Indicators

Abortion Restrictions

Targeted Regulation of Abortion Providers (TRAP)

Hospital admitting privileges or alternative arrangements required for abortion providers, 2019

Indicator Impact:
Requiring abortion providers to have hospital admitting privileges or alternative arrangements reduces access to care without improving patient safety.

Data Source:
Guttmacher Institute. State laws and policies: Targeted regulation of abortion providers. Guttmacher Institute; Jun 2019. Available at: https://bit.ly/2a2YPdQ.

Ambulatory surgical center standards imposed on facilities providing abortion, 2019

Indicator Impact:
Imposing ambulatory surgical standards on facilities providing abortion can result in clinic closures, limiting access to care. These standards also increase the cost of care, which can further impede access.

Data Source:
Guttmacher Institute. State laws and policies: Targeted regulation of abortion providers. Guttmacher Institute; Jun 2019. Available at: https://bit.ly/2a2YPdQ.

Data Source:
Guttmacher Institute. State laws and policies: An overview of abortion laws. Guttmacher Institute; Jun 2019. Available at: https://bit.ly/1Ta92Dw.

Procedure Restrictions

Any gestational age limit for abortion, whether at viability or pre-viability, is set by law, 2019

Indicator Impact:
Gestational age limits for abortion can prevent pregnant people from being able to access care and force them to continue unwanted pregnancies. Not being able to access care because of gestational age limits can also reduce self-esteem and life satisfaction.

Data Source:
Guttmacher Institute. State laws and policies: State bans on abortion throughout pregnancy. Guttmacher Institute; Jun 2019. Available at: https://bit.ly/2eFmmUV.

Medication abortion must be administered in accordance with the outdated FDA labeling and/or must be provided by a clinician who is physically present during the procedure, 2019

Indicator Impact:
Requiring medication abortion to be administrated in accordance with outdated FDA protocols denies patients access to evidence-based regimens for care, and reduces the number of providers able to offer medication abortion. Requiring a clinician to be physically present during the procedure limits access to abortion, particularly for people living in remote areas. It may also delay access to care and increase travel time to care.

Data Source:
Guttmacher Institute. State laws and policies: Medication abortion. Guttmacher Institute; Jun 2019. Available at: https://bit.ly/2qVoDUq. Guttmacher Institute. Medication abortion. Guttmacher Institute; Nov 2019. Available at https://bit.ly/2wwJxxa

Specific abortion procedures in the second trimester are banned, such as intact Dilation & Evacuation (D&E) or all D&E procedures, 2019

Indicator Impact:
Method bans for safe and effective abortion procedures limit the ability of physicians to provide patients with the most appropriate care. This may limit access to abortion and lead to increased complications and worse health outcomes for patients.

Data Source:
Guttmacher Institute. State laws and policies: Bans on specific abortion methods used after the first trimester. Guttmacher Institute; Jun 2019. Available at: https://bit.ly/2X770kj.

Coverage/Financial Restrictions

Restrictions on abortion coverage in Medicaid except in cases of life endangerment, rape, or incest, 2019

Indicator Impact:
Restrictions on the use of federal funds for abortion coverage outside of health exceptions (in cases of life endangerment, rape, and incest) disproportionately impacts low-income patients. The out-of-pocket costs of abortion can delay individuals from obtaining abortion care, force women and their families to endure financial hardships to afford care, and force women who cannot afford abortion care to continue unwanted pregnancies.

Data Source:
Guttmacher Institute. State laws and policies: An overview of abortion laws. Guttmacher Institute; Jun 2019. Available at: https://bit.ly/1Ta92Dw.

Restrictions on abortion coverage in all private health plans or in health plans offered through the health insurance exchanges, 2019

Indicator Impact:
Restrictions on abortion coverage in private health insurance plans can interfere with women’s personal medical decisions, and undermine women’s autonomy by putting care out of financial reach. The out-of-pocket costs of abortion can delay women from obtaining abortion care, force women and their families to endure financial hardships to afford care, and force women who cannot afford abortion care to continue unwanted pregnancies.

Data Source:
Guttmacher Institute. State laws and policies: Restricting insurance coverage of abortion. Guttmacher Institute; Jun 2019. Available at: https://bit.ly/2c2NBpH.

Restrictions on abortion coverage in state employee health plans, 2019

Indicator Impact:
Though little research has documented the specific impacts of restricting abortion coverage in public employee health insurance plans, there is ample data showing the harms of limiting public insurance coverage of the procedure. Such restrictions can interfere with women’s personal medical decisions, and undermine women’s autonomy by putting care out of financial reach. The out-of-pocket costs of abortion can delay women from obtaining abortion care, force women and their families to endure financial hardships to afford care, and force women who cannot afford abortion care to continue unwanted pregnancies.

