01/09/2014 10:19 am ET Updated Mar 11, 2014

The Still Uncertain State of Reproductive Health in America

In a few weeks the president of the United States will be giving a report on the state of the union, but it is not too early to take a look at the state of reproductive health in this country. This week the Population Institute released its second annual report card on reproductive health and rights in the US, and the results were not encouraging. Thirteen states received a failing grade, and the US as a whole received a "C-" for the second year in a row.

America is at the crossroads with respect to reproductive health and rights. At the federal level we continue to see improvement. Within the past year the Department of Health and Human Services (HHS) ruled that Plan B One Step should be made available over-the-counter without an age restriction, and, thanks to the Affordable Care Act (ACA), women are now able to access family planning services without a co-pay requirement. In addition, expanded Medicaid eligibility is ensuring that millions of more women will be able to access reproductive health services.

At the state level, however, reproductive health and rights remain under vigorous assault. While the ACA paved the way for Medicaid expansion, 25 states have refused to expand their Medicaid eligibility, denying millions of women improved access to health care, including reproductive health services. In addition, several states have restricted funding for Planned Parenthood and other family planning providers, while also enacting abortion restrictions that will further serve to limit women's access to family planning clinics.

Legal challenges are also clouding the picture of reproductive health and rights in the United States. As a result of pending cases, the US Supreme Court this year will hear a challenge to the HHS ruling that insurance companies, under the ACA, must provide coverage of contraceptive services when religiously affiliated hospitals and schools refuse to provide such coverage for their employees.

This year's report card on reproductive health and rights ranked each of the 50 states and the District of Columbia using nine criteria:

• Thirty percent of the grade is based on measures of effectiveness. This includes the latest available data on the teenage pregnancy rate (15 percent) and the rate of unintended pregnancies (15 percent).
• Twenty percent of the grade is based upon prevention. This includes mandated comprehensive sex education in the schools (15 percent) and access to emergency contraception (5 percent).
• Thirty percent of the grade is based upon affordability. This includes if states are expanding Medicaid under the Affordable Care Act (10 percent), Medicaid eligibility rules for family planning (10 percent), and funding for family planning clinics serving low-income families (10 percent).
• The final 20 percent of the grade is based upon clinic access. This includes abortion restrictions (10 percent) and percent of women living in a county without an abortion provider (10 percent).

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 changes or legislation.

Only 17 states received a B- or higher. Just four states (California, Maryland, Oregon and Washington) received an "A." Oregon received the highest composite score. Thirteen states received a failing grade ("F"). States receiving a failing grade included Georgia, Idaho, Indiana, Kansas, Louisiana, Mississippi, Missouri, Nebraska, South Dakota, Tennessee, Texas, Utah, and Wyoming.

The ACA was designed to produce a nationwide improvement in access to reproductive health care services, but the failure of 25 states to expand their Medicaid eligibility has severely undermined the potential progress. With so much happening and so much at stake, it is imperative that people who care about reproductive health and rights keep apprised of what is happening in their state.

All of the hard-earned gains that have been made with respect to reproductive health and rights over the past half-century, along with the advances that were made with the passage of the ACA, are not to be taken for granted. As aptly demonstrated by what is happening in half of the 50 states, this is no time for complacency. America remains at the crossroads.

Rates of teenage and unintended pregnancy in the United States remain unacceptably high. Indeed, despite continuing declines in adolescent pregnancies, the rate of teenage pregnancy in this country is still the highest among industrialized nations, and nearly half of all pregnancies in the United States remain unintended. When it comes to reproductive health and rights, America is still not making the grade.