The entryway to a New Hampshire center operated by Planned Parenthood of Northern New England. Courtesy photo
By Kylie Valluzzi-Granite State News Collaborative
In New Hampshire, the fight over access to reproductive health care, particularly abortion, isn’t just a state or federal issue. Local officials, such as city councils and select boards, zoning boards and county prosecutors can profoundly affect reproductive rights through the policies they enact and enforce.
One key area is zoning regulations, which dictate where medical facilities, including abortion clinics, can operate.
While New Hampshire has not seen the same aggressive use of zoning laws to restrict abortion clinics as some other states, local governments do have the power to control where clinics can be located.
For instance, a town or city might implement restrictive zoning rules that prevent abortion clinics from operating near schools, residential neighborhoods or in specific business districts. By making it harder for clinics to open or stay in business, local regulations can restrict access to abortion services, even in a state where the procedure is legal.
Cassie O’Keefe, patient and public engagement coordinator at Equality Health Center, a reproductive health center in Concord, emphasized the importance of local clinics in this landscape.
“Equality Health Center has provided comprehensive reproductive health care since opening in 1974,” she said. “Our services include abortion care, contraception and family planning, miscarriage management, STI testing and treatment, as well as gender-affirming care and behavioral health services. We believe that health care is a human right.”
The officials responsible for local controls, who typically sit on a planning board or zoning board of adjustment, are elected or appointed locally. Therefore, local officials' views on reproductive rights can directly affect access to health care in their communities.
If a majority of a town’s zoning board is anti-abortion, the board could approve zoning restrictions that make it difficult for clinics to find locations to operate. Conversely, local officials who support reproductive rights might push back against attempts to restrict where clinics can operate, ensuring that access to services remains available.
But the power of local governments over reproductive rights extends beyond zoning. The prosecutors in New Hampshire’s 10 counties also have discretion when it comes to enforcing state-level abortion laws.
New Hampshire’s 24-week abortion ban, passed in 2021, carries potential criminal penalties for doctors who perform abortions after that point. How strictly this law is enforced can depend on a county prosecutor, who decides whether to bring charges against health care providers.
Beyond regulation, clinics also face challenges stemming from funding cuts.
“For the past two years, the five-member New Hampshire Executive Council has voted 4-1 to cut family planning contracts that previously had helped support nonprofit organizations like ours in providing a wide range of services and educational outreach to lower-income folks, including STI prevention, well care, contraception and family planning support,” O’Keefe said.
Those cuts have imposed additional barriers for patients, especially in rural areas where options were already limited. Equality Health Center has responded by adopting a sliding fee scale and providing practical support, such as assistance with transportation, to help patients obtain care.
Local decisions like those can significantly influence the availability of reproductive health care, even as federal and state-level laws dominate the headlines. National debates over abortion laws, such as the overturning of Roe v. Wade in 2022, provide the legal framework, but it’s often local governments that determine the practical realities of access.
For voters in New Hampshire, that means elections for local officials are just as important as state or national races when it comes to reproductive rights. Decisions made by these local officials can shape the landscape of reproductive health care in their communities, sometimes in ways that aren’t immediately visible.
Along with voting, O’Keefe emphasized the need for continued advocacy.
“In New Hampshire, urgent needs regarding the protection of reproductive rights center on access and advocacy,” she said. “It is essential to ensure that abortion services remain accessible.”
These articles are being shared by partners in theGranite State News Collaborativeand the Know Your Vote youth voter guide. The Know Your Vote youth voter guide project was designed, reported and produced by student and young professional journalists from The Clock,The Concord Monitor, The Equinox, Granite State News Collaborative, Keene State College, The Laconia Daily Sun, The Monadnock Ledger-Transcript, Nashua Ink Link and The Presidency and the Press program at Franklin Pierce University. You can see the full guide at www.collaborativenh.org/know-your-vote