Model City

N IRH has developed a Model City to exemplify what a city could look like if it used the full extent of its policy and programmatic powers to support the freedom and ability of each person to control their reproductive and sexual lives, foster thriving families, and destigmatize abortion and contraception. Grounded in current realities rather than representing a utopia, the Model City is a blueprint that all localities can achieve. Any city, regardless of its current political climate or policy landscape, should be able to identify programs or policies that could be implemented today, as well as those they can work towards in the future.

Protecting Abortion Access

The city recognizes abortion as an essential part of comprehensive reproductive health care and takes all necessary steps to ensure that access to that care is comprehensive, safe, and affordable. Abortion clinics are easily accessible, recognized as valuable, and integrated into the city’s health care system.

  • The local government actively provides public information about the care and services available at abortion clinics.
  • Clinic protections ensure safe access to abortion clinics without shame or harassment, reproductive health providers and staff are able to work and live in safe environments, and law enforcement works with clinics to offer protection and support.
  • Zoning policies explicitly treat abortion clinics like all other health institutionsthat provide similar services.
  • The public understands the deceptive practices of anti-abortion pregnancy centers and recognizes them as entities that do not provide comprehensive reproductive health care, including abortion.
  • Discrimination based on reproductive health decisions is prohibited.

By embracing abortion providers as an important part of their city’s health care infrastructure, local leaders do the important work of ensuring that residents have information about where they can get the care they need. This also destigmatizes abortion and places it back on the spectrum of health care where it belongs. To protect safe and timely abortion access, cities also need to understand the deceptive practices of anti-abortion pregnancy centers and the harassment that anti-abortion protesters engage in so that they can respond appropriately with regulation and/or public education. Even in cities without an abortion clinic, anti-abortion pregnancy centers are likely to exist and should be addressed, and residents need information about where they can go for abortion care.

Strategies to Consider

  • Conduct a scan of the local reproductive health landscape to gain a better understanding of the abortion clinics, family planning providers, support services for parents, and anti-abortion pregnancy centers in the city. Create an online directory of comprehensive reproductive health care providers and encourage residents to seek care at those facilities. Launch a public awareness campaign that directs people to the online directory and other municipal resources and educates them about anti-abortion pregnancy centers.
  • Address the deceptive practices of anti-abortion pregnancy centers through regulation. Possible legislative solutions include prohibiting deceptive advertising or requiring that the city contract with or provide health care funding only to entities that offer comprehensive reproductive health care counseling.
  • Organize as a community against hospital or health system mergers that would reduce access to abortion or contraception. Offer public education about the limits on services provided in Catholic health care settings.
  • Address anti-abortion harassment at local clinics by developing a policy tailored to local clinics’ needs to allow safe access to clinics while protecting First Amendment rights.
  • Prevent harassment by enacting a policy that keeps the personal information of clinic staff confidential under certain circumstances and/or that prevents picketing at private residences.
  • Host a meeting with local law enforcement to clarify federal, state, and local policies on safe access to abortion clinics and discuss enforcement of those protections. Local government can be a crucial liaison between clinics and law enforcement and can help them establish a strong working relationship.
  • Understand city zoning regulations for abortion clinics and the areas immediately around them, are zoned. Consider whether it is necessary to explicitly state in zoning ordinances that abortion clinics are a health institution like any other that provides similar services.
  • Pass a reproductive health nondiscrimination ordinance to ensure that landlords and employers are not able to discriminate against a person based on their decisions about their reproductive health, including the choice to use contraception or to have an abortion.
  • Officially recognize March 10 as Abortion Provider Appreciation Day, and mark that date to celebrate the important work of local abortion providers and clinics.

Funding and Coverage for Reproductive Health Care

The city budget demonstrates the city’s values by providing funding for reproductive health services, including abortion.

  • The city directly funds reproductive health care services, including abortion, contraception, and the treatment and prevention of sexually transmitted infections (STIs).
  • The city’s education budget includes adequate funding to implement comprehensive sexuality education.
  • Reproductive health care providers working in public hospitals are trained in the full range of reproductive health care services, including abortion.
  • The city does not fund anti-abortion pregnancy centers and provides health care funding and support only to health centers that provide accurate information and care without bias or stigma.
  • Municipal employee insurance plans cover contraception and abortion care.

Budget creation is among the most important responsibilities of a local government. By providing financial support for reproductive health services, cities “put their money where their mouth is” and can establish themselves as beacons for access to abortion, contraception, and other vital care. When cities are unable to provide services they value themselves, they can use their budget to fund community-based organizations to provide them. More than just a means to fund a city’s services, local budgets are documents that outline a city’s values and priorities.

