that provides low-income and uninsured individuals in the U.S. with access to ... informed public debate, the Population
C-
October 2012
The State of Reproductive Health and RIghts: 50-State Report Card
The Precarious State of Reproductive Health and Rights Forty-three years ago, the Population Institute played a critical role in expanding family planning services for those in need, including the enactment of Title X, the federal program that provides low-income and uninsured individuals in the U.S. with access to birth control and other preventive healthcare services. Thanks to Title X and expanded Medicaid coverage, tens of millions of women with limited financial means have been able to limit or space their pregnancies using modern methods of contraception. The benefits in terms of maternal and child health have been extraordinary. Since the passage of Title X in 1970, several other advances have occurred. Comprehensive sex education programs have helped to lower America’s teenage pregnancy rate. U.S. Supreme Court rulings have given women the right to choose a legal abortion, drastically reducing the number of unsafe abortions. Nearly 30 states have chosen to expand their Medicaid eligibility rules for family planning services, making birth control far more accessible to millions of low-income women. Emergency contraception has been approved by the FDA , and several states have required private healthcare insurers that cover prescription drugs to include coverage of prescription contraceptives and devices. Today, however, four decades after President Nixon signed Title X, all these advances are under political assault. While Congress has rejected efforts by social conservatives to defund Title X, several states have slashed their funding for family planning clinics, and, rejecting the overwhelming weight of research findings, many states are promoting abstinence education in lieu of proven comprehensive sex education curricula. Many states are adopting abortion curbs and other restrictions that are forcing the closure of family planning clinics. Several states are debating “personhood’ amendments to their constitutions that would potentially criminalize all abortions and restrict access to several forms of hormonal birth control.
THE UNITED STATES GETS A “C-” The United States as a whole has been given a grade of C-. Here’s why: n
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America’s rate of unintended pregnancy remains stubbornly high: almost half of all pregnancies in the U.S. are unintended. Since 1991, America’s teenage pregnancy rate has fallen by 40 percent, but it is still higher than the vast majority of OECD countries including: Japan, Slovenia, Germany, Czech Republic, France, Estonia, and the United Kingdom. Among OECD countries only the U.S. has a teen pregnancy rate higher than Chile and Mexico. Many of the gains that have been made in reproductive health could be reversed if social conservatives prevail in Congress and the state legislatures. Family planning clinics are being threatened by funding cuts and burdensome laws and regulations.
Grading Reproductive Health and Rights While most Americans are aware of the national political debate over birth control and abortion, many are uninformed about the status of reproductive health and rights in their own state. In the interest of an informed public debate, the Population Institute is releasing a report card that gives an overview of what’s happening in the 50 States and the District of Columbia.
THE 50-STATE REPORT CARD Focus: The 50-state report card focuses on four broad indicators or policies relating to reproductive health and rights: Effectiveness (30 points): Statewide, what percentage of pregnancies are unintended, and how high is the state’s teenage pregnancy rate? Affordability (30 points): Does the state have policies designed to make birth control affordable to uninsured and low-income individuals? Prevention (20 points): Does the state promote comprehensive sex education in the schools, and does it support access to emergency contraception? Access (20 points): Does the state impose harassing or burdensome requirements on those seeking family planning or abortion services?
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cCriteria and Scores: Nine criteria are used in determining a state’s composite score. States with the best grades will have: 1. A low rate of teenage pregnancy (15 points maximum)
2. A low rate of unintended pregnancy (15 points maximum)
3. A Medicaid “waiver” expanding eligibility for family planning services (10 points maximum) 4. Comprehensive sex education in the schools (10 points maximum)
5. Funding for family planning clinic serving low-income households (10 points maximum) 6. An absence of burdensome abortion restrictions (10 points maximum) 7. Access to emergency contraception (10 points maximum)
8. Laws promoting insurance coverage of prescription birth control products (10 points maximum)
9. Clinic access legislation designed to prevent the harassment of women seeking family planning or reproductive health services (10 points maximum) Core Grade: Each state is assigned a “core” grade based upon the following grading system:
A: 75-100 points
B: 60-74.9 points
C: 50-59.9 points
D: 40-49.9 points
F: < than 40 points
Final Grade: If there are noteworthy developments that are not reflected in the state’s “core” grade, a state may be accorded a plus (+) or a minus (-), depending upon whether it is likely to improve reproductive health and rights. State
Total Scores
Letter Grades
State
Total Scores
Letter Grades
State
Total Scores
Letter Grades
AL
42.7
D
KY
43.9
D
ND
38.7
F
AK
46.9
D
LA
30.5
F
OH
42.6
D
AZ
34.1
F
ME
70.0
B
OK
53.7
C-
AR
45.7
D
MD
71.4
B
OR
79.3
A
CA
75.9
A
MA
58.0
C
PA
43.3
D
CO
65.1
B
MI
50.9
C-
RI
57
C
CT
48.6
D
MN
54.0
C
SC
54.2
C
DE
50.5
C
MS
27.3
F-
SD
32.0
F
DC
44.9
D
MO
41.9
D-
TN
33.2
F
FL
37.4
F
MT
60.9
B
TX
44.7
D-
GA
45.3
D
NE
33.3
F
UT
41.0
D
HI
47.9
D
NV
39.5
F
VT
65.0
B
ID
41.0
D
NH
58.0
C-
VA
46.3
D
IL
58.9
C
NJ
59
C
WA
88.3
A+
IN
41.6
D
NM
63.4
B
WV
51.0
C
IA
57.0
C
NY
71.4
B
WI
74.7
B-
KS
42.6
D-
NC
66.7
B-
WY
42.2
D
Final Grade OVERVIEW
GRADES ■ A+ to A ■ B to B■ C to C■ D to D■ F to F-
STATE BREAKDOWNS: For state press releases and state-by-state breakdowns of the scoring, more information can be obtained at www.populationinstitute.org/reportcard. FOR MORE INFORMATION: n n
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About teenage pregnancy in the U.S., see http://www.guttmacher.org/pubs/USTPtrends.pdf About the rate of unintended pregnancies in the U.S, see http://www.guttmacher.org/pubs/ journals/4307811.html About state abortion restrictions, see http://www.guttmacher.org/statecenter/spibs/spib_OAL.pdf About state Medicaid family planning waivers, see http://www.guttmacher.org/statecenter/spibs/ spib_SMFPE.pdf About sex education requirements at the state level, see www.siecus
ACKNOWLEDGEMENTS: The Population Institute owes a debt of gratitude to two Stanback Interns from Duke University for their many contributions to this report: Joy Tsai and Lucy Dicks-Mireaux. We also wish to express our deep appreciation to the Guttmacher Institute, the Sexuality Information and Education Council of the United States (SIECUS), Planned Parenthood Federation of America, and other organizations working in this field for the research and reporting that made this report card possible.
107 2nd St, NE, Washington, DC 20002 I Phone: 202-544-3300 I www. populationinstitute.org
