31 states are failing to provide vital reproductive and sexual health services to women in the US, damning report says

Thirty-one U.S. states are failing to provide basic sexual health and reproductive services, a damning new report has revealed.

Activist group rePROs Fight Back’s annual report found that reproductive healthcare in the U.S. continues to be in a perilous state in the aftermath of the overturning of Roe v Wade in 2022 during President Donald Trump’s first term in the White House.

The failing states were ranked with a ‘D’ or ‘F’ grade depending on whether they provided access to a number of vital sexual and reproductive health services and rights.

Just two of the failing states, New Hampshire and Massachusetts, voted for Democratic presidential candidate Kamala Harris in the 2024 election. While others, such as Wisconsin, Michigan, and Kentucky, boast Democratic governors.

In 2021, the year before Roe v Wade was overturned, 26 states had failing grades. Since the grading system began in 2011, the U.S. has fallen from a C- to an F. The number of falling states in the first year of the study was just nine.

The overturning of legislation also led to a surge in attacks on gender-affirming care for minors, the organization says.

In his first week, President Donald Trump signed a pair of executive orders to revive two anti-abortion policies from his first term in 2017, despite declaring that the issue should be left to individual states.

As things stand, abortion has been completely banned or almost completely banned in 19 states.

Consequently, thousands of women across the country have had basic healthcare access refused, jeopardizing their future fertility and, in many cases, putting lives at risk.

Trump’s latest threats to slash Medicaid funding have also mounted fresh fears on the future of abortion and reproductive rights in America.

“Looming on the horizon is the possibility of a federal abortion ban or restrictions on mifepristone, which would be crippling to abortion access around the country,” the rePROs Fight Back report stated.

According to the report, best practice medication and surgical care is banned in nearly half of U.S. states, but rePROs have warned that under the direction of Trump, state bans could soon extend to being enforced at a national level.

For the sixth year in a row, the U.S. as a whole received an “F” grade, meaning that safe reproductive healthcare remains at its lowest.

In the report, states are graded on three key factors: prevention, affordability, and access.

States are asked about sexual education in schools, if emergency rooms are dispensing emergency contraception, and if minors are allowed to consent to contraceptive services.

They are also posed with questions about the expansion of Medicaid under the Affordable Care Act, who qualifies for Medicaid family planning, postpartum coverage, insurance coverage for abortion services, and if there are harassing or burdensome requirements on those seeking family planning, abortion services, or gender-reaffirming services.

States that score highly will have comprehensive sex education in schools, emergency contraception mandated in the emergency room, access to contraception services for minors, Medicaid expansion under the Affordable Care Act, a Medicaid “waiver” expanding eligibility for family planning services, Medicaid postpartum coverage expanded to 12 months, insurance coverage of abortion services, an absence of abortion restrictions, an absence of TRAP laws (Targeted Regulation of Abortion Providers), access to abortion medication and access to gender-affirming care.

The highest for a state to score is between 86-100, an A, and the lowest is less than 49.9, an F. The more points a state is awarded, the better the services available.

Only five U.S. states were awarded an A in the report. In descending order, these were Oregon, Washington, California, New Mexico, and Vermont.

The 25 states that received a failed “F” grade were:

Jennie Wetter, Director of rePROs Fight Back, said that “the fight for bodily autonomy is far from over.”

Speaking on the political climate and how sexual health rights had worsened, Wetter said that states had been forced to resort to “enacting policies to protect abortion providers from investigations in hostile states,” which she called “true beacons of hope in this gathering storm.”

However, she said that attacks on bodily autonomy were not slowing down anytime soon and insisted that hostility towards abortion and transgender rights is gaining momentum.

She said the threats presented by the Trump administration were “a menacing storm looming on the horizon.”

“We are already failing when it comes to meeting people’s sexual and reproductive health needs by banning abortion, denying young people access to evidence-based sex education, blocking people from accessing affordable health care via Medicaid, putting gender-affirming care out of reach for many, and so much more,” Wetter said.

“These impacts are never felt equally and disproportionately affect those who are already marginalized, such as BIPOC, people with low incomes, young people, those with disabilities, the LGBTQ+ community, and those at multiple intersections of these identities.

“With the threats posed to our right to bodily autonomy by potential federal actions from the new administration related to abortion access, transgender health care, health care costs, and more, people in every state are at risk. We must be ready for a long, hard fight to achieve a world with reproductive freedom for all.”