Data Source:
Guttmacher Institute. State laws and policies: Restricting insurance coverage of abortion. Guttmacher Institute; Jun 2019. Available at: https://bit.ly/2c2NBpH.

Restrictions on the allocation of public funds, such as Title X family planning funds and state family planning funds for abortion providers and reproductive health services, or reproductive health-focused providers are given the lowest priority when distributing family planning funds, 2019

Indicator Impact:
Restrictions on the allocation of public funds, such as Title X force clinics to separate family planning and abortion practices, which imposes significant challenges on low-income patients who receive care under Title X. Patients would not be able to hear medically pertinent information about their reproductive health choices, including abortion.

Data Source:
Guttmacher Institute. State laws and policies: State family planning funding restrictions. Guttmacher Institute; Jun 2019. Available at: https://bit.ly/2WHINBN.

Questions Patient Decision-Making

Mandatory counseling prior to an abortion, 2019

Indicator Impact:
Mandatory counseling laws can postpone the timing of some abortions, particularly when counseling must be received in person or when an individual must wait a state-specified amount of time between obtaining counseling and receiving an abortion.

Data Source:
Guttmacher Institute. State laws and policies: An overview of abortion laws. Guttmacher Institute; Jun 2019. Available at: https://bit.ly/39Y0Ju5

Involvement and/or consent required from one or both parents before a minor obtains an abortion, 2019

Indicator Impact:
There is no evidence to suggest that parental involvement laws deter minors from engaging in sexual activity (as is the often-stated thinking behind the laws). However, some minors do try to circumnavigate the laws by obtaining a judicial bypass or traveling outside of their home state to obtain an abortion in a state without parental involvement laws. The laws can delay the procedure which makes abortion less accessible.

Data Source:
Guttmacher Institute. State laws and policies: An overview of abortion laws. Guttmacher Institute; Jun 2019. Available at: https://bit.ly/1Ta92Dw.

Requirement to have or be offered an ultrasound before an abortion, 2019

Indicator Impact:
Viewing an ultrasound generally does not impact women’s abortion decision making (though that is the reasoning behind the law).

Data Source:
Guttmacher Institute. State laws and policy: Requirements for ultrasound. Guttmacher Institute; Jun 2019. Available at: https://bit.ly/2iIMfTJ.

Waiting period required between time of first appointment and abortion, 2019

Indicator Impact:
Mandatory waiting periods can postpone the timing of abortions, increase the proportion of second-trimester abortions occurring in a state, and increase the number of women traveling out of state for an abortion. They can also negatively impact women’s emotional well-being.

Data Source:
Guttmacher Institute. State laws and policies: An overview of abortion laws. Guttmacher Institute; Jun 2019. Available at: https://bit.ly/1Ta92Dw.

Abortion is banned on the basis of sex, race or fetal diagnosis, 2019

Indicator Impact:
Reason and discrimination bans question and undermine patients’ decisions about their reproductive health, and perpetuate harmful stereotypes, which may lead to patients withholding information or lying in order to receive care. These bans undermine the patient-provider relationship and create barriers to open communication.

Data Source:
Guttmacher Institute. State laws and policies: Abortion bans in cases of sex or race selection or genetic anomaly. Guttmacher Institute; Jun 2019. Available at: https://bit.ly/2WWVEfg.

Restricts Abortion Access

Number of abortion providers per 100,000 women aged 15-44 is below the national average, 2017

Indicator Impact:
The quality and functionality of any health care delivery system depends on the availability of medical personnel. A limited number of abortion providers likely impedes access to health care and disproportionately impacts those living in medically underserved areas.

Data Source: Guttmacher Institute. State data center, create a table: Number of abortion providers, 2017. Total number of women aged 15-44. Available at: https://data.guttmacher.org/states.

Health care providers can refuse to provide abortion services, 2019

Indicator Impact:
Allowing health care providers to refuse to provide abortion services violates standards of medical care and reduces accessibility of abortion. This likely disproportionately impacts pregnant people living outside of urban areas.

Data Source:
Guttmacher Institute. State laws and policies: An overview of abortion laws. Guttmacher Institute; Jun 2019. Available at: https://bit.ly/1Ta92Dw.

Other Restrictions

Trigger bans or pre-Roe abortion bans, which would ban all or nearly all abortions if Roe were overturned, 2019

Indicator Impact:
In the absence of Roe v. Wade, decisions about abortion would be left up to the states. Trigger bans would immediately halt abortion access within the state, returning the state to pre-Roe status. Patients seeking abortion would be forced to find care elsewhere, if they are able, possibly increasing the number of abortions performed later in pregnancy. Many individuals without the resources to travel would be forced to carry unwanted pregnancies to term.

