • Planned Parenthood of Metropolitan New Jersey

New York

  • Buffalo Women Services

North Carolina

  • Mecklenburg County Public Health
  • NARAL Pro-Choice North Carolina

North Dakota

  • North Dakota Women’s Network
  • Planned Parenthood Minnesota, North Dakota, South Dakota Action Fund


  • The Center for Community Solutions
  • Cleveland Metropolitan School District
  • Cuyahoga County Board of Health
  • NARAL Pro-Choice Ohio
  • Preterm


  • Oklahoma Women’s Coalition
  • Oklahoma Call for Reproductive Justice
  • Thrive: Sexual Health Collective for Youth


  • The NARAL Pro-Choice Oregon Foundation
  • Western States Center


  • AccessMatters
  • Keystone Progress
  • Philadelphia Women’s Center
  • Women’s Medical Fund


  • CHOICES Memphis Center for Reproductive Health
  • SisterReach


  • City of Austin
  • Lilith Fund
  • NARAL Pro-Choice Texas
  • National Latina Institute for Reproductive Health
  • Office of Travis County Judge Sarah Eckhardt
  • Texas Equal Access (TEA) Fund


  • Comunidades Unidas
  • International Rescue Committee in Salt Lake City


  • Richmond City Health District


  • Public Health – Seattle & King County
  • Surge Reproductive Justice

Washington, D.C.

  • If/When/How

West Virginia

  • WV Free


  • Wisconsin Alliance for Women’s Health