Strategies to Consider

  • Allocate municipal dollars to the city’s local abortion fund. Abortion funds are local non-profit organizations that help people who could not otherwise afford abortion care pay for the services they need. Alternatively, a city can establish and administer its own small abortion fund. A relatively small investment in an abortion fund can both help members of the community access medical care and stand up against the cruel abortion restrictions that seek to harm women and abortion providers.
  • Ensure that immigrants, including those who are undocumented, are able to benefit from the programs the city funds, and that protections are in place to guard their information so that they can feel safe accessing these services.
  • Fund a residency training program in city or county hospitals that includes training in abortion and miscarriage management for medical residents in obstetrics, family medicine, and other relevant specialties. Supporting medical education in reproductive health services will improve access to care in the community.
  • Develop a public awareness campaign using the city’s health advertising budget to improve understanding around important local issues related to reproductive and sexual health, such as contraceptive choice or STD/STI prevention. City campaigns around reproductive and sexual health can connect residents to vital services and change the cultural conversation by framing these issues in a nonjudgmental way without stigma or shame.

Supporting Young People

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

  • City schools prioritize age-appropriate, K-12, LGBTQ-inclusive comprehensive sexuality education, operating with the necessary funding to train and support teachers.
  • City schools offer LGBTQ-friendly reproductive health care in school-based health centers (SBHCs).
  • City programs support pregnant and parenting youth, enabling them to continue their education and receive a high school diploma while parenting their children.
  • Juvenile detention and foster care programs give young people access to comprehensive sexuality education and reproductive health care services without coercion or cost.
  • The city supports young people’s agency in making reproductive health decisions for themselves. If state laws mandate that young people seeking abortion services must obtain parental permission before accessing care, the city will help them understand their rights and navigate the judicial bypass system. 

The autonomy and needs of young people should be included in any city’s approach to advancing reproductive and sexual health. Cities have the opportunity to protect and empower young people by providing medically accurate information, confidential services, and programs that reject the stigma and shame that can often harm young people as they navigate matters of sexual and reproductive health.

Strategies to Consider

  • Require schools to implement a K-12 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 vital lessons about reproductive and sexual health. By funding teacher training and support, curriculum development, and monitoring and evaluation, schools can effectively implement robust sexuality education programs.
  • Fund SBHCs that offer reproductive health care services, including contraception services and counseling and STI/HIV screening. This will help students get the care they need without having to contend with barriers like cost, transportation, or concerns about confidentiality.
  • 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 breastfeeding, childcare options, supportive counseling, and a flexible absence policy.
  • Work with local legal programs to help young people seeking abortion care navigate the judicial bypass process, if necessary, in order to obtain the services they need if they are unable to involve a parent or guardian. Use the city’s website to inform young people of their rights and connect them with services offering confidential assistance, abortion funding, or transportation support.

Supporting Families

The city supports every resident’s right to parent and support a family in a healthy, safe, and secure environment.

  • The city offers paid family leave to municipal employees.
  • The city creates a safe environment for breastfeeding in public spaces and provides support to private entities to encourage similar policies.
  • The city’s environmental regulations and programs protect maternal and infant health.
  • The city bans housing and employment discrimination based on pregnancy or family status.
  • City initiatives are addressing maternal and infant mortality rates, with a focus on addressing the systemic racism and inherent bias that cause racial disparities in health outcomes.
  • The city does not prosecute pregnant women, or other people who can become pregnant, for their pregnancy outcomes. The city offers programs and services that support healthy pregnancies and a range of comprehensive birthing options. 

The right to parent and support a family is a vital component of reproductive freedom. Cities must look at the whole picture when it comes to their residents’ lives and recognize how discrimination around race, class, and gender creates barriers to safe and respectful reproductive health care. Although some of these policies may fall outside the lines of traditional health care, they serve as important building blocks towards creating a healthy and safe city for all.

Strategies to Consider

  • Create a local maternal mortality review board of medical professionals, public health specialists, and community-based birth justice advocates to confidentially review cases of maternal mortality and morbidity and make recommendations to improve care in local facilities. Require implicit bias training for obstetric doctors, nurses, and staff in city hospitals.
  • Require paid family leave for municipal employees, including those who work part time and for contractors working with the city.
  • Require government-operated facilities or public spaces to create breastfeeding rooms that are clean, comfortable, and equipped with necessities like a refrigerator, a sink, and an electrical outlet. Introduce incentives for private businesses to build similar breastfeeding rooms.
  • 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 local doula training program and subsidize doula care for low-income families at rates that ensure doulas earn a living wage. Provide education and/or guidelines to hospital staff on the important role doulas play during birth.