Data Source:
Center for Reproductive Rights. What if Roe fell? Center for Reproductive Rights; 2019. Available at: https://bit.ly/2T3U36D

Supportive Policies

Improves Access to Health Care

Affordable Care Act Medicaid expansion, 2019

Indicator Impact:
Without Medicaid expansion, many women fall into a coverage gap, making too much to qualify for Medicaid but not enough to qualify for subsidized health coverage through the exchanges. Low-income women without health insurance are more likely to report going without needed care, are less likely to have a regular health care provider, and are less likely to access preventive services than low-income women with health insurance.

Data Source:
The Henry J Kaiser Family Foundation. State health facts: Status of state action on the Medicaid expansion decision. Available at: https://www.kff.org/907f6c5/.

Automated renewal of Medicaid/CHIP, 2019

Indicator Impact:
Streamlined renewal processes help prevent lapses in health care coverage for enrolled women and children, and reduce the administrative burden for both states and enrolled families.

Data Source:
The Henry J Kaiser Family Foundation. State health facts: Medicaid Renewal Processes. Available at: https://bit.ly/2PbSpPa

Above average Title X funding per patient, 2017 (excl. DC)

Indicator Impact:
Title X funding provides states with the support to ensure access to family planning services for low-income women, which can decrease unintended pregnancy rates.

Data Source:
National Family Planning & Reproductive Health Association. Title X in Your State, 2017. Available at http://bit.ly/2n7aIYt.

Insurers that cover prescription drugs must provide coverage for any FDA-approved contraceptive, 2019

Indicator Impact:
Contraceptive parity laws protect access to contraception for insured women should the parity provision in the Affordable Care Act be affected. These laws ensure that women are able to access effective, more affordable contraceptives through their insurance and avoid unintended pregnancy and the associated poor health outcomes.

Data Source:
Guttmacher Institute. State laws and policy: Insurance coverage of contraceptives. Guttmacher Institute; Jun 2019. Available at: https://bit.ly/2yMusne.

Insurers required to cover or offer coverage for infertility diagnosis and treatment or fertility preservation laws are in place for medically-induced infertility, 2018

Indicator Impact:
Mandated insurance coverage for infertility treatment increases the utilization of care, particularly among older, educated women who are more likely to have infertility issues. Fertility preservation has positive impacts on the quality of life for women of reproductive age.

Data Source: National Conference of State Legislators. State laws related to insurance coverage for infertility, 2018. Available at: https://bit.ly/1wSt4WS.

Supports Pregnant People

Medicaid income limit for pregnant women is at least 200% of the federal poverty line, 2019

Indicator Impact:
Increased Medicaid eligibility limits for pregnant women has been shown to increase health care coverage of pregnant women and to reduce infant mortality and low birth weight.

Data Source:
Center for Medicare & Medicaid Services. Medicaid, children’s health insurance program, & basic health program eligibility levels. Available at: https://bit.ly/2wLdZAr.

Family leave standards more expansive than the federal Family Medical Leave Act (i.e. expanding the amount of leave available or the classes of persons for whom leave may be taken), 2016

Indicator Impact:
Parental leave has been associated with numerous positive outcomes, including lower rates of premature birth, increased birth weight, higher rates of breastfeeding and well-baby care, positive changes in wages, and lower levels of public assistance receipt.

Data Source:
National Conference of State Legislatures. State family medical leave and parental leave laws. Available at: http://bit.ly/1mXjWgB.

Maternal mortality review committee established, 2019

Indicator Impact:
Maternal mortality review boards monitor and analyze maternal deaths and propose recommendations to improve maternal health. Maternal mortality review boards are recommended by Amnesty International and the American Public Health Association.

