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Ever since the Roe v. Wade decision in 1973, abortion foes and anti-choice activists have been working to roll back progress made in the fight for reproductive justice. Both the 2010 and 2014 midterm elections were decidedly Republican victories, and with those electoral wins came an onslaught of legislation designed to strip women of their constitutionally protected right to an abortion. Missouri, Kansas and Texas, among others, have passed laws that curtail abortion access. But, while it may seem as if pro-choice activists must constantly play defense, several cities and states, including Washington and Oregon, as Nina-Liss Schultz details at RH Reality Check, have begun playing offense on reproductive rights.

The National Institute for Reproductive Health works in partnership with advocates at both the local and state level. Since 2008, the Institute has been working to ensure that public policy and discourse includes emphasis on how to move forward with improving access to reproductive health. NIRH works with localities and state legislatures and, with the help of partner organizations, managed to craft policy adopted by the City of Madison, Wisconsin, that "emphasized the importance of covering a wide range of reproductive health services, including abortion and the need to eliminate the Hyde Amendment and all of its variations in federal law," NIRH president Andrea Miller says.

NIRH has seen successes at the local level when trying to mitigate the impact of crisis pregnancy centers (CPCs). CPCs are anti-choice facilities that prey on vulnerable women. "They are often lied to and manipulated and in an effort to prevent them from making a fully informed decision including abortion as option," says Miller. In several cities like New York and Baltimore city ordinances that will require CPCs inform women if they do not employ licensed medical providers. These ordinances "make sure there is at least some disclosure and some recognition of what these facilities do and don't do," says Miller.

On the 42nd anniversary of Roe v. Wade, HB 1647 was introduced in the state legislature in Washington. The Reproductive Health Act addresses a wide range of policies related to reproductive health. The bill includes improved and expanded access to contraceptives by "guaranteeing insurance companies cover all FDA-approved birth control methods without cost sharing, delays or denials of coverage."

"The compliance with that provision that there be no co-pay is horrible across the country," says Lisa Stone, executive director of Legal Voice , a legal non-profit formed in 1978 that employs a lawyer who worked on drafting the bill. "What happens instead is that plans will direct women to the cheapest, most convenient form for the insurance carrier rather than the woman deciding the best one for her." Working with their partners, Legal Voice is trying to get the bill passed in the state legislature.

"We're trying to shift things so that we're not always on defense," Stone explains. "We have really tried to shift the conversation in the reproductive rights and health justice arena so it's not just about prevention and termination of pregnancy. Those are very critical rights, as is the right to give birth how you want and to have the full range of reproductive health care."

HB 1647 also calls for reducing barriers to access by requiring that all "state-regulated insurance companies cover at least a one-year supply of birth control at a time, dispensed on-site at the health provider's office." Traditionally, patients receive a three-month supply of birth control but the year-long requirement mirrors what is available to Medicaid patients. According to Stone, the typical three-month supply can be troubling for college students. "If they're dependent on their college health-care system, and the timing of their educational terms don't work out, they can be adrift in the summer."

As more and more states pass laws that reduce access to reproductive care, groups like Legal Voice face myriad obstacles. For Stone, what's increasingly worrisome is the opposition to birth control. "The concerted effort to roll back women's rights is not at all confined to abortion anymore. There is vociferous opposition to contraception."

The tendency for state legislators to believe their constituents are more conservative than they really are also provides a source of concern for reproductive activists. Because of redistricting and low voter turnout, particularly in the 2010 and 2014 midterm elections, there is a large disconnect between the positions of anti-choice state legislators and the views of their constituents, according to Miller.

Yet despite the gains made by anti-choice politicians in the last set of midterm elections, 2014 was a good year for pro-active abortion legislation, says Miller. "It was, in fact, a year where more bills were introduced to move things in a positive direction than ever before and [it's] that momentum we're seeing continue to carry into this year," she says.

If passed, Washington State's Reproductive Health Act would require insurance companies to equitably serve patients by covering abortion care if they cover maternity care. Included in the bill is a provision for a study on health care disparities based on socioeconomic status, race, sexual orientation, gender identity, ethnicity, geography, and other factors. "We hope very much that this bill will pass this year," said Stone in a hopeful tone. "And if it doesn't we'll be back the year after, and the year after that."

The onslaught of anti-women and often medically and/or scientifically incorrect bills can seem overwhelming to those dedicated to fighting for reproductive justice. And while it may seem like state after state is introducing legislation that will no doubt gut reproductive services all over the country-it's important to remember to occasionally play offense. As Andrea Miller says, "your best defense is a good offense."