NARAL Pro-Choice America and NARAL Pro-Choice America Foundation have supporting documentation for statements of fact made in Who Decides? The Status of Women's Reproductive Rights in the United States. Copies of source documents are filed in NARAL Pro-Choice America and 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 (Rachel Jones and Jenna Jerman, Abortion Incidence and Service Availability In the United States, 2011, Perspectives on Sexual and Reproductive Health, Mar. 2014, 46(1)).
STATE AND LOCAL LEGISLATIVE INFORMATION: This report uses "laws" to refer specifically to statutes adopted by the legislature or enacted by ballot measure. "Measures" is a broader term that includes the following: constitutional provisions, statutes, regulations, court decisions, ballot measures, opinions of state attorneys general, state policies, and other governmental actions with statewide effect. In addition to the types of measures that are highlighted on the "Fast Facts" pages of Who Decides?, the counts of anti-choice measures enacted provided on the "Key Findings" pages include but are not limited to measures that restrict state funds from going to any health center that provides abortion care; require a forced ultrasound as a condition of getting abortion care; and mandate "abstinence-only" programs. The pro-choice counts of measures enacted include but are not limited to measures that ameliorate anti-choice actions (e.g. require crisis pregnancy centers to disclose anti-choice bias); improve reproductive health; support healthy childbearing; and provide young people with comprehensive sex education. For further information, please contact the NARAL Policy Department.
Report Card Methodology
Who Decides? reflects the legal state of women's access to reproductive-health services in the previous calendar year. (Note: The Key Findings: Political Landscape data reflect the year ahead.)
For 17 years, Who Decides? has used a grading system to capture the cumulative burden each state imposes on access to reproductive-health care. Points are subtracted for anti-choice measures and added for pro-choice measures. Measures that impose the greatest burdens on women are weighted most heavily.
Likewise, demerits fall most heavily on measures that are in force, rather than measures that courts have declared invalid. For each issue area listed below, a state receives points in return if the measure is held unconstitutional or enjoined. A detailed analysis of the report-card methodology appears below. For the purposes of this publication's methodology, the term "exceptions" may include but is not limited to exceptions for the life or health of the woman; rape and incest; emergency situations; cases of fetal anomaly; situations of child abuse; private employers; and state employees.
The nationwide grade reflects not only state restrictions on the right to choose, but also federal anti-choice measures.
State rankings and grades are based on a combination of factors, including enacted measures, level of legislative and regulatory activity, and a state's overall legislative and political landscape as it pertains to advancing or restricting reproductive rights.
(- up to 80 points)
Points were subtracted for each abortion ban based either on the point in pregnancy when the ban(s) begin, or on whether the statute bans a specific procedure. Points were added for certain exceptions included in the ban(s). Additional points were subtracted for any 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 allocated 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 material, oral or written, that contains biased information. No points were subtracted if a state has an abortion-specific informed-consent measure that does not require biased counseling or a mandatory delay.
COUNSELING BAN/GAG RULE
(- up to 10 points)
Points were subtracted if the ban applies to counseling and/or referrals and if the ban applies to all or some public funds or employees. Points were added based on the exceptions included in the measure.
CRISIS PREGNANCY CENTERS
(- up to 15 points)
Points were subtracted if a state funds CPCs directly with taxpayer dollars or tax benefits; requires a woman to go to a CPC or refers women to CPCs; and/or has a "Choose Life" license-plate program (enacted by the legislature or executive) if there is no corresponding pro-choice option. There are multiple potential sources of direct funding for CPCs; while most states use state dollars, some states channel federal funds to CPCs. Points were added if states disclosed the limited nature of CPC services in any of their measures.
(+ up to 25 points)
Points were added if the state ensures that sexual-assault survivors receive counseling about and access to emergency contraception (EC) in emergency rooms; 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 measure specific to EC or one that permits collaborative-therapy agreements generally and includes EC. (These measures were in place before the Food and Drug Administration (FDA) approved Plan B One-Step® for over-the-counter sales for women of all ages.)
FREEDOM OF CHOICE ACT
(+ up to 55 points)
Points were added if a state has passed legislation to codify the protections of Roe v. Wade and provides an affirmative right to choose.
