The Slippery Slope:
Reproductive Health and Rights in the U.S.
The reproductive health and rights of women in the U.S. are on a slippery slope. For five years now the Population Institute has been releasing an annual 50-State Report Card on Reproductive Health and Rights, and during that period the grades have been drifting lower and lower. Our report card on 2016 — released this week — reveals that the slide is continuing. The United States, as a whole, slipped from a ‘D+’ to a ‘D’, and 20 states received a failing grade, up from 19 the year before. And, looking ahead, 2017 could turn out to be the worst year for reproductive health and rights in over a generation.
In this year’s report card, only twenty-one states received a B- or higher. Twenty states received a failing grade (“F”), including Alabama, Arkansas, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Mississippi, Missouri, Nebraska, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, and Wisconsin. Just five states (California, New Jersey, New Mexico, Oregon and Washington) received an “A”.
Our 2016 report card reveals a growing national divide on reproductive health and rights. While a woman’s reproductive health should not depend on where she lives, it often does. Women in many states are experiencing reduced access to reproductive health care services, including abortion. Nineteen 19 states have refused to expand Medicaid under the Affordable Care Act (ACA), leaving tens of millions of women without the improved access to contraception services made possible by the ACA. The state-level attacks on Planned Parenthood are also taking a toll. In 27 states today more than 50 percent of women live in a county without an abortion provider, and because family planning clinics in many states are being forced to close, an increasing number of women face barriers in accessing family planning services.
At the federal level, Congressional opponents of family planning and abortion rights were largely unsuccessful in 2016. Emergency funding for the Zika crisis, however, was held up for months, when the House Appropriations Committee attempted, unsuccessfully, to prevent Planned Parenthood from getting any of the funding. Last year, House appropriators tried again — and failed again — to slash funding for comprehensive sex education and eliminate Title X, which provides financial support to family planning clinics serving low-income women.
Our report card offers an eye-opening view of what is happening with respect to reproductive health in each of the 50 states and the District of Columbia. Thirty percent of the grade is based on measures of effectiveness, including the latest available data on the teenage pregnancy rate and the rate of unintended pregnancies. Twenty-five percent of the grade is based upon preventive measures, including comprehensive sex education in the schools and laws giving minors access to contraceptive services. Another quarter of the grade looks at the affordability of contraceptive services, including coverage under the ACA. The final 20 percent of the grade looks at state laws governing access to abortion services. 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.
As bad as things were last year, 2017 could be much worse. Congress and the new Administration are expected to curtail access to contraceptive services by blocking all funding for Planned Parenthood and possibly eliminating Title X, a program that has been providing support for family planning clinics for nearly half a century. The Trump Administration will likely repeal the ACA’s no-cost birth control mandate. And while the Supreme Court is not expected to repeal Roe v. Wade anytime soon, the next appointment to the U.S. Supreme Court could move the Court one step closer to repealing a ruling that has stood for nearly 44 years.
Comprehensive sex education in our schools could also be on the Congressional chopping block, as Congressional opponents seek to replace programs that have been proven effective in reducing teen age pregnancy with ineffective “abstinence-only” programs.
Reproductive health and rights in America, already on a slippery slope, could be in free fall by the end of the year. And that will translate into more unplanned pregnancies, more abortions, and higher rates of teenage pregnancy. The situation is not hopeless, but reproductive health advocates need to be better informed about the threats that are arising at the state and federal levels.
Looking back, the news has not been all bad. The Affordable Care Act — thanks, in part, to the “contraceptive mandate” — has reduced the cost of contraceptives for women, and the U.S. Supreme Court last year struck down, as unconstitutional, the arbitrary restrictions that Texas imposed on abortion clinics. We have also seen notable progress in reducing teenage pregnancy rates, but, despite these advances, the overall state of reproductive health and rights in this country is in decline.
The gains that have been made in reproductive health and rights over the past several decades are slipping away. They should not be taken for granted.