Anti-abortion, left, and abortion rights advocates face off this month outside the U.S. Supreme Court.

Story highlights

Nearly 250 anti-abortion measures are pending in state legislative sessions

Abortion rights lawmakers not keeping pace with those pushing Roe v. Wade's reversal

A new playbook, offering model legislation on abortion rights side, aims to change equation

CNN  — 

It’s no secret that states have railed against abortion access in the years since 1973, when Roe v. Wade legalized the procedure in America. Nearly 900 bills restricting abortions have passed in the past 20 years alone, according to the nation’s oldest abortion rights group.

Last year, states enacted dozens of new laws, including one in Texas that forced clinic closures across the state. A case challenging that law is now in the hands of the U.S. Supreme Court.

What’s less known, though, is a similar state-by-state effort by abortion rights advocates to strengthen access to abortion services and birth control.

Partly that’s a result of the numbers: Judged strictly by the volume of bills introduced in state legislatures, the abortion rights movement simply hasn’t kept pace with efforts to chip away at Roe v. Wade.

In this current legislative session, nearly 250 anti-abortion measures are in the mix in more than three dozen states – twice the number of pending abortion rights bills, according to the Public Leadership Institute, a nonprofit that supports abortion rights.

Counting only those reproductive rights bills that deal directly with abortion – as opposed to contraception, for example – there are about four times as many anti-abortion measures.

Some would ban abortions after the first trimester, while others seek to get rid of them altogether. One measure would remove the buffer zones between protesters and patients outside clinics. There are bills to prohibit charitable donations to abortion providers, and others that require the distribution of medically disputed information.

In 2015 alone, 41 anti-abortion measures were enacted in 22 states, according to NARAL Pro-Choice America. Seven of those measures passed in a single state: Arkansas.

A new playbook

Part of what has driven the proliferation of anti-abortion legislation is a playbook put out by Americans United for Life. “Defending Life,” first published in 2006, includes model legislation that state lawmakers cut, paste and use.

This tactic has resulted in legislation requiring delays and state-mandated counseling. Bans on funding and referrals. Regulations that prompt clinic closures – and result in “abortion deserts” in places such as Texas.

To answer this push, the Public Leadership Institute recently released its own compilation of prototype bills: “A Playbook for Abortion Rights,” a guide for policymakers on state and local levels.

Aimee Arrambide is a co-editor of this resource. A lawyer by training, the Austin, Texas- based mother of two is a reproductive rights policy specialist and a self-professed policy wonk.

She shares this playbook with pride; it was a labor of love that she and her colleagues saw as long overdue.

“They’re out-introducing our side, which is why we created the playbook,” she says. “We wanted to make it easier for legislators to introduce these bills.”

These bills include measures to protect and expand access to abortions, to provide full access to birth control and to guarantee medically accurate health care information – thereby, for example, barring crisis pregnancy centers, many of which are funded by states, from deceiving women.

The centers, called CPCs, have been known to mislead women into believing they offer abortion services and unbiased counseling, when in fact they are often Christian ministries on a mission to prevent abortions, abortion rights activists say. There are more than 4,000 CPCs in the United States, according to NARAL. They outnumber abortion clinics by thousands.

Especially close to Arrambide’s heart are bills to stop anti-abortion harassment. Her late father was an abortion provider in South Texas, and she keeps his old Kevlar vest on her shelf to remind her why she does this work.

Legislation such as the Prevent Anti-Abortion Terrorism Act would, among other things, ensure a safe distance between protesters and those entering clinics, guarantee the confidentiality of home addresses of abortion providers and clinic employees and treat crimes against clinics, workers and patients as hate crimes.

Included with each piece of model legislation are background summaries, including statistics and research findings, to make the process of introducing and advocating for these bills as simple as possible.

So far, she says, hundreds of legislators have received the playbook, and their staffers are asking for more. For those with limited time to strategize and do their own research, Arrambide hopes this tool will fill a void, provide a balance when it comes to the flood of bills being introduced across the country and help change the national conversation.

Michigan state Sen. Rebekah Warren, a Democrat, helped research, fact-check and compile legislation for the new publication. Having once run the Michigan affiliate for NARAL for seven years, Warren found being a part of this endeavor a natural progression.

