At the end of 2021, anti-abortion crusaders appear to be on the cusp of achieving their decades-long goal to eliminate federal protections for abortion rights.  

Against this bleak backdrop, NIRH’s Gaining Ground: Proactive Reproductive Health, Rights and Justice Legislation in the States reports a record number of states have stepped up to protect and secure abortion access and make reproductive health care more accessible, equitable, and humane.

In 2021, state legislatures introduced at least 1,096 proactive health, rights, and justice pieces of legislation – believed to be the greatest number of proactive bills ever attempted. Thirty-six states and the District of Columbia enacted at least one proactive law to address reproductive health care, leading to the 179 enacted reproductive health, rights and justice policies – the most passed in a single year since NIRH began keeping track. 

Cover of 2021 Gaining Ground report
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Map of proactive legislation in 2021
Highlights from 2021 include:
  • In 2021, state legislatures introduced at least 1,096 proactive pieces of legislation to advance reproductive health, rights, and justice pieces — believed to be the greatest number of proactive measures ever attempted. Thirty-six states and DC enacted at least one proactive law to address reproductive health care. The 179 bills enacted in 2021 surpasses the previous record, set in 2019

  • Nine states enacted 13 laws to protect the right and expand access to abortion care, with one more expected to do so any day. These include: 

    • Delaware removed abortion from its criminal code and eliminated the provisions of its law that treated abortion differently from other medical procedures. 
    • New Mexico repealed a 1969 law that criminalized abortion, ensuring that the outdated law cannot be used to threaten New Mexico providers and their patients if abortion rights are further weakened or overturned. 
    • Illinois repealed its parental involvement requirement for minors’ access to abortion care, making it the second state to roll back parental involvement laws (following Massachusetts in 2019). The Illinois bill is expected to be soon signed by the Governor – which will push the number of proactive abortion measures in 2021 to 14 laws in 10 states.  
    • Virginia repealed a state law prohibiting the inclusion of abortion coverage in private health insurance plans.  
    • Hawaii expanded access to abortion care by authorizing qualified advanced practice registered nurses to perform first-trimester abortions. 
    • Connecticut prohibited crisis pregnancy centers from engaging in deceptive advertising that would mislead people seeking abortions
       
  • Ten states overall passed laws to allow pharmacists to prescribe contraception and/or allow a one-year supply: Arkansas, Arizona, Colorado, Delaware, Illinois, Maryland, Nevada, North Carolina, Utah, Virginia.

  • Among the 31 states that enacted laws to increase access to pregnancy care, NIRH was especially proud to work with Connecticut partners to define doulas in statute and explore a state certification process; and with Rhode Island partners to pass a bill requiring private insurers to cover doula care and provide for Medicaid coverage for doula care through a budget item.

  • Several states passed legislation that will increase the availability of free menstrual products to students in public schools and universities, including Alabama, Arkansas, California, Colorado, Delaware, Illinois, Maryland, Nevada, Oregon, Rhode Island, and Washington. 

See the Year in Review reports from previous years: