The Local Reproductive Freedom Index evaluates the reproductive health, rights, and justice policies of 50 U.S. cities – and draws a roadmap for how cities can put policies in place to become more equitable communities.
We are in the midst of unprecedented attacks upon reproductive freedom from the courts and conservative states. Cities play a crucial role in ensuring that people can control their reproductive and sexual lives, choose whether and when to become parents, and get the support they need to raise their families.
The 2021 Local Index analyzes how local policy responded to and was impacted by the major events of 2019-2020 – the onset of the COVID-19 pandemic, uprisings for racial justice, and attacks upon voting, elections, and the fundamental pillars of democracy.
CITY PROFILES AND SCORECARD
The Local Index offers a snapshot of how localities have proactively risen to advance reproductive freedom. The Local Scorecards capture the policies and practices that 50 U.S. cities had in place as of December 31, 2020.

Click the image to zoom in and explore the scorecard.
THE ROADMAP: A POLICY AGENDA FOR CITIES
The roadmap is a proactive policy agenda to establish a city that truly advances reproductive freedom, across six separate focus areas. Below is a selection of possible policies to explore; for the full policy agenda, see the 2021 Local Index.
Recommended policies ensure that access to abortion care is safe, affordable, and protected, integrated into the city’s health care system, and not stigmatized or criminalized.
- Engage every relevant department in the city to implement and enforce policies and practices to prevent harassment and disruption at abortion clinics, including noise regulations, parking and traffic regulations, and anti-nuisance regulations.
- Launch a public awareness campaign to ensure residents know about the safe and legal abortion care they can access in the city, and to educate residents on how to identify an AAPC.
- Officially recognize March 10 as Abortion Provider Appreciation Day to celebrate the important work of local abortion providers and clinics.
We recommend that the city budget reflects the city’s values by providing funding to fully meet the need for high-quality, patient-centered reproductive health care and services, including abortion.
- Allocate municipal dollars to the city’s local abortion funds, directly to local abortion providers, and/or topractical support funds that help people pay for costs associated with accessing abortion, such as travel, lodging, and childcare.
- Mandate that insurance benefits for municipal employees cover comprehensive reproductive health care benefits, including abortion.
- Offer trainings to reproductive health care providers and staff on how to provide care to populations with unique needs — including LGBTQIA-friendly care, teen-friendly care, and culturally responsive care — and on how to provide person-centered care to all patients.
The city should equip young people with the reproductive and sexual health information and services they need to make the best decisions for themselves regarding their health, relationships, families, and futures.
- 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 lactation, childcare, and a flexible absence policy.
- Require schools to implement a K-12 comprehensive 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 lessons about sexual and reproductive health.
- Fund SBHCs that offer reproductive health care services, including contraception services and counseling and STI/HIV screening. Train SBHC staff on providing LGBTQIA-friendly reproductive health care.
The city should support every resident’s right to create, raise, and support their families in a healthy, safe, and secure environment.
- Require paid family leave for municipal employees, including those who work part time and for contractors working with the city.iv
- 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 free local doula training program to increase opportunities for low-income people to become doulas, and subsidize doula care for low-income families at rates that ensure doulas earn a living wage.
The city is committed to health, economic security, safety, 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.
- Allocate municipal dollars for free menstrual hygiene products in all public places, including jails, prisons, juvenile detention centers, government buildings, 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.
- Implement programs and policies to 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.
- 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 pregnant people who are incarcerated while pregnant, in labor, or postpartum. Engage in training and oversight to ensure these policies are instituted and followed.
The city establishes its social justice values, including its support for reproductive freedom, through resolutions and public statements. The city speaks out on local-, state-, and federal-level reproductive health, rights, and justice issues that impact its residents.
- Pass a resolution or issue a proclamation opposing the deceptive practices of AAPCs and calling for an end to any state or federal funding they receive.
- 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. This includes calling on the state or the federal government to expand insurance coverage of abortion, pass the federal EACH Act and 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 the city a safe and welcoming place for all to receive reproductive health care, including abortion.
MODEL CITY
The Model City provides a framework that all cities can strive to meet by using every tool possible to support the freedom and ability of each person to control their reproductive and sexual lives, foster thriving families, and destigmatize abortion and contraception.
Click the image to explore the city in more detail.

Highlights of City Policies
The Nation’s First Reproductive Justice Commission
AtlantaThe Nation’s First Reproductive Justice Commission
In October 2019, NIRH worked with advocates in the Amplify GA coalition and elected officials in the Atlanta City Council to establish a first-of-its-kind Reproductive Justice Commission in Atlanta, GA.
Funding Abortion Access
Austin & New York CityFunding Abortion Access / Austin & New York City
In 2019, NIRH helped Austin, TX, and New York, NY become the first cities in the country to directly fund abortion care through their municipal budgets.
Free Diapers During COVID-19 Pandemic
BaltimoreFree Diapers During COVID-19 Pandemic / Baltimore
The Baltimore City Health Department distributed 500,000 diapers to city residents during the pandemic.
Engaging Residents in Local Government
Birmingham, ALEngaging Residents in Local Government / Birmingham, AL
In 2019, Birmingham started a program to make local policymaking more accessible to community members by bridging the distance between the community and their leaders.
Free Menstrual Hygiene Products in its Public Schools
BostonFree Menstrual Hygiene Products in its Public Schools / Boston
In Fall 2019, Boston Public Schools launched a pilot program to bring free menstrual supplies to students in public schools.
Housing Security for Young Parents
Denver, COHousing Security for Young Parents / Denver, CO
Denver is home to the Florence Crittenton High School, offers pregnant and parenting young people curriculum to earn high school diploma or an Associate’s degree, and offers food, on-site daycare and services, and a comprehensive medical clinic, including dental care.
Protecting the Right to Vote During the COVID-19 Pandemic
Harrison County, TXProtecting the Right to Vote During the COVID-19 Pandemic / Harrison County, TX
The Harris County, TX Clerk used CARES Act and other funding to create a 23-point initiative to address voting disparities, including tripling the number of early and Election Day polling locations, establishing drive-through polling places, and facilitating access to mail-in voting.
Addressing Maternal Health Disparities
Richmond, VAAddressing Maternal Health Disparities / Richmond, VA
In 2019 the mayor of Richmond and the Richmond City Health Department convened Greater Richmond Regional Maternal Child Health Taskforce, to address racial disparities in maternal health outcomes.
Monthly Income to Pregnant Black and Pacific Islanders
San Francisco, CAMonthly Income to Pregnant Black and Pacific Islanders / San Francisco, CA
San Francisco’s Abundant Birth Project provides an unconditional monthly income supplement of $1,000 to about 150 Black and Pacific Islander residents from pregnancy to 6 months postpartum.
Recognizing Abortion Provider Appreciation Day
Multiple CitiesRecognizing Abortion Provider Appreciation Day / Multiple Cities
To honor abortion providers, Austin, TX; Atlanta, GA; Minneapolis, MN; St. Louis, MO; and St. Paul, MN all issued proclamations recognizing Abortion Provider Appreciation Day.
FAQ
RESOURCES
Local Index Self-Scoring Tool and Directions for Use
Local Policy Recommendations for Responding to TX SB 8
Protecting Reproductive Freedom in Cities and Counties During the COVID-19 Pandemic
Declaring Abortion Provider Appreciation Day in Your Community: A Proclamation Toolkit
Tools for Local Advocates & Policymakers
Local Reproductive Freedom Index: Evaluating U.S. Cities 2019
Local Reproductive Freedom Index: Evaluating U.S. Cities 2017