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 bills 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.  

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. Women 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 level.  

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.

As 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.