As the Lieutenant Governor of Alabama and thus presiding officer of the Alabama Senate, Ainsworth has advocated for numerous conservative legislative actions, including Alabama's 2019 abortion bill (HB-314). When an exemption for rape and incest was struck from the bill, Democratic state senators accused Ainsworth of gaveling the removal too quickly. Ainsworth defended his position afterwards and called abortion murder, emphasizing his desire for the state legislature to pass abortion restrictions. Ainsworth has also promoted a ban on critical race theory and supported school choice, as well as constitutional carry.
