In spite of Roe v. Wade and eight years of a Democratic president, American women have lost an alarming number of reproductive freedoms in the last several years. There are now 20 states receiving a failing grade on reproductive rights, according to the Population Institute's current report card on reproductive rights in 2016. That's up from nine states five years earlier.
At the national level, things are not much better. The same report card, developed using reporting from organizations like the Guttmacher Institute, the Kaiser Family Foundation, and the Planned Parenthood Federation of America, gave the country as a whole a "D," slipping from the prior year's "D+" and a recent high of a "C" in 2014. Back then, liberals were riding high on the Affordable Care Act's expansions. Now, that could be the next thing to go.
That's scary, but when you break it down by state, it's even worse. You can quickly gauge just how divided the country is on this issue. A few states have a perfect A+, but far more have an F or even F-. When you're considering where to invest your engagement efforts, or even where to relocate for work, keep in mind that these 20 states are failing on reproductive rights.
1) Alabama: F-
On the report card's scoring system, Alabama gets just 33.7 out of 100. Minors don't have explicit access to contraception. The state didn't expand Medicaid. There are all sorts of anti-abortion laws, like bans after 20 weeks, mandatory ultrasounds, and a 48-hour waiting period. Some 59 percent of women in Alabama live in a county without access to an abortion provider.
2) Arkansas: F-
Technically a little better than Alabama, Arkansas received just 42.7 on its report card. The state has no mandated sex education, but minors do explicitly have access to contraception. On the upside, Medicaid was expanded, though family planning is not include in the coverage.
Limits on abortion include bans after 20 months, counseling on fetal pain, and a 48-hour waiting period. Some 78 percent of women in the state live in a county without an abortion provider.
3) Florida: F
Despite the large population centers in the state and its reputation as a swing state, Florida had a score of just 31.1. No sex education, right to emergency contraception, or explicit access for minors to contraception generally. No Medicaid expansion, either.
Florida does a bit better on access to abortions, though. An ultrasound is mandatory, and minors must receive permission. Just 22 percent of Floridian women live in a county without a provider.
4) Georgia: F
Georgia receives a grade of 38.5. The main issues are the lack of comprehensive sex education, emergency contraception, and Medicaid expansion.
As for abortion? The procedure is banned after 20 weeks, and the mother must receive counseling 24 hours before that talks about fetal pain. 58 percent of women in the state live in a county without a provider.
5) Idaho: F
Idaho is faring a bit better at 42. Minors can access contraception, but they won't be taught about it explicitly in school. There's also no emergency contraception. Medicaid was not expanded.
As for abortion, there's a 24-hour wait and parental consent is required. There are no video conference procedures, either.
6) Indiana: F-
Indiana received 44.5 on its report card. The state has HIV education, but doesn't have to mention condoms. No emergency contraception or explicitly access to contraception for minors. There is, though, the Medicaid expansion.
As for abortion access, Indiana receives a score of 0 — the worst. Abortion is prohibited after 20 weeks, counseling, including on fetal pain, is required, an ultrasound must be performed, there's an 18-hour waiting period, parental consent is required, and they must be done in person with the physician.
7) Kansas: F-
The score of Kansas is 31.7, and there is very little good news to share. There's no sex education, no emergency contraception, and minors are not explicitly allowed to access contraception generally. There was no Medicaid expansion.
And when it comes to abortion, the state also has some of the worst laws. There's a ban after 20 weeks, required counseling that (incorrectly) points to a link to breast cancer, fetal pain, and psychological effects. An ultrasound must be performed and parental consent is required. Some 74 percent of women in the state live in a county without an abortion provider.
8) Louisiana: F
The state of Louisiana edges up to a 34. The state is just as bad with prevention as Kansas, except that it does have the Medicaid expansion.
As for abortion, there's also a 20-week ban, required counseling, an ultrasound (which the doctor must describe and show), and a 24-hour ban. In the state, 63 percent of women live in a county without a provider.
