The Local Imperative: An Urban Initiative for Reproductive Health

Emily Alexander

Reproductive health advocates cannot afford to make the same mistake we made in the 90's: letting anti-choice grassroots local policy efforts pass while we craft our wish lists for a progressive President.

After last week’s resounding
reproductive health successes across the country–electing a pro-choice
President, increasing the number of pro-choice members of Congress, and
defeating three anti-choice ballot initiatives–now is the
moment to clarify our strategy to promote
a new progressive vision for the nation. However, we cannot afford to neglect
the work that is both possible and desperately needed at the city and
county level to protect and expand rights and increase access to reproductive
health information and services. After suffering defeat on a variety
of levels, including referendums in three states, our anti-choice counterparts
will no doubt be organizing at the local level to advance their agenda.
As reproductive health advocates, we cannot afford to make the same
mistake we made in the 90’s that let anti-choice grassroots local
policy efforts pass while we crafted our wish lists for a progressive
President after years of conservative control. 

Just before our pro-choice
victories, media reports drew attention to an anti-choice strategy used
in Indiana to create burdensome and unnecessary requirements of abortion
providers, often called "Targeted
Regulation of Abortion Providers"

(TRAP) laws, at the local level. (TRAP laws erect needless barriers
to abortion services by adding additional legal requirements
for abortion care facilities and/or abortion providers beyond those
that are required of other similar medical facilities or professionals.)
After a state bill to restrict women’s access to abortion services
failed, anti-choice advocates turned to their local county governments
to push a coordinated series of ordinances that would create restrictions
similar to those proposed by the failed state bill. Last year, anti-choice
advocates used a similar strategy to restrict women’s access in Virginia,
this time at the city level. In the fall of 2007 the Manassas, Virginia,
City Council passed a resolution to form a committee that would review
the current abortion clinic regulations in order to determine whether
more stringent controls were needed. Similar
to Indiana, legislation that would have added onerous regulations to
the provision of abortions in private clinics
had died in the Virginia State Senate after passing the House of Delegates.
Both Indiana and Virginia already have considerable restrictions
on the books that obstruct a woman’s access to abortion, such as mandatory
waiting periods and parental involvement requirements.  

Anti-choice strategies
that use local ordinances or resolutions to restrict abortion are a
wake-up call to pro-choice advocates. We need to turn our attention
to the city and county level, not only to stop the passage of anti-choice
bills but to improve women’s access to quality health
care and information. A good place for us to start would be urban centers,
where officials tend to be more progressive and there is often a larger
concentration of pro-choice advocates. We need to seize on opportunities
to push forward our own progressive local agenda to affirm rights, increase
access to health care, and target locally run programs to address the
particular reproductive health challenges that a city or county is facing.  

Unfortunately, over the past
eight years, pro-choice advocates’ attention has been tied up playing
defense at the state and federal levels to help protect women’s rights
and access to reproductive health care. And that attention has been
warranted; during the 2007 legislative sessions, 464 anti-choice
were considered
in states across the country. It is critical that advocates protect
the rights and access of women in their states against these efforts.
However, pushing for localized city or county advocacy would enable
pro-choice advocates to promote progressive, pro-active policies and
programs that even now would face insurmountable political odds and
political maneuvering at the state or federal levels. These efforts
can fill in the gaps that are created by political impasses at the state
and federal levels, effecting immediate change for women and families
in our communities. In some states, city and county-based work could
provide advocates with their only opportunity to push forward a progressive,
pro-active agenda. For advocates in states with friendly state governments,
city and county-based work offers the chance to pilot progressive, cutting-edge
efforts that can later be replicated at the state, and maybe now even federal, level.  

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A local strategy also has the
potential to reach a tremendous number of Americans. Close to 80% of
the U.S. population lives in a metropolitan area.
living in large cities are more likely to be in their reproductive years
than their rural counterparts and experience higher
fertility rates. They also tend to
suffer from increased rates of infant
mortality and sexually transmitted infections
. Women of color as well as foreign-born women
are often more likely to live in metropolitan areas.
Women and families living in large
cities are in need of progressive pro-choice advocacy to increase access
to quality, culturally competent and linguistically appropriate health
care information and services to improve health outcomes and address
widening reproductive health disparities. It is incumbent upon us to
cultivate public and elected official allies at the city and county
level to broaden the scope and tools of our movement. We cannot afford
to wait any longer–as is demonstrated by the Indiana and Virginia
examples, our opponents are busy mobilizing elected allies at the local

To help support and promote
pro-active reproductive health and justice efforts at the local level,
the National
Institute for Reproductive Health

is currently leading a program, the Urban
Initiative for Reproductive Health
to coordinate and connect advocates and officials across the country
working at the city and county level. In May 2008 the Urban Initiative,
with the support of New York City Mayor Michael Bloomberg and City Council
Speaker Christine Quinn, held a National Urban Initiative for Reproductive
Health Summit that brought together local advocates, public health leaders
and elected officials from over 35 cities to share successes and challenges.
Building on this momentum, Regional Summits will take place throughout
2009. The Urban Initiative will further partnerships
between elected and public officials and advocates at the city and county
level and advance an agenda promoting policies and programs that increase
access to comprehensive reproductive health services, reduce unintended
pregnancies, address reproductive health disparities, and lead to healthier
birth outcomes. The strategies highlighted through the Urban Initiative
demonstrate the potential of collaborative efforts between local advocates,
public health and elected officials that work across issue areas to
improve the lives of the women and families in their communities.

an example of successful local pro-choice work, the cities of Pittsburgh
and Oakland have passed "buffer zone" legislation to protect clinics
and women seeking abortion care from obstructive anti-choice protesting;
a similar bill is currently pending before the New York City Council.  

While our victory at the federal
level and in many states will no doubt require policy and programmatic
plans that both repair the Bush Administration’s damage as well as
advance our long dormant proactive agendas, there is a tremendous need
to focus on local city and county strategies to improve reproductive
health indicators, access and rights. The recent anti-choice ordinances
in Indiana counties should not only motivate reproductive health advocates
to mount a strong defense, but also help mobilize us to act on the local
level to promote our own agendas that foster justice and access for
all women and families.

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