General Methodology

NARAL Pro-Choice America Foundation has supporting documentation for statements of fact made in Who Decides? The Status of Women's Reproductive Rights in the United States. We do not cite all the letters, notes, emails, records of telephone interviews, and faxed information in the publication itself, but we maintain such documentation in NARAL Pro-Choice America Foundation's offices.

Access Facts: The number of abortion providers and analysis of census data was supplied by the Guttmacher Institute (2004–2005 Guttmacher Abortion Provider Survey and U.S. Census population counts as of April 1, 2005).

State Legislative Information: This report uses the term "measures enacted" to refer to statutes and resolutions adopted by the legislature. "Laws" refers to constitutional provisions, statutes, regulations, court decisions, and opinions of state attorneys general. NARAL Pro-Choice America Foundation keeps memoranda on the criteria used for this report's count of legislative measures. In addition to the types of laws that are highlighted in Who Decides?, the anti-choice counts include a variety of other anti-choice measures, including but not limited to providing "Choose Life" license plates, funding anti-choice "crisis pregnancy centers", mandating unproven "abstinence-only" programs, and granting legal status to embryos and fetuses separate from pregnant women. The pro-choice counts include but are not limited to measures designed to ameliorate antichoice laws or actions (e.g. requiring "crisis pregnancy centers" to disclose anti-choice bias); various measures designed to improve reproductive-health through research, education, or improved access; measures to support healthy childbearing; and measures to require scientific and medical accuracy in sex education. For information about bills pending in your state, please visit our Bill Tracker pages. For further information, please contact the Policy Department.

Report Card Methodology

For 12 years, Who Decides? has used a ranking system to capture the cumulative burdens each state imposes on access to reproductive-health care. The ranking system adds points for anti-choice restrictions on abortion and other aspects of reproductive-health care, and subtracts points for pro-choice laws. The ranking system penalizes most heavily the laws imposing greater burdens on women. Likewise, its demerits fall most heavily on laws that are enforced, rather than laws that courts have declared invalid. A detailed analysis of the report card methodology appears below. The nationwide grade reflects not only state restrictions on the right to choose, but also federal anti-choice measures including the Federal Abortion Ban and the Federal Refusal Clause, signed into law by President Bush in 2003 and 2004, respectively.

Abortion Ban(s) (+ up to 90 points)
Points were added based on the point in pregnancy when the ban(s) begin and the exceptions included in the ban(s). Separate points were added for ban(s) whose effective dates would be triggered if the Supreme Court overturns Roe v. Wade.

Biased Counseling & Mandatory Delays (+ up to 25 points)
Points were added based on the length of the waiting period; whether multiple trips are required; whether a physician is required personally to provide specified information; whether the woman must receive state-prepared materials; and whether the woman must receive other information, oral or written, that contains information beyond risks, benefits, and alternatives. If a state simply has an abortion-specific informed-consent law that does not require biased counseling or a mandatory delay, no points were added.

Contraceptive Equity (- up to 20 points)
Points were subtracted if a state requires health-insurance plans to cover contraceptives to the same extent that they cover other prescription medication; fewer points were subtracted if the law has an overly broad refusal clause or requires an insurer only to offer and make available such coverage but not include it in every plan.

Counseling Ban/Gag Rule (+ up to 10 points)
Points were added if the ban applies to counseling and/or referring; if the ban applies to all or some public funds or employees; and the exceptions included in the ban.

Emergency Contraception (- up to 25 points)
Points were subtracted if the state allows sexual-assault survivors greater access to emergency contraception (EC) in emergency rooms (ER) (receiving EC in the ER and/or receiving information about EC in the ER), if the state's Medicaid program covers over-the-counter EC, and if pharmacists are allowed to provide EC to a woman without a prescription through a law specific to EC or one that permits collaborative-therapy agreements generally and includes EC. (These laws were in place before the FDA approved EC for over-the-counter sales and still provide greater access in some states, particularly to young women who are excluded from the FDA's ruling.)