GUARANTEED ACCESS TO PRESCRIPTIONS
(+ up to 10 points)
Points were added if a state explicitly guarantees a woman's right to have her birth-control prescription filled.
INSURANCE COVERAGE FOR ABORTION
(+ up to 35 points)
Points were added if a state guarantees insurance coverage of abortion: in the private insurance market, the state health-insurance exchange, and for all or some state and/or municipal employees.
INSURANCE COVERAGE FOR CONTRACEPTION
(+ up to 20 points)
Points were added if a state requires health-insurance plans to cover contraceptives to the same extent that they cover other prescription medication, and if a state limits strictly a health plan's ability to impose cost-sharing on certain forms of contraceptive products. Fewer points were added if the measure has an overly broad refusal clause or requires an insurer only to offer and make available such coverage but not to include it in every plan.
INSURANCE PROHIBITION FOR ABORTION
(- up to 35 points)
Points were subtracted if the measure prohibits insurance coverage of abortion in the private insurance market; if the measure prohibits insurance coverage of abortion in the state health-insurance exchange; if the measure prohibits insurance coverage of abortion for all or some state and/or municipal employees; and if the measure requires insurers to provide a policy alternative excluding abortion. Points were added based on the exceptions included in the measure.
LOW-INCOME WOMEN'S ACCESS TO ABORTION (AND RESTRICTIONS ON LOW-INCOME WOMEN'S ACCESS TO ABORTION)
(- up to 25 points)
Points were deducted 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 subtracted.
LOW-INCOME WOMEN'S ACCESS TO FAMILY PLANNING
(+ up to 5 points)
Points were added if the state provides increased coverage for Medicaid-covered reproductive-health-care services through a federal Medicaid waiver or through a family planning state plan amendment (SPA). A state that applies for and receives a waiver or SPA is generally allowed to increase eligibility for Medicaid family-planning 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 expanded coverage program vary from state to state. While pursuant to the Affordable Care Act it is anticipated that Medicaid family-planning waivers may be phased out and replaced with SPAs, for the time being, NARAL Pro-Choice America and NARAL Pro-Choice America Foundation will continue to include Medicaid waivers as an indicator of states' commitment to providing essential family-planning care to low-income women.
POST-VIABILITY ABORTION RESTRICTION
(- up to 10 points)
If a post-viability abortion restriction has adequate life and health exceptions and does not define viability as occurring at a particular point in pregnancy, no points were subtracted. Points were subtracted for the lack or inadequacy of the health exception and if the state defines viability as occurring at a particular point in pregnancy.
PROTECTION AGAINST CLINIC VIOLENCE
(+ up to 15 points)
Points were added if the measure 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 added if the measure creates a buffer zone, and/or permits injunctive relief.
PUBLIC FACILITIES AND PUBLIC EMPLOYEES RESTRICTION(S)
(- up to 10 points)
Points were subtracted if all or some public employees and/or facilities are prohibited from providing abortion services. Points were added based on the exceptions included in the measure.
REFUSAL TO PROVIDE MEDICAL SERVICES
(- up to 20 points)
Points were subtracted for each area in which individuals or organizations may refuse to provide: abortion, contraception, or sterilization, and/or related counseling, referrals, insurance coverage, or prescriptions.
RESTRICTIONS ON YOUNG WOMEN'S ACCESS TO ABORTION
(- up to 25 points)
Points were subtracted based on whether consent or notice is required before a minor may obtain abortion services, whose consent or notice is required, whether there is a physician bypass, whether the judicial-bypass procedure is adequate, and whether there is a waiting period. Points were added based on the exceptions included in the measure.
STATE CONSTITUTIONAL PROTECTION
(+ up to 20 points)
Points were added if a state constitution protects the right to choose beyond the U.S. Constitution, and to the degree that the state constitutional protection prevents imposition of restrictions on the right to choose.
TARGETED REGULATION OF ABORTION PROVIDERS (TRAP)
(- up to 30 points)
Points were allocated based on the breadth and severity of all TRAP measures imposed. Additional points were subtracted if a state prohibits certain qualified health-care professionals from providing abortion care. (Because of the breadth of TRAP measures, the summaries include only select examples that illustrate the burdens these measures impose on abortion providers.)