The Landscape of Women's Reproductive Health

The Landscape of Women's Reproductive Health

The Landscape of Women's Reproductive Health

Eighteen subtopics. Fifty states. 789 legal citations. The law that governs a womans reproductive health exists it just exists in pieces, across four layers of jurisdiction, and almost none of it is published in a form she can use.

Eighteen subtopics. Fifty states. 789 legal citations. The law that governs a womans reproductive health exists it just exists in pieces, across four layers of
jurisdiction, and almost none of it is published in a form she can use.

She has the right. That does not mean it reaches her.

Inspired by Marli Ehrman

Four issue areas. Eighteen places where the law actually sits.

Four issue areas. Eighteen places where the law actually sits.

Four issue areas. Eighteen places where the law actually sits.

Reproductive rights work in the United States organises around a small number of issue areas. Four of them cover most of what a woman in this country actually faces: abortion, maternal health, assisted reproduction and contraception. We have broken those four into eighteen subtopics the level at which the law is actually written, and the level at which she runs into it.

They run from the ones everyone expects abortion access, prenatal care, contraception coverage, IVF to the ones almost nobody has mapped: menstrual health, menopause, reproductive data privacy, cervical screening, ovarian cancer. Thirteen of the eighteen are already someones area of focus. Five are on nobodys.

Application of all eighteen varies by jurisdiction.

Reproductive rights work in the United States organises around a small number of issue areas. Four of them cover most of what a woman in this country actually faces: abortion, maternal health, assisted reproduction and contraception. We have broken those four into eighteen subtopics the level at which the law is actually written, and the level at which she runs into it.

They run from the ones everyone expects abortion access, prenatal care, contraception coverage, IVF to the ones almost nobody has mapped: menstrual health, menopause, reproductive data privacy, cervical screening, ovarian cancer. Thirteen of the eighteen are already someones area of focus. Five are on nobodys.

Application of all eighteen varies by jurisdiction.

The three-way complexity

The three-way complexity

The three-way complexity

789 legal citations sit behind the 18 subtopics:

789 legal citations sit behind the 18 subtopics:

Federal:

Federal:

14

14

State:

State:

State:

642

642

District:

District:

4

4

Local(City/County):

Local(City/County):

129

129

Fourteen of the eighteen subtopics are not driven by the legal citation alone. They also turn on specific eligibility criteria 472 of the 789 rights carry one. Across those subtopics there are 71 distinct criteria, falling into eleven categories.

Take IVF

Take IVF

In New York, the law is on her side: her insurer must cover it. But the right comes with conditions. She qualifies after twelve months of trying without a pregnancy six months if she is thirty-five or older. The coverage runs to three cycles. And once she qualifies, her age alone cannot be used to turn her away.

Now move the same woman across a state line. In Texas, the right exists in a weaker form: the law only requires insurers to offer IVF coverage, not to provide it, so her employer can simply decline it. In Florida, the right does not exist at all.

Accessing rights is difficult because it has to be done in her context, and three things set that context the

jurisdiction, the type of right within the topic, and the eligibility criteria.

Every right sits at one point in this space. Move along any one of the three axes and the answer changes.

Every right sits at one point in this space. Move along any one of the three axes and the answer changes.

For one woman

For one woman

For one woman

One woman. One statute. Two different answers.

One woman. One statute. Two different answers.

Take Texas. IVF coverage exists in the law but only as a right to be offered, not a right to have. The insurer must put the coverage on the table; her employer decides whether to take it. And beneath the state law there is no federal floor at all. No federal law requires IVF coverage for anyone.

So at one employer in Dallas she has the benefit, and at the employer next door she has nothing. Same state, same statute, different right.

She is thirty-three, fourteen months trying to conceive, working for an employer of around four hundred people on a fully insured plan. Nothing about her changed. Her employer declined the offer in writing, and that alone decided it.

What exists today, and what we can add

What exists today, and what we can add

What exists today, and what we can add

One subtopic is mapped. Seventeen are not.

One subtopic is mapped. Seventeen are not.

The strongest single asset in this landscape is the definitive state-by-state map of abortion law. But abortion is one of eighteen subtopics, and it is the only one anyone publishes state by state. The other seventeen exist for a woman only as scattered statutes she cannot find.

We add what is missing. The 789 legal citations and 71 eligibility criteria behind this study are that missing layer already researched, already structured. With it, any organisation working in this field can answer an individual woman in her own context: her state, her type of right, her eligibility, across all eighteen subtopics.

Analytics for policy and advocacy

Analytics for policy and advocacy

While building this layer for individual women, the study produced a second asset. Read the same data across states and patterns appear that no one has published. Two follow: where the legal deserts are, and how abortion restriction and motherhood support move together. This analytics can lead policy and advocacy work.

While building this layer for individual women, the study produced a second asset. Read the same data across states and patterns appear that no one has published. Two follow: where the legal deserts are, and how abortion restriction and motherhood support move together. