Reproductive Health: The Battle Resumes

Based upon their scores, each state received a "core" grade (A, B, C, D or F), but some states received an additional "plus" or a "minus" for factors not reflected in the core grade, such as pending regulations or legislation. Only 17 states received a B- or higher.
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With the convening of the new Congress, the fight over reproductive health and rights has been renewed, and members of the new Congress are not wasting any time in drawing the battle lines. Reps. Trent Franks (R-Ariz.) and Marsha Blackburn (R-Tenn.) reintroduced legislation this week to stop women from terminating pregnancies after 20 weeks.

The proposed abortion ban is part of a much larger, ongoing struggle over reproductive health and rights in America. This week the Population Institute released its third annual 50 state report card on reproductive health and rights in the U.S., and the results were mixed. The U.S. as a whole received a "C" for 2014, a slight improvement over last year's grade ("C-"), but 15 states received a failing grade, and several states recorded a lower score or grade in 2014.

Nationally, we saw some notable improvements in reproductive health last year. The reported teenage pregnancy rate, while still high, continued to decline, and thanks to the Affordable Care Act, more women were insured and able to access contraceptive services without a required co-pay. Those advances are largely responsible for the slight improvement that we see in the national grade for 2014. At the state level, however, there were some major setbacks for reproductive health and rights. Several states enacted arbitrary abortion restrictions that will likely lead to the closure of more family planning clinics, making contraceptive services more difficult to access. Other states approved further cutbacks in funding for family planning clinics, and just as importantly 23 states still reject the expansion of Medicaid coverage called for by the Affordable Care Act, effectively denying millions of women improved access to contraceptive services.

Unfortunately, next year's report card could look a whole lot worse. If the U.S. Supreme Court overturns key sections of the Affordable Care Act or Congress repeals it altogether, millions of women could be forced to pay a lot more for their contraceptive coverage. And if Congress slashes or eliminates funding for Title X, the federal program that provides family planning services to low-income households, millions of women could suffer a loss of contraceptive services.

We are also likely to see more setbacks at the state level. If more states cut funding for family planning clinics or more states impose arbitrary restrictions on birth control clinics providing abortion services, more clinics will close and more women will have to travel long distances to get access to family planning services. The threat of clinic closures today is very real. The political attacks on Planned Parenthood are taking a toll and, contrary to the stated intention of the attackers, the practical effect will be more abortions, not fewer.

Using nine criteria, the Institute's report card ranked each of the 50 states and the District of Columbia. Thirty percent of the grade is based on measures of effectiveness. This includes the latest available data on the teenage pregnancy rate (15% of the score) and the rate of unintended pregnancies (15%). Twenty percent of the grade is based upon prevention. This includes mandated comprehensive sex education in the schools (15%) and access to emergency contraception (5%).

Thirty percent of the grade is based upon affordability. This includes whether states are expanding Medicaid under the Affordable Care Act (10%), Medicaid eligibility rules for family planning (10%), and funding for family planning clinics serving low-income families (10%). The final 20 percent of the grade is based upon clinic access. This includes abortion restrictions (10%) and percent of women living in a county without an abortion provider (10%).

Based upon their scores, each state received a "core" grade (A, B, C, D or F), but some states received an additional "plus" or a "minus" for factors not reflected in the core grade, such as pending regulations or legislation.

Only 17 states received a B- or higher. Just four states (California, New Mexico, Oregon and Washington) received an "A". Fifteen states received a failing grade ("F"). States receiving a failing grade included Alabama, Idaho, Indiana, Kansas, Louisiana, Mississippi, Missouri, Nebraska, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Virginia, and Wyoming.

Last year could have been a great victory for women's reproductive health with tumbling teen pregnancy rates and increased access to reproductive health care for women under the Affordable Care Act. Unfortunately, setbacks at the state level negated some of the gains.

The reported teen pregnancy rate continued its historic drop, a 51% decline since its 1990 peak and a 15% drop between 2008 and 2010. But despite the drop, America's teenage pregnancy rate is still higher than other industrialized nations and nearly half of all pregnancies in the U.S. are unintended. To change this we must ensure that all women, including young women, have access to affordable reproductive health services and that young people receive comprehensive sex education in the schools.

America, however, could be headed in the wrong direction. With the makeup of the new U.S. Congress, the cases pending before the Supreme Court, and more setbacks anticipated at the state level, the outlook for 2015 is not positive. While the teen pregnancy rate will hopefully continue its historic fall, millions of women could experience reduced access to contraceptive services in the next year. We should not let that happen.

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