9) Mississippi: F
Mississippi has an extremely low score of 22.6. The state has no prevention measures, including access to contraception and emergency contraception or sex ed. It does, however, have Medicaid-funded family planning (although no expansion).
As for abortion, there's the 20-week ban, mandatory counseling, a waiting period, and both parents must consent. Shockingly, 91 percent of women in the state live in a county without a provider.
10) Missouri: F-
The state of Missouri does surprisingly badly, receiving a score of 32.1, with no prevention services save Medicaid family planning (no expansion).
As for abortion, mandatory counseling, info on fetal pain, a 72-hour waiting period, and parental consent are all required. And 74 percent of women in the state don't have a provider in their county.
11) Nebraska: F
Nebraska has a score of 30.5. There's no preventative anything, nor insurance support.
As for abortion, there's a 20-week ban, required counseling, a 24-hour waiting period, and parental consent is needed.
12) North Dakota: F-
North Dakota gets a relatively high 43.2 among these states. It is about the same as the worst, except for one big difference: It has the Medicaid expansion.
As for abortion, it's not allowed after 20 weeks, there's a 24-hour waiting period, and parental consent is needed from both parents.
13) Oklahoma: F-
Oklahoma scored 28.4 and has one redeeming quality: HIV education with the mention of condoms. Otherwise, no prevention or insurance support.
As for abortion, there's a 20-week ban, mandatory counseling that includes information on breast cancer and fetal pain, an ultrasound, a 72-hour waiting period, and you need parental consent. Then 55 percent of the state's women live in counties without providers.
14) South Carolina: F-
South Carolina scores a relatively high 45.2, with points for sex education and emergency contraception being available on request. There is no Medicaid expansion, but those who do qualify can get family planning.
When it comes to abortion, there is a 20-week ban, a waiting period of 24 hours, and parental consent is required. Some 72 percent of women live in a county without a provider.
15) South Dakota: F
South Dakota scores even lower than its northern neighbors, with just 27.6. The state has no preventive measures or insurance support.
As for abortion, there is required counseling and a waiting period, and parental consent is required. There's no 20-week ban, though 77 percent of the state's women live in a county without a provider.
16) Tennessee: F-
Tennessee rates a 30.9 on the report card, and it gets points for giving minors access to contraception explicitly in the law. There's no insurance support.
As for abortion, there's a 48-hour waiting period, and parental consent is required.
17) Texas: F-
Texas gets a score of 36.6, which may seem high when you consider the state was the one whose anti-abortion law was overturned by the Supreme Court last year. It does have some emergency contraception access (information, anyway). It also allows private insurance to pay for abortions (unlike the others on this list). Texas also opted into Medicaid family planning, but not the Obamacare expansion.
As for abortion, as of this 2016 report card — more regulations have since been passed, including a ban on a specific second-term procedure — there was a ban after 20 weeks, intense counseling including fetal pain, psychological effects, and more. A physician must describe and show the ultrasound to the patient. Plus there's a waiting period, and parental consent is required.
18) Utah: F-
With a score of 40.7, Utah might not sound so bad by comparison. There is sex education, and it must be medically accurate (although that doesn't mean comprehensive). It also has access to emergency contraceptives.
Abortion restrictions are difficult, but less stringent than in some of the other states on the list. There's no 20-week ban, but intensive counseling is required, there's a 72-hour waiting period, and parental consent and notice are mandatory. And 62 percent of women in the state live in a county without a provider.
19) Virginia: F-
Virginia gets a 36.8 on the report card, gaining points for explicitly giving minors access to contraception and offering family planning through Medicaid (although there's no Obamacare expansion).
With regards to abortion, the ultrasound is required, there's a 24-hour waiting period, and parental consent is needed. Some 78 percent of women in Virginia live in a county without a provider.
20) Wisconsin: F-
Wisconsin scored a 40.6. It does have emergency contraception access, and the Medicaid covers family planning. But that's it.
With abortion, there's a 24-hour waiting period, an ultrasound must be shown and described, and parental consent is required.
The scariest part of this list? Several of these states have joined it for the first time in the latest version. Just five years ago, only nine states rated an "F."