Written by Walker Kahn and Maria Manansala
The Problems and Progressive Local Solutions
Despite America’s enormous wealth and medical expertise, our reproductive healthcare system is quite bad. Pregnancy and childbirth always bear significant health risks, but America has the highest rates of maternal mortality among comparably wealthy countries (Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Switzerland, and the UK). Outcomes for women of color are even more dire.
This failure is caused by gross inequalities in the distribution of material determinants of health, a uniquely predatory for-profit healthcare system, and now the conservative movement’s success in removing a half-century of constitutional protection of abortion rights through the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization (2022). With Congress still not declaring those right by statutes, and regressive state governments around the country using their newfound power to undermine reproductive healthcare, it is imperative that local leaders do what they can to help make family care and planning possible for their residents.
They can do this, even as their powers are constrained by states now preempting their home rule rights (see ProGov21’s Home Rule Roadmap for more information on preemption). Critical goals include: (1) protecting people who choose to end a pregnancy and abortion providers from violence and legal threats; (2) reducing obstacles to reproductive care, especially those due to gender or sexual orientation bias, racial discrimination, or economic disadvantage; (3) reducing total maternal mortality and combating racialized disparities in maternal mortality; and (4) expanding paid sick leave and parental leave. positive spillover effects on others in communities. They not only improve women’s health but community health.
Available Local Levers & Targets for Reform
Wherever possible, local governments can improve access to reproductive healthcare by requiring employers to provide high-quality, affordable, comprehensive health insurance to workers and their families. Cities should lead my example on this front—as Cincinnati did when updated municipal employee’s insurance plans to cover reproductive and sexual health necessities like birth control, STI testing, and (if not preempted) abortion care. Municipalities can also provide funding for these services: Kalamazoo created the first Reproductive Health Fund to finance sexual, reproductive and gender-affirming health care. St. Louis passed an ordinance redirecting funds from the American Rescue Plan Act to their city’s Reproductive Equity Fund.
In states where access to abortion has been restricted, cities and towns can resist the criminalization of abortion by deprioritizing, defunding, or prohibiting criminal investigations, arrests, or prosecutions related to reproductive healthcare. Boise, New Orleans, and Memphis have passed resolutions instructing local law enforcement agencies not investigate or pursue abortion providers or people who’ve had abortions. Tucson’s City Council acted with the Chief of Police to revise the police department’s general orders and instruct that “no physical arrest” be made for alleged violations of the Arizona’s abortion law. Austin’s GRACE resolution prevents city funds from being used by local law enforcement to investigate, document, or share information about abortions, miscarriages, and reproductive healthcare. Chicago—a city in a state where abortion access is not currently in legal jeopardy—passed an ordinance prohibiting city agencies from participating in investigations or proceedings related to reproductive care in jurisdictions, making the city a safer option for traveling from out of state for abortion. It is important to note that these interventions are not infallible; preemption makes it difficult for cities and counties to effectively challenge state law.
In states where abortion is legal, local governments must take further steps to ensure the abortion seekers and providers from violence and harassment. New York City, West Palm Beach, Pittsburgh, and Louisville have passed ordinances creating “safe zone” around reproductive health clinics that prevent harassment, physically contacting medical professionals or clients, and the blockading clinic doors. This Bernalillo County ordinance prevents picketing homes of reproductive healthcare providers. Chicago, along with the policy above prohibiting local law enforcement from cooperating with out-of-state police investigations into reproductive healthcare, prevents retaliation against individuals who have received abortion services by banning discrimination in employment and housing based on a person’s reproductive health decisions.
Along with protecting reproductive healthcare clinics, communities can act to regulate “crisis pregnancy centers” that do not offer medical care. They should begin by mandating transparency from health clinics and publicizing information about the deceptive practices of “crisis pregnancy centers (CPCs).” An ordinance from San Francisco prohibits CPCs from making misleading statements or posting deceptive advertisements about their services. In a similar vein, Hartford and New York City both have ordinances that require fake clinics to disclose whether there is a licensed medical provider on-site.
Local governments can also partner with activists to encourage—or pressure—district attorneys not to pursue prosecution. Activists successfully persuaded a Starr County, TX, district attorney to drop charges against a person who self-administered a medication abortion—something not technically illegal under Texas state. District attorneys in Orleans Parish, Durham County, DeKalb County, Fairfax County, and various Texas counties have announced that they will deprioritize prosecuting people under state anti-abortion laws. Additionally, 68 prosecutors around the country have vowed to never prosecute individuals for having/providing an abortion.
Self-administered medication abortion remains available in most states, although the legal landscape is changing constantly. If/When/How and the Repro Legal Helpline are organizations that can be shared with the public and policymakers to help people stay up to date. Medication abortions are generally very safe, and the FDA has made them available nationwide without an in-person doctor appointment. While they are currently legal to receive through the mail and to possess, some states have prosecuted people for using these medications for their intended purpose. Self-administered medication abortion remains a legal grey area in some states, but the medications are available and it is important for local communities and elected officials to remain up-to-date on this issue. Organizations committed to providing access to and information about self-administered medication can readily be found online. With reference to relevant state and local law, elected officials should keep constituents informed as to all options available to them.
The policy landscape after Dobbs has been a whirlwind: this National Institute for Reproductive Health toolkit provides a comprehensive analysis of proactive strategies used by local governments to respond the decision.
Taking it to the Next Level
When addressing reproductive health, local policymakers must also address disparities caused by race, social class, and gender identity. Black women are more likely to experience complications throughout the course of their pregnancies than white women. Compared to white women, Black women are four times more likely to die from pregnancy-related complications. A variety of factors may contribute to this disparity, including discrimination and structural racism in the healthcare industry that leads to Black women receiving poorer quality care than their white counterparts.
Poverty is a critical factor driving disparities in maternal mortality. Poor women have limited access to reproductive and sexual health services. An organizing guide by The Institute for Reproductive Health Access outlines how stakeholders can protect reproductive healthcare for low-income women at the federal, state, and local level. Paid family and sick leave programs are an important tool for combating the impact of poverty on reproductive health. Paid leave programs have far reaching benefits for public health as a whole, as evidenced by the states and the District of Columbia which have all enacted paid family and medical leave programs. See the ProGov21 Wages and Benefits Roadmap for more on paid family and medical leave.
Helpers, Allies, and Other Useful Organizations
- National Institute for Reproductive Health - The National Institute for Reproductive Health is an advocacy organization that fights for just and equitable access to reproductive health care in states and cities nationwide.
- Women’s Fund of Rhode Island - The Women’s Fund of Rhode Island invests in women and girls through research, advocacy, grantmaking and strategic partnerships designed to achieve gender equity through systemic change.
- Institute for Women’s Policy Research - The Institute for Women’s Policy Research is a national think tank that builds evidence to shape policies that grow women’s power and influence, close inequality gaps, and improve the economic well-being of families.
- National Women’s Law Center - The National Women’s Law Center fights for gender justice—in the courts, in public policy, and in our society—working across the issues that are central to the lives of women and girls.
Mayors Innovation Project, our sister organization, is a national learning network for mayors committed to shared prosperity, environmental sustainability, and efficient democratic government.