WASHINGTON -- As many states debate and pass new restrictions on abortion, often against increasing resistance, a small number of others are considering moves in the opposite direction, weighing legislation that would increase access to and coverage of abortions.
A California bill awaiting its first hearing this week in the state's House would allow licensed nurse practitioners, physician assistants and nurse midwives to perform aspiration abortions on women in their first trimester. Four other states currently have similar regulations.
California State Sen. Christine Kehoe (D-San Diego), who introduced the bill, said she was worried by the current tenor of the national conversation on abortion. "I think it's a step backward. I think it's targeting women and women's healthcare as something that is bad, when in actuality we need more and better health care, not less," she said. "We would like to see that negative conversation turn around and emphasize women's health and safe early access to reproductive services."
She said the tone of the discussion in her state has been markedly different.
"When we see other states rolling back access to reproductive health, the bills that we've seen in Virginia and other states requiring ultrasounds and lectures from the doctor to the woman -- those are not policies I support, nor do I think the majority of the California legislature supports those kinds of policies," Kehoe said.
The opinions of state legislatures increasingly determine the degree of a woman's access to abortion, said Elizabeth Nash, who manages state issues for the Guttmacher Institute, a nonprofit that monitors and supports abortion rights.
"A state may have anywhere from zero to one or two laws around restricting access, all the way up to a dozen or more," said Nash. "Your access to reproductive healthcare depends greatly on where you live."
Such differences aren't lost on Josh Brahm, the director of education at Right to Life of Central California, who moved to the state from Georgia.
"Georgia is definitely a more conservative state politically, which means they have the opportunity to pass a lot of pro-life bills that wouldn't have a shot in California," Brahm said in an email.
California voters have a history of opposing measures to restrict abortion. While 37 other states require parental notification or consent for minors to have abortions, Californians have rejected such notification measures three times in seven years. A fourth proposal is likely to make the 2012 ballot.
"If we continue to fail to pass a bill like that, I'm not convinced pro-life groups should continue spending money on legislative efforts in California, at least for the time being," Brahm said.
He added, "I think the short term goal in California, and perhaps every other state, should be to engage pro-choice people on the idea level."
Several other state legislatures, primarily Democratic-leaning ones, have contingents making efforts to secure abortion rights, among them the pro-choice advocates in New York who are pushing a measure that would effectively codify Roe v. Wade in state law.
Meanwhile, Democratic lawmakers in Washington state also sought to expand access to abortion this year, proposing a bill that would have made the state the first in the nation to require that all insurance plans include abortion coverage unless they claimed a conscience exemption.
The bill passed the state House but died in the state Senate during a procedural fight over the state's budget. Supporters said they believe they would have had the votes to pass the measure, and they expect to reintroduce it in 2013.
Washington State Rep. Laurie Jinkins (D-Tacoma), a sponsor of the bill, said the trend toward increasing restrictions elsewhere in the country had energized abortion rights supporters in her state.
"It's started to make people, and women in particular, realize how important it is that we push on reproductive health issues," Jinkins said. "Every time folks think, 'We have legal protections, everything's fine, we're going to be fine,' then this kind of stuff happens across the nation and people start to see how quickly you can lose those protections."
Jinkins said that uncertainty at the national level reinforced the need for states to take action.
"There's a huge attack on women's reproductive health," she said. "Everything from our access to simple birth control to the right to choose to have an abortion if that's what you decide to do ... It does make it more clear why in states like Washington, where we've had a 40-year history of protecting women's rights, why we need to make sure that we keep on doing it."
Efforts like those in California and Washington are still unusual, said Nash.
"We haven't seen much action around those proactive issues, around family planning, for the past couple years precisely because there has been a lot of defensive work that has had to be done at the state level," she said. But she said that public outcry this year could mark a step toward change.
"Certainly this year we have seen push-back in ways we were not seeing in 2011 or 2010," she said.