NIRH would like to thank the many staff members who contributed to this report. Special acknowledgments go to Arpita Appannagari, ShelLynn Beasley, Jenny Dodson Mistry, Kelsey Lain, Hunter Stewart, and interns Christy Atangana and Zaire Bartholomew. NIRH received support from the following organizations to establish our framework in previous years, and their resources continue to inform this edition of the Local Index: A Better Balance, Advocates for Youth, Bold Futures, CityMatCH, FairVote, Fight for $15, National Latina Institute for Reproductive Justice, RepresentWomen, Sex Workers Outreach Project (SWOP) USA, and Sex Workers Outreach Project (SWOP) Behind Bars. Finally, we applaud the achievements of local leaders, advocates, and community members who have worked tirelessly for decades to create the thriving cities we were inspired to learn about throughout the course of this research. That especially includes the following individuals and organizations, who generously provided assistance and expertise in researching this report:


  • Pro-Choice Arizona


  • Planned Parenthood of Northern California
  • San Francisco Department of the Status of Women


  • Reproductive Equity Now


  • Jacksonville National Organization for Women
  • Metro Mommy Agency
  • Women’s Fund of Miami


  • Chicago Abortion Fund


  • Kentucky Health Justice Network


  • Louisiana Abortion Fund
  • Newcomb Institute
  • New Orleans Department of Health 
  • New Orleans Maternal and Child Health Coalition


  • Planned Parenthood League of Massachusetts
  • Reproductive Equity Now


  • Michigan Voices
  • Michigan Organization on Adolescent Sexual Health (MOASH)


  • Our Justice


  • Abortion Action Missouri


  • Converge


  • Blue Mountain Clinic
  • Planned Parenthood of Montana


  • CityMatCH


  • Hon. Adrienne Adams, Speaker, New York City Council
  • New York City Health Department


  • Pro-Choice North Carolina


  • Red River Women’s Clinic


  • Pro-Choice Ohio


  • Northwest Abortion Access Fund (NWAAF)


  • ACLU of Pennsylvania


  • Healthy & Free Tennessee
  • SisterReach


  • ACLU of Texas
  • Avow Texas
  • TEA Fund


  • Family Planning Elevated


  • Birth in Color
  • Whole Woman’s Health Alliance




  • Collaborative for Reproductive Equity
  • Health First Network
  • Planned Parenthood of Wisconsin, Inc.

What is your research process?

We have a multi-round research process. NIRH staff conduct the first round of research independently by reviewing municipal websites, including from the city and county government, 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. Next, we conduct phone and email interviews with people and organizations in the community. Interviewees represent organizations in our partnership network, other community-based organizations, departments of health, school districts, and city and county officials in each of the cities. Then, we share our initial draft of the scorecard with local advocates and the heads of city or county departments of health for review. Final City Scores are based on the sum of this work. 

How did you select these 35 policy indicators?

These indicators and the policies and principles of the Model City are based on NIRH’s expertise and values developed over more than a decade of local advocacy, as well as feedback from our partner organizations and the work of allied social justice movements. For indicators we did not have direct expertise in, we reached out to national and state-level experts for advice starting with the first edition of the report in 2017. These experts include A Better BalanceAdvocates for YouthAll* Above AllBold FuturesCityMatCHFairVoteFight for $15National Latina Institute for Reproductive JusticeRepresentWomenSex Workers Outreach Project (SWOP) USA, and Sex Workers Outreach Project (SWOP) Behind Bars. The indicators have been refined over the years as we learned from our research and received feedback from partner organizations and local advocates. 

Why are some indicators worth 2 points instead of 1?

NIRH considers several factors when determining the value of an indicator. Several indicators that protect abortion access are rated as 2 points because these policies remain rare at the local level compared to other indicators we review. We also consider the difficulty of passing a given policy and the policy’s impact on reproductive freedom.  

Has anything changed about the indicators this year?

We added the indicator “Initiative to address pregnancy-related mortality” this year to reflect the importance of localities in addressing the ever-growing crisis of pregnancy-related mortality. Since 2017, NIRH has tracked pregnancy-related mortality data, but these data are challenging to collect at the local level and are rarely disaggregated by race, masking stark race-based disparities.

Do you evaluate cities and counties at the same time?

Our research process defaults to city policy, so we first check if the city has any policies or programs in place that meet our metrics. If so, the indicator is scored based on these findings. If we can’t find data at the city level, we then research county-level policies and score the indicators based on our findings. City-level policies are marked on the scorecard as a square, while county-level policies are marked as a circle.

What about preemption?

If an indicator is preempted by state policy, we remove the points for that indicator from the denominator and do not give any points in the numerator, so preempted indicators do not impact the final score. NIRH considers a policy to be preempted if a state bans a municipality from acting on that issue, such as restricting cities from setting their own minimum wage, or if a state passes a policy comprehensive enough that it does not require a city to take further action, such as a statewide comprehensive sexuality education mandate.

What if my city or county isn’t included in the Local Index?

We have tools for you! You can use our Self-Scoring Tool to do your own research on your city’s indicators and create a Scorecard. You can also use the Model City and Roadmap as a framework to build a policy agenda for your city.  

How can I contribute to NIRH’s research or have the opportunity to review the scorecard for my city next time?

Send us an email at partnerships@nirhealth.org, and we’ll add you to our outreach database for the next report! 

I think you made a mistake in your research!

We know we aren’t perfect – conducting original research on 50 cities and counties is hard. We welcome the opportunity to review our research with you and, if necessary, to correct our findings. If you think there might be a mistake, please email partnerships@nirhealth.org with the subject line “Proposed Correction for [CITY].” 

Self-Scoring Tool
The Local Index Self-Scoring Tool follows the rubric that NIRH used in assessing the scores of the 50 cities included in the Local Index. This tool is intended for advocates and officials in the cities, counties, and towns that are not currently included in the Local Index who want to use NIRH’s framework to assess their locality’s standing and create scorecards of their own, which can be used to advance policy goals and support work on the local level.
Tools for Advocates and Policymakers
These tools are designed for advocates, policymakers, and candidates to advance reproductive freedom in their cities and counties. These tools are available for download and you are encouraged to share and use them with your community, allies, and elected officials.
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