She had watched while Michigan became an incubator for anti-abortion efforts in the mid-’90s as Republicans with deep pockets funded pet policies such as procedure bans and mandatory waiting periods. When she was first elected to the state House of Representatives in 2006, she was a member of the majority and able to beat back some of what had happened. But by 2010, when the tide shifted, she became part of the minority in the state Senate.

She talks about how Michigan lawmakers barred insurance companies from covering abortion care without requiring an additional rider – meaning that women would have to buy extra insurance. She explains how only eight of Michigan’s 42 insurance providers offer such a policy, and no provider on the Michigan health insurance exchange does.

She recalls the testimonies of women who paid the price for not having abortion insurance. They’d desperately wanted babies and never imagined having abortions. But because of serious health complications, including dangerous ectopic pregnancies, they had to terminate their pregnancies. Without insurance coverage, they were slapped with hospital-stay bills exceeding $10,000.

“Right now our bodies and our health have become a political football” tossed around by mostly male politicians, Warren says. “We have to stand up and say we’re not going to do this anymore.”

Asked about abortion activists’ push for legislation, abortion foes were unmoved. Kristi Hamrick, a spokeswoman for Americans United for Life, says the abortion industry tries to duck its responsibility to protect women “by hiding behind their new favorite buzzword – ‘access.’ ”

Abortion pill can be used later in pregnancy, FDA says

How did we get here?

The 2010 election changed the equation, according to Donna Crane, who heads up policy at NARAL’s national office. She says her organization’s ability to maintain traction in many states came to a “screeching halt” as governors’ mansions and state legislatures flipped and turned red.

Candidates who ran on the economy with promises to create jobs won election while holding their stance on reproductive rights close to their conservative vests, she says. Once they got in, they targeted reproductive rights.

It was a “bait-and-switch” strategy, she says, that left many women stunned – and paying the price.

A January NARAL report, “Who Decides? The Status of Women’s Reproductive Rights in the United States,” examined state trends – and doled out grades. Twenty-seven states – including Ohio, Wisconsin, Texas and Pennsylvania – earned an F.

Nationally, the country didn’t fare much better: The United States got a D when it came to reproductive rights. But there are some states that earned gold stars, none more than California.

Between enshrining the right to choose in the state constitution, ensuring abortion and contraception insurance coverage and barring crisis pregnancy centers from deceptive practices, California was the only state to earn an A+ grade

In direct response to the surge of anti-abortion measures that started in 2010, U.S. Sen. Richard Blumenthal, a Connecticut Democrat, introduced the Women’s Health Protection Act in 2013. The fight to pass such legislation, at a time when so many lawmakers want to go in the opposite direction, is a daunting battle – but it’s one he and other supporters plan to keep waging.

“The protections in this measure are more necessary now than ever before in our history because an avalanche of restrictive, reprehensible state laws is drastically reducing fundamental health care rights,” Blumenthal said in a written statement when he reintroduced the bill last year.

“The Women’s Health Protection Act seeks to strip away the deceptive pretext of safeguarding women’s health when the goal of such state laws is actually to sabotage fundamental constitutional rights, and increasingly they are achieving that goal.”

On the state level, abortion rights bills currently on the table have run the gamut. A bill in New York seeks to include abortion training in medical residencies. Another in Arizona demands that crisis pregnancy centers share scientifically accurate information and requires the posting of a notice in both English and Spanish that states, “This center is not a licensed medical facility.” Legislation in Michigan, Missouri and New York seeks to protect employees from discrimination in the workplace based on reproductive health choices.

The list goes on: A New Jersey bill would require pharmacies to stock and dispense emergency contraception. Others in Alaska, Hawaii, Illinois and more than half a dozen other states seek to allow pharmacists to prescribe contraception. Still others highlight what they say is the hypocrisy between how women and men are treated when it comes to legislating their health and bodies.

One bill introduced in Kentucky requires health care practitioners to have two office visits with a patient before prescribing erectile dysfunction drugs and asks that a man swear that he will only use the prescription when having sexual relations with his current spouse. A measure in Tennessee seeks to exclude erectile dysfunction drugs from coverage in state employee insurance plans. And a lengthy bill out of Iowa requires patients taking erectile dysfunction medications to undergo cardiac stress tests every 90 days to ensure they’re cleared for sexual activity.

These “Viagra bills,” as they’re sometimes dubbed, represent just one strategy in an arena where women remain outnumbered: 75.5% of state lawmakers voting on women’s reproductive health care matters are men.