The Local Reproductive Freedom Index (LRFI) is the National Institute for Reproductive Health’s (NIRH) biennial report that analyzes intersecting policies that shape reproductive freedom landscapes — either directly or indirectly — in 50 cities and counties in the US. This report includes a roadmap of municipal-level policies that strengthen the reproductive health and rights of citizens living in these communities.

This is the first LRFI release since the sudden passing of our president, Andrea Miller. Andrea was a longstanding leader in the reproductive health, rights, and justice movement who trailblazed a partner-based model in state and local focused advocacy work. The LRFI is one among many examples of Andrea’s creative approach to exploring the possibilities rather than settling for the status quo. Finding opportunities for proactive change at the city and county level was an experiment ten years ago, and this fourth edition of the LRFI is a testament to Andrea’s vision, which has become part of the fabric of reproductive freedom. May her legacy live on through our work.

This year’s report looks back on a time of intense turmoil in our country – covering the year before and the time since the Supreme Court’s devastating decision in Dobbs v. Jackson Women’s Health Organization, which overturned Roe v. Wade and ended the federal right to abortion in an instant. Analyzing the period from January 1, 2021 to December 31, 2022, the data demonstrate the real-world impact of the loss of Roe v. Wade and the subsequent wave of abortion bans and restrictions. The LRFI shows the often underreported, yet powerful change that happens at hyperlocal levels beyond state legislatures, and in some cases, in spite of state governments. Notably, this edition of the LRFI shows unprecedented proactive responses from localities solving reproductive health challenges in a post-Roe reality, especially in states where government has banned or severely restricted abortion access.

Key findings include:

  • Cities were scored on a scale of 0 to 5 stars. Cities’ scores ranged from 0 stars to 4.5 stars. The average score for the 50 cities was 2 stars, a slight drop from the 2021 average of 2.2 stars.
  • No city achieved a perfect score. New York City and Chicago received the highest scores of 4.5 stars.
  • “Funding for abortion” was the indicator that saw the largest percentage increase in the number of new cities scoring “Yes” or “Limited.”
  • Local efforts to protect and advance democracy, address pregnancy-related mortality, and protect against discrimination based on gender identity were among the most common policies identified.

Cities in states that banned abortion were more likely to see a slight drop in their scores compared to the third edition of the LRFI, reflecting the increasingly hostile landscape in a post-Roe era. Yet even in some of the most challenging times, some cities in the most restrictive states — Cleveland, OH; St. Louis, MO; Austin, TX; Madison, WI; and Columbus, OH (the top 5 abortion-forward cities in banned states with anti-abortion state majorities) — exemplified what it means to think outside of the box, and as a result, passed policies that advanced reproductive freedom. Local advocates and leaders in each of these cities have been vocal and proactive in their support for abortion rights and for reproductive freedom writ large.

In this year’s report, we hope that all supporters of reproductive freedom will find the information and the inspiration they need to take action in their hometown to protect and advance reproductive freedom – from the ground up.