How to Use the Report

T he Local Index is intended to be a resource for advocates, community leaders, and elected officials who would like to advance reproductive freedom in their cities. It is both a snapshot of the status of health, rights, and justice policies in 50 cities, and a roadmap to be used as a starting point for new ideas or to inform the creation of actionable policy agendas.

Every community has unique needs, and the policy indicators and recommendations included in the Local Index do not purport to address every possible issue or to offer an exhaustive list of everything a city or county could do. Local leaders should always talk with stakeholders in their community and with advocates and experts to evaluate ideas and tailor them to their particular context.

Staff at NIRH are available to work with local advocates, community leaders, and elected officials interested in the ideas offered in this report. Contact localrepro@nirhealth.org with questions or for individualized guidance on advancing reproductive freedom in a particular city.

For Advocates in a Higher-Scoring City

In cities with above-average scores, the Local Index can be used as both a celebration of past achievements and a starting point for an even bolder vision. No city is perfect, including those with the highest scores in this report, and there is always more that can be done to create a community that truly protects and advances reproductive health, rights, and justice. If a City Scorecard indicates that a city has achieved most of the policies we track, advocates and officials can look to the values of the Model City to determine how to improve and expand upon their existing policies, including ensuring more effective implementation and oversight.

For Advocates in a Lower-Scoring City

The Local Index offers cities with below-average scores a plethora of policy ideas, strategies, and real-world examples to pursue. While the values and policies reflected in the Model City may feel utopian and out of reach for some localities in the near term, there are many incremental steps a city can take to get closer to achieving that expansive vision. The scores in this report seek to provide an honest assessment of local needs and challenges and are not intended to be judgmental or punitive. Moreover, it is important to note that lower-scoring cities often have smaller budgets and smaller population bases, and/or are located in states that are more conservative, all of which can make it difficult to achieve many of the indicators in this report.

Advancing Reproductive Freedom in Your City: A Tool for Advocates

As an advocate, you can refer to the Local Reproductive Freedom Index to understand local trends in reproductive health, rights, and justice and support your work on the ground. This Tool for Advocates helps local advocates use the Local Index to push forward proactive policies at the local level.
Get the tool here.

Advancing Reproductive Freedom in Your City: A Tool for Policymakers

As a policymaker, you can refer to the Local Reproductive Freedom Index, other resources from NIRH, and our trusted partners to understand local trends in reproductive health, rights, and justice and support your work on the ground. This Tool for Policymakers helps local policymakers use the Local Index to push forward proactive policies at the local level.

Get the tool here.

Self-Scoring Tool

Thumbnail of self-scoring tool.

Download (Excel file)

For advocates and officials whose city is not included in the Local Index, NIRH has issued a companion Self-Scoring Tool that can be used to assess your city, town, or locality.

The Local Index Self-Scoring Tool follows the rubric (found in appendix C in the report) that NIRH used in assessing the scores of the 50 cities in the Local Index. Use the Self-Scoring Tool to assess how your city, town, or county stands.

Use the City Scorecard worksheet to track your city’s policies.

Advancing Reproductive Freedom: Beyond Legislative Strategies

Legislation is a meaningful way to make change, but it is not the only way. Local officials have a range of tools at their disposal to meaningfully impact reproductive health, rights, and justice in their communities.

  • Procurement: In 2018, Milwaukee passed a paid sick leave policy, but it was preempted by then-Governor Scott Walker in 2011. Subsequently, Milwaukee updated its procurement processes to incentivize private sector companies to adopt policies like paid sick leave, even though they could no longer mandate it. The Milwaukee Common Council overhauled itsbid scoring system for city contracts to award extra points to “socially responsible” contractors. Potential programs or actions that can qualify a contractor include providing paid sick leave, providing breastfeeding facilities, underwriting or facilitating access to help employees obtain childcare and family-related dependent care, or support for resolving tardy child support payments.
  • Adoption of an internal equity lens: The New York City Department of Health and Mental Hygiene launched an internal reform effort, “Race to Justice,” to educate staff on how racist policies in government institutions have led to disparities in health outcomes. In Austin, TX, the mayor established an Equity Office to evaluate the impact of city programs and services on racial equity and to address the city’s own hiring practices to increase diversity and ensure government employees reflected the racial makeup of the city.
  • Implementation of state policy: After North Dakota passed a law mandating that businesses provide their employees with private spaces for breastfeeding, the city of Fargo stepped up to support their local business community. Recognizing that implementation can be just as important as good policy, the Fargo Cass Public Health Department now offers businesses microgrants of up to $500 to help them comply with the law. This small amount of funding can offset the cost of a comfortable chair, refrigeration, the installation of locks or an outlet, or other important features of a breastfeeding space.
  • Zoning: An anti-abortion pregnancy center in a residential-zoned area of Boston petitioned its neighborhood association in 2015 to obtain a “conditional use permit” to operate an ultrasound, a device that is key to anti-abortion pregnancy centers’ strategy because it grants a false impression of medical authority; a free ultrasound can also lure women in, even if the center does not offer comprehensive care. After learning about the deceptive practices of these centers, the association voted unanimously to deny the permit, determining that the use of the ultrasound would not be in harmony with the purpose and intent of the zoned area. In South Bend, IN, when an anti-abortion pregnancy center sought to open a facility in a residential zone next door to a new abortion clinic, they had to request that the property be rezoned. Mayor Pete Buttigieg acted to protect public safety in South Bend when he vetoed the effort to rezone a property, which would have enabled the anti-abortion pregnancy center to open directly next door to an abortion clinic.

Preemption: What It Is, How to Think About It, and Tips for Fighting Back

Progressive cities in conservative states must balance their desire and ability to advance significant policies that will improve the lives of their residents with the reality that state legislatures may respond by passing legislation that preempts those local efforts. Preemption laws are those intended to prevent municipalities from setting their own policies on a range of important issues or override policies they have already set, including those in the Local Reproductive Freedom Index. Some of the most commonly preempted policies include the ability of localities to set a minimum wage, mandate paid sick leave, ban discrimination on the basis of gender identity, or provide funding for abortion care. For example, Texas Senate Bill 22, passed in 2019, prevents municipalities from using their own funding to partner with an abortion provider in any way.

If policymakers or advocates are considering working on a local policy that could be at risk of being preempted by subsequent state law, NIRH recommends taking a few considerations into account:

  • Identify supportive coalitions and allied organizations. Is there an existing coalition of progressive organizations dedicated to opposing preemption? If so, they will likely have important insights and expertise that will be beneficial, including how to evaluate the likelihood of preemption and the best ways to fend off a preemption bill. They can also be important allies if a preemption bill is introduced, sharing effective messages and acting as allies in opposition to the bill.
  • Calculate side benefits of passage. If the policy is preempted, will this be a total loss or are there other benefits that will remain meaningful regardless? For instance, the enactment of the policy or the fight against preemption on the state level may raise needed awareness of the issue or encourage entities like businesses and schools to willingly adopt the policy or take the action that is otherwise preempted.
  • Consider the political landscape. If the state legislature and governor are conservative on the issue at hand, does it seem likely that the ideological makeup of state government will remain that way for the foreseeable future? Conversely, is it possible that in the next few years the majority in the legislature or the governor might change to be more supportive of the issue? If the latter, it may be worth holding off on passing a local policy that could prompt a state preemption bill, since repealing a preemption law may be challenging even in a more supportive environment. If the former, and there are other benefits to the policy’s passage even if it is preempted, it may be worth moving forward because even preemption is unlikely to change the status quo.
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