Democratic gains in the 2018 midterms have produced a range of pro-choice bills across the United States that would repeal abortion restrictions and open up abortion access.

As pro-choice legislators in states like New York fight to protect Roe v. Wade, lawmakers across the United States are joining the fray by filing pro-choice bills as reproductive health advocates are suing to remove discriminatory laws.

From bills to decriminalize abortion access in Nevada to states fighting back against the Trump administration’s rollback of the birth control benefit, legislators are pushing to protect access to reproductive health in 2019 while an anti-choice administration and Supreme Court threaten to curtail it.

It seems as if the pro-choice laws passed in California and New York are saying to legislators in more conservative states that change is possible after years of Republican-backed laws eroding access to abortion and contraception, Elizabeth Nash, senior state issues manager at Guttmacher Institute, told Rewire.News.

“We have really started to see legislators in hostile states trying to change the conversation and push back, eventually saying enough is enough,” she said. “These bills mean that people are looking at all the ways to expand reproductive access.”

Nearly half the country, 21 states, is considered “hostile” or “very hostile” to abortion policy, a marked change from 2010, when ten states were hostile and none were deemed as very hostile, according to Guttmacher’s latest analysis. A lot of this activity is in response to the composition of the U.S. Supreme Court, Nash said.

However, there is a pro-choice majority in the U.S. House of Representatives for the first time in nearly a decade, and a record number of women and pro-choice legislators nationwide after the midterms, signaling a new era.

Safeguarding Roe protections in the states 

States celebrated the anniversary of the landmark 1973 Roe v. Wade decision last month, and New York, where Democrats control both chambers of the legislature for the first time in a decade, passed the Reproductive Health Act after a lengthy fight to enshrine those protections statewide.

New Mexico and Nevada could be next to ax pre-Roe abortion bans with pro-choice bills. Lawmakers in Rhode Island, which has a new pro-choice majority, held hearings last week in the continued effort to pass similar Roe protections that anti-choice Democrats there have repeatedly blocked.

The “Trust Nevada Women Act” seeks to repeal criminal penalties for abortions performed outside the scope of Nevada’s abortion statute, including self-induced abortions, which are punishable by a minimum one-year and maximum 10-year prison sentence and a fine of up to $10,000 under state law. It seeks to change the state’s abortion informed consent law, and repeal the state’s forced parental notification statute, which was ruled unconstitutional in 1991, according to the Nevada Independent.

New Mexico Democrats are trying to remove its criminal penalties for abortion. The bill passed the house on Wednesday and will be considered in the state Senate. Democratic Gov. Michelle Lujan Grisham intends to sign it.

Massachusetts repealed antiquated abortion laws last year but is looking to further bolster reproductive rights with two pro-choice bills this session: the Roe Act to remove restrictions on abortion, and a health equity act to require health insurance plans to cover all pregnancy-related care, including abortion.

Even in progressive Maine, where the right to abortion has long been protected, Gov. Janet Mills (D), who replaced the anti-choice Gov. Paul LePage, has vowed to fight national efforts to erode that right.

The U.S. Supreme Court on Thursday blocked an effort in Louisiana that advocates say would burden access to clinics that provide abortions. The measure, requiring doctors at abortion clinics to have admitting privileges at nearby hospitals, passed in 2014, but never took effect.

Lawsuits challenge ‘physicians only’ anti-choice laws 

State-level lawmakers are working to expand access by trying to repeal physician-only laws that restrict physician assistants and advanced registered nurses from providing abortion care. Ten out of 33 states are facing lawsuits to eliminate these types of laws: Idaho, Indiana, Kansas, Louisiana, Maine, Mississippi, Montana, Texas, Virginia, and Wisconsin, ThinkProgress reported.

Physician-only laws, supported primarily by GOP legislators, prevent people from getting the care they need and block qualified advanced practice clinicians from providing care, especially in low-income areas and medically underserved areas.

People in the largely rural Idaho, for example, already face significant barriers to accessing sexual and reproductive health care services. In 2014, about 95 percent of Idaho counties had no abortion care provider. Requiring physician-only abortion serves to further reduce access without medical justification, advocates say.

Pro-choice advocates hit back against attacks on birth control access

Contraception is another area lawmakers are looking to expand. While the Affordable Care Act (ACA) required employers to provide contraceptive coverage without a co-pay, the Trump administration continues to fight it, stacking the Department of Health and Human Services with anti-choice activists who oppose contraception. A federal judge recently blocked Trump’s attack on the ACA’s birth control mandate.

According to Guttmacher, 29 states require insurers to cover FDA-approved prescription contraceptive drugs and devices; 14 states prohibit the cost coverage.

In Arkansas, lawmakers will weigh in on a bill that would allow women 18 and older to get birth control without a prescription from their doctor. In Michigan, the attorney general has filed a lawsuit to prevent employers from refusing contraceptive insurance coverage to workers on religious or moral grounds. In Texas, lawmakers have once again introduced “Rosie’s Law,” a bill that would expand Medicaid insurance coverage for abortion care, prevented in many states due to the discriminatory Hyde Amendment. The 1976 federal law banned the use of Medicaid insurance for abortion in all but a few narrow circumstances.

Others are fighting against logistical barriers like forced waiting periods, parental consent, targeted regulation of abortion providers (TRAP) laws, and so-called heartbeat bans—all creations of conservative think tanks and anti-choice legislation mills.

“Conservative state legislatures are the last group anyone should want determining whether they have access to abortion care, and our increasingly conservative courts come in a close second,” said Pamela Merritt, co-director of Reproaction, a direct action group working toward reproductive justice. “Regardless of the political climate, reproductive oppression impacts everyone and every community, so supporting and organizing to expand access must be a top priority. It’s exciting to see activists and organizations embrace the reality that when we take bold unapologetic action, we create a more favorable climate for abortion rights and reproductive justice.”

Despite a conservative U.S. Supreme Court threatening to overturn Roe, more lawmakers seem eager to expand reproductive rights in their home states in 2019.

The midterms have made it clear that voters “want more access to health care, not less, including access to safe, legal abortion,” Dr. Leana Wen, president of Planned Parenthood Federation of America, told Rewire.News. Yet, more than 400 restrictions have been placed on abortion over the past seven years and 16 cases are aiming to overturn Roe v. Wade.

“States will be a critical backstop, which is why reproductive health care champions in state legislatures—red and blue—are stepping up to pass legislation that expands access,” Wen said. “The success of the Reproductive Health Act in New York shows what states can do when we work together to protect women’s health and rights. From Maine to Idaho to Missouri, we’re fighting for policies that expand access to reproductive health care could change people’s lives for the better.”