Data Source:
• Excl. HI, MT, NH, TN, TX, VT: Amnesty International. Deadly delivery: The maternal health care crisis in the USA. Available at: http://bit.ly/2kQmK7i.
• AR: House Bill 1440, 2018-2019 Leg., Reg. Session (Ark. 2019). Available at: bit.ly/33YdcuN. • AZ: Senate Bill 1121, 2011 Leg., Reg Session (Ariz. 2011). Available at: http://bit.ly/2qDOsJV.   • CT: Senate Bill 304, 2018 Leg., Reg Session (Conn. 2018). Available at: http://bit.ly/2o8aAuT.
DE:
• DC: D.C. Law 22-111 (D.C. 2018). Available at: http://bit.ly/2BAQaOm. 2019. • GA: Senate Bill 273, 2013-2014 Leg., Reg. Session (Ga. 2014). Available at: http://bit.ly/2pGyglD.
• HI: Senate Bill 2317, 2016 Leg., Reg. Session (Haw 2016). Available at: http://bit.ly/2q84YPx.
• ID: House Bill 109, 2019 Leg., Reg, Session (Idaho 2019). Available at: http://bit.ly/2pEb9gt.
• KS: Kansas Revised Statutes  §65-177. Available at: http://bit.ly/2MECW9C.
• MS: House Bill 494, 2017 Leg., Reg. Session (Miss. 2017). Available at: http://bit.ly/2pGD67o. • MT: House Bill 28, 2013 Leg., Reg. Session (Mont. 2013). Available at: http://bit.ly/2q9Idcp.
• NE: Nebraska Revised Statutes §71-3404 – 71-3409, Reg. Session (Neb. 2013). Available at: http://bit.ly/2JcCGfK. • NH: House Bill 1553, 2010 Leg., Reg. Session (N.H. 2010). Available at: http://bit.ly/2r57wf3.
• NM: Senate Bill 215, 2019 Leg., Reg. Session (N.M. 2019). Available at: http://bit.ly/35XBPtj. • NV: Assembly Bill 169, 2019 Leg., Reg. Session (Nev. 2019). Available at: http://bit.ly/31EVdI9. • OR: House Bill 4133, 2018 Leg., Reg. Session (Or. 2018). Available at: http://bit.ly/2N524VZ.
• PA: House Bill 1869, 2018 Leg., Reg. Session (Pa. 2018). Available at: http://bit.ly/2Wf9zy1.
• RI: Senate Bill 0574, 2019 Leg., Reg. Session (R.I. 2019). Available at: http://bit.ly/2MXHkPO. • TN: Senate Bill 2303, 2015-2016 Leg., Reg. Session (Tenn. 2016). Available at: http://bit.ly/2q6KqaK.
• TX: Texas Legislature Online. Senate Bill 495: Relating to the creation of a task force to study maternal mortality and severe maternal morbidity, 2013. Available at: http://bit.ly/VtE0QD.
• VT: Senate Bill 15: Midwifery insurance coverage, 2011-2012 Leg., Reg. Session (Vt. 2011). Available at: http://bit.ly/2r6Sgiu.

Reasonable accommodations for pregnant workers, 2019

Indicator Impact:
Despite the federal Pregnancy Discrimination Act, many pregnant workers are at risk of losing their jobs or being forced to take unpaid leave due to their pregnancy.

Data Source:
National Partnership for Women and Families. Reasonable accommodations for pregnant workers: State laws and local laws; Jun 2019. Available at: https://bit.ly/2I4I04F.

Shackling of pregnant prisoners is restricted or prohibited, 2017

Indicator Impact:
Restraining pregnant women increases the risk of injury to the woman and the fetus and can interfere with medical care during labor, delivery, and recovery. The American Congress of Obstetricians and Gynecologists, the American Medical Association, and the American Public Health Association oppose shackling pregnant women.

Data Source:
Ferszt GG, Palmer M, Mcgrane C. Where does your state stand on shackling of pregnant incarcerated women? Nursing for Womens Health. 2018;22(1):17-23.

Employers must provide paid sick leave, 2018

Indicator Impact:
Paid sick leave helps reduce the spread of influenza and infectious diseases and allows employees to visit doctors. Paid sick leave decreases job loss due to illness, reduces job turnover, and increases the ability of parents to care for sick children.

Data Source:
National Conference of State Legislatures. Paid sick leave, 2018. Available at: https://bit.ly/2glA3KQ.

Workplace lactation rights beyond federal requirements, 2019

Indicator Impact:
Workplace protections for breastfeeding promote exclusive breastfeeding, which has been shown to increase maternal-child attachment and protect the child against infectious diseases and increase cognitive development. Breastfeeding also decreases the risk of breast and ovarian cancer for mothers. Employers also benefit from decreased parental absenteeism to care for sick infants, improved morale, and increased retention of experienced employees.

Data Source:
U.S. Department of Labor: Women’s Bureau. Employment protections for workers who are pregnant or nursing. Available at: https://bit.ly/2WL3HQB.
National Conference of State Legislatures. Breastfeeding state laws, 2019. Available at: https://bit.ly/1lHJI8E.

Promotes Children’s and Adolescents’ Health, Education, and Safety

Children can enroll in CHIP with no waiting period, 2019

Indicator Impact:
Requiring children to be uninsured before enrolling in CHIP disrupts continuity of care and affects children’s ability to access needed health care; 23 organizations, including the American Academy of Pediatrics, Children’s Defense Fund, and March of Dimes, have signed onto a letter calling on the United States Department of Health and Human Services to eliminate waiting periods.

Data Source:
Brooks T, Roygardner L, Artiga S. Medicaid and CHIP eligibility, enrollment, and cost sharing policies as of January 2019: Findings from a 50-state survey. The Henry J Kaiser Family Foundation; Mar 2019. Available at: https://bit.ly/2uyOEZI.