Building Healthy and Just Communities

The city is committed to health, justice, 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.

  • The minimum wage is a living wage, and paid sick leave is available to all employees.
  • The city runs public awareness campaigns on sexual and reproductive health that reflect issues that are important to the community, are sex-positive, and do not stigmatize or shame.
  • A sufficient supply of high-quality menstrual hygiene products, including tampons and pads, is available to anyone who needs them, regardless of their ability to pay.
  • The local criminal justice system practices a holistic approach to community safety, protects the rights and civil liberties of every individual, and provides a safe and healthy environment to those community members who are incarcerated.
  • Public transportation is easily accessible, safe, affordable, child-friendly, and reliable, and it helps people get to health care centers for the services they need.
  • The city is committed to protecting the institutions of democracy and encourages residents to vote and run for office.

Reproductive justice, a framework developed in the 1990s by Black women who did not see their needs, lives, and priorities reflected in the reproductive rights movement, is defined by SisterSong as “the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.”* A city can adopt the reproductive justice framework by seeing and embracing its residents’ multiple identities and understanding and addressing the intersectional systems of oppression that impact their lives. Local governments must also recognize and understand their historic and ongoing role in perpetuating systems of oppression rooted in patriarchy and white supremacy. Then, in partnership with the relevant communities, local governments can create policies and practices grounded in equity that allow all people to thrive and determine their future.

Strategies to Consider

  • Establish a $15 minimum wage or higher for employees in the city, including tipped and contract employees. Require that all entities that contract with the city or county provide their employees with a living wage and comprehensive benefits.
  • Repeal the local sales tax on items essential to menstrual hygiene, including pads and tampons, and provide funding for free menstrual products in public institutions such as jails, prisons, 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.
  • Adopt a set of reproductive justice-informed values for all of the city’s public awareness campaigns regarding sexual and reproductive health. Commit to reject stigmatizing messages around sexuality and individual behavior and instead offer accessible and culturally appropriate solutions.
  • Prohibit law enforcement from relying on the fact that someone is carrying a condom as a basis for an arrest, charge, or prosecution for intent to engage in sex work.
  • Pass a “shield” law that protects sex workers from arrest or prosecution when reporting a violent crime (such as sexual assault, robbery, or human trafficking) as a victim or a witness.
  • Pass a gender identity anti-discrimination ordinance, ensuring that landlords and employers are not able to discriminate against individuals based on their gender identity.
  • Establish alternatives to incarceration programs that are available to as many people as possible, and offer opportunities for mothers who are incarcerated and their babies to be physically together.
  • 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 people who are incarcerated when pregnant, in labor, or postpartum. Engage in training and oversight to ensure these policies are instituted and followed.
  • Study the existing transportation barriers to local reproductive health care clinics, and work with providers, community members, and community-based organizations to develop equitable solutions to the barriers.
  • Implement programs and policies that will 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.

Taking a Stand

The local government takes action to support or oppose state- and federal-level reproductive health, rights, and justice issues that impact its residents.

  • The city embraces the opportunity to provide a safe and welcoming environment for people from across the state and beyond to access reproductive health care, including abortion.
  • The city is a leader in opposing discriminatory policies and restrictions on reproductive freedom and uses its voice to destigmatize reproductive health care.

Cities have become an increasingly important source of reproductive health services, especially abortion care, as an onslaught of cruel and medically unnecessary restrictions have closed clinics across the country and created other, sometimes insurmountable barriers to access. In this environment, cities should embrace their role as welcoming places where people can safely access the reproductive health care they need. Progressive policies around reproductive health have an impact far beyond a city’s borders, and cities can go further by taking a stand on state and federal legislation or ballot initiatives, both destigmatizing reproductive health care and educating their residents about important issues at the same time.

Strategies to Consider

  • Pass a resolution or issue a proclamation declaring the city a safe and welcoming place for all to receive reproductive health care, including abortion, regardless of restrictions passed at the state and federal levels.
  • 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. Call on the state or the federal government to expand insurance coverage of abortion, pass the federal EACH Woman Act or 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 opposition to anti-abortion ballot initiatives or legislation on the state or federal level, such as bans on abortion based on a person’s reasons for choosing an abortion or bans on insurance coverage of abortion.
  • Submit public comments to executive agencies supporting policies that will expand access to reproductive health care, including details on how it will help people in the city, and opposing initiatives that will restrict access to reproductive health care, including details on how it will harm people in the city.
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