C ities, counties, and other localities* have a unique opportunity to mitigate a hostile climate created by the federal and state governments and to innovate in ways that advance reproductive freedom. Many cities across the country are rising to this occasion, exemplifying municipal resistance to the state and federal assault on reproductive health care.

The Local Reproductive Freedom Index: Evaluating U.S. Cities (Local Index), published by the National Institute for Reproductive Health (NIRH), evaluates the reproductive health, rights, and justice policies of cities across the United States. The Local Index analyzes the policies in place in 50 cities across the country and offers suggestions for how any can become a more equitable community, one in which all people have the freedom to control their reproductive and sexual lives, the ability to choose whether and when to become parents, and the support they need to raise their families.

This report recognizes that multiple factors intersect to impact people’s reproductive freedom, and serves as a call to action for local leaders who have the power to address these issues. Our country is experiencing severe anti-abortion hostility from the federal government, U.S. Supreme Court, and many states. Serious threats to federal sexuality education initiatives and policy changes that fundamentally undermine the purpose of the Title X program mean that access to comprehensive sexuality education and the full range of reproductive health care, especially among immigrants, young people, and people who are low-income, is in peril. At the same time, racial inequality, attacks on immigrants, homophobia and transphobia, and economic injustice conspire to weaken our communities.

Mitigating these harms and improving the lives of people in our communities rests on cities’ shoulders. There is a clear urgency for cities to address these challenges and to forge ahead by creating environments where all people truly have the right and ability to choose whether or not to become parents, safeguard their health and well-being, raise their children in safety and security, and fully achieve their own potential.

Cities can act to support the reproductive rights and bodily autonomy of women, transgender men, and other people who can become pregnant*, and establish themselves as safe havens committed to reproductive freedom. The Local Index is a tool for those cities ready to meet this challenge. It serves as a snapshot of information for advocates and policymakers to understand the resources and services they already have in place, and as a roadmap for what more they can do to become a true model city.

The Local Index was first released in October 2017, covering the 40 most populous cities in the United States. The 2019 edition updates the data from those 40 cities and includes 10 additional municipalities. Each city has been assigned a score ranging from zero to five stars based on a range of policy indicators related to reproductive health, rights, and justice. The 2019 edition also refines and adds to the set of policy indicators used in 2017, for a new total of 34 indicators.

This report evaluates local policies in place as of December 31, 2018.

NIRH’s findings include the following:

  • Cities’ scores ranged from .5–4.5 stars. The average score for the 50 cities was 2.3 stars.
  • No city achieved a perfect score. San Francisco received the highest score of 4.5 stars.
  • Many cities have taken bold action in the past two years to protect and advance reproductive freedom, including abortion access, as highlighted in the Reproductive Freedom Timeline. These cities have exemplified municipal resistance to the state and federal assault on reproductive health care.
  • Highlights from this period include five municipalities’ passage of resolutions supporting an end to bans on abortion coverage; passage of a reproductive health nondiscrimination ordinance in St. Louis, MO; regulation of the deceptive practices of anti-abortion pregnancy centers in Hartford, CT; and the veto of a rezoning ordinance that would have allowed an anti-abortion pregnancy center to open next door to a new abortion clinic in South Bend, IN.
  • The highest-scoring cities tend to be significantly larger and located in relatively progressive states on the coasts. High-scoring cities generally have large budgets that give them a greater ability to implement progressive policies. They also tend to have a long history of advancing social justice causes and have made a renewed commitment in recent years to addressing racial disparities and building a more equitable culture.

The Local Index features a Model City and policy agenda, which set out concrete steps cities can take, with a wide range of options that take into account the varying resources, capacities, and political environments of communities across the country. For example, cities that are home to abortion clinics can and should embrace them as an important part of community life. Cities without abortion clinics can still combat anti-abortion stigma and ensure that their residents have the information and resources they need to travel to the best health care provider for them.

In creating this Local Index, NIRH has built upon its long history of policy advocacy across the country, including a decade of experience at the local level. In 2008, NIRH launched the Urban Initiative for Reproductive Health to serve as a catalyst for progress for reproductive health, rights, and justice. At the time, not many advocacy efforts focused on the local level, despite the robust possibilities for cities and counties to improve reproductive health outcomes. Since then, NIRH has provided funding and strategic and technical support to more than 170 organizations in 43 states including 64 localities. This is in addition to NIRH’s work on the state level, where it works to change public policy on the state level, galvanize public support, and normalize women’s decisions about abortion and contraception. Using a partnership model, NIRH provides state and local advocates with strategic guidance, hands-on support, and funding to create national change from the ground up.

In researching this report, a wide variety of local advocates and government officials made it clear that they are committed to advancing reproductive freedom. NIRH is proud to publish the Local Index to document and celebrate the important achievements they have already made, and as a tool to support the work to come.

NEXT: Reproductive Freedom Timeline