Freedom of Choice Act (- 55 points)
Points were subtracted if a state provides an affirmative right to choose abortion prior to viability without government interference.

Guaranteed Access to Prescriptions (- 10 points)
Points were subtracted based on whether a state explicitly guarantees a woman's right to have her birthcontrol prescription filled.

Insurance Prohibition for Abortion (+ up to 10 points)
Points were added if the law prohibits insurance coverage for abortion for all or some public funds or employees; if the law prohibits abortion coverage unless an extra premium is paid; if the law requires insurers to provide a policy alternative excluding abortion; and the exceptions included in the law.

Low-Income Women's Access to Abortion (and Restrictions on Low-Income Women's Access to Abortion) (+ up to 25 points)
Points were added based on the circumstances under which the state medical assistance program funds abortion services: only to preserve the woman's life; only in cases of rape, incest, or life endangerment; or in cases of rape, incest, life endangerment, and limited health circumstances. If a state medical assistance program funds abortion care in all or most circumstances, no points were added.

Low-Income Women's Access to Family Planning (- 5 points)
Points were subtracted if the state provides increased coverage for Medicaid-covered reproductive-health-care services through the receipt of a federal Medicaid waiver. A state that applies for and receives a waiver is generally allowed to increase eligibility for Medicaid familyplanning services and/or improve the quality of those services for a specific period of time. The duration, eligibility requirements, and covered services provided by each state's waiver vary from state to state.

Other Anti- or Pro-Choice Law (+/- up to 25 points)
Points were added if a state has codified a choice-related public-policy position, or has imposed another significant restriction on or protection for a woman's right to choose that does not fall within existing Who Decides? issue areas.

Post-Viability Abortion Restriction (+ up to 10 points)
If a post-viability abortion restriction contains adequate life and health exceptions and does not define viability as occurring at a particular point in pregnancy, no points were added. Points were added for the lack or inadequacy of the health exception and if the state defines viability as occurring at a particular point in every pregnancy.

Protection Against Clinic Violence (- up to 15 points)
Points were subtracted based on if the law prohibits interference with entry or exit to a facility; physical invasion of the facility including trespass, property damage, arson, and bombing; excessive noise, odors, or telephone calls; and threats, including weapon possession at demonstrations. Points were also subtracted if the law creates a buffer zone, and/or permits injunctive relief.

Public Facilities and Public Employees Restriction(s) (+ up to 20 points)
Points were added if all or some public employees and/or facilities are prohibited from providing abortion services and the exceptions included in the law.

Refusal to Provide Medical Services (+ up to 20 points)
Points were added if the law applies to abortion, insurance coverage for contraception, family planning/birth control, sterilization, individual health-care instructions, or prescriptions.

Restrictions on Young Women's Access to Abortion (+ up to 25 points)
Points were added if consent or notice is required before a minor may obtain an abortion, whose consent or notice is required, whether there is a physician bypass, whether the judicial-bypass procedure is adequate, whether there is a waiting period, and the exceptions included in the law.

Spousal Consent/Notice (+ up to 10 points)
Points were added based on whether spousal consent or notice is required.

State Constitutional Protection (- up to 20 points)
Points were subtracted if a state constitution protects the right to choose beyond the federal Constitution, and whether state constitutional protection prevents imposition of almost all restrictions on the right to choose or whether it allows some substantial restrictions.

Targeted Regulation of Abortion Providers (TRAP) (+ up to 30 points)
Points were added based on the following considerations: the totality of TRAP laws imposed, whether a state restricts the provision of abortion care to physicians, and whether laws are in effect. (Because of the breadth of TRAP laws, we have included in the summaries only select examples that illustrate the burdens these measures impose on abortion providers. NARAL Pro-Choice America Foundation maintains a list of each state's TRAP laws.)

For all categories except TRAP: A standard deduction of 80 percent was taken if the law is enjoined or otherwise unconstitutional and/or unenforceable, and a smaller, variable percentage was taken if the law is partially enjoined or only some aspects are unenforceable.