The 2023 Local Index covers 50 US cities and counties. NIRH has identified 35 specific policy or programmatic “indicators” by which we evaluate each of the cities and counties, all of which fall within six broader issue categories that NIRH has determined are core to securing and advancing reproductive freedom at the city level. These indicators and the policies and principles of the Model City are based on NIRH’s expertise and values, those of our partner organizations, and the work of allied social justice movements.

It is important to note that while this report is informed by a reproductive justice framework, the indicators and Model City do not encompass all the issues that would be included in a comprehensive reproductive justice analysis. Doing so would require including indicators on safe and affordable housing, community safety, disability rights, initiatives to address intimate partner violence, and a range of other important concerns related to self-determination and human rights.

Local Landscape: To create a more complete profile of each city, and to complement and contextualize the 35 policy indicators, NIRH also collects demographic and additional policy data related to reproductive freedom. This information is reflected in the “Local Landscape” featured on each City Scorecard but does not contribute to a city’s overall score.


NIRH researchers review a range of sources to inform the City Scores, including websites of city and county governments, local and state departments of health, departments of education and school districts, and other relevant government agencies and commissions, as well as publicly available information from local community-based organizations and local media. Researchers also conduct phone and email interviews whenever possible with partner organizations, other community-based organizations, departments of health, school districts, and city and county officials in each of the cities. Initial findings are shared with local advocates and departments of health for review. Final City Scores are based on the sum of this work.

Protecting Abortion Access
Clinic safety ordinance 2
Regulations on deceptive practices of AAPCs 2
Local protections for abortion clinics and providers 2
Public awareness about access to abortion care 1
Anti-discrimination ordinance for employees: reproductive health decisions 2
Anti-discrimination ordinance for housing: reproductive health decisions 2
Funding and Coverage for Reproductive Health Care
Funding for abortion 2
Funding for STD/STI testing and prevention 1
Municipal insurance coverage of abortion 2
Funding to train providers in reproductive health care 2
Funding for contraception 1
Funding for community-based organizations to provide CSE 1
Supporting Young People
Support for pregnant and parenting youth 1
Funding for comprehensive sexuality education 1
Comprehensive sexuality education 1
Reproductive health care in SBHCs 2
Supporting Families
Supportive lactation policies 1
Paid family leave for municipal employees 1
Environmental protections for maternal and reproductive health 1
Anti-discrimination ordinance for employees: pregnancy and family status 1
Anti-discrimination ordinance for housing: pregnancy and family status 1
Initiative to address pregnancy-related mortality 2
Building Healthy and Just Communities
Positive public awareness campaigns on sexual and reproductive health 1
Menstrual equity initiative 1
“Shield” law for victim reporting 1
Paid sick leave 1
$15 minimum wage 1
Support for immigrants to access reproductive health care 1
Advancing democracy 2
Anti-discrimination ordinance for employees: gender identity 1
Anti-discrimination ordinance for housing: gender identity 1
Proclaiming Local Values
Opposition to deceptive practices of AAPCs 1
Support for abortion coverage, including the Equal Access to Abortion Coverage in Healthcare Act (EACH Act) 1
Pro-choice stance on state or federal legislation or ballot initiatives 1
Support for anti-discrimination 1

A city’s score is determined using an equation that weighs the total number of points a city achieved divided by the total number of possible points.

Each city can receive one of the following marks for each indicator:

  • Yes: A city or county has a policy or program related to the indicator in place.
  • No: A city or county does not have a policy or program related to the indicator in place.
  • Limited: A city has taken some steps toward achieving the indicator but has not acted to its fullest extent. Limited measures count toward a city’s overall score as half of the full point value.
  • Preempted: State policy prevents a city from acting on the policy described by an indicator, or a state policy fully addresses the entire area described by an indicator, making it unnecessary for the city to take further action. Preempted measures do not impact the city’s overall score.
  • N/A: NIRH was unable to find sufficient information on a given measure to determine its status as of December 31, 2022. N/A measures do not impact the city’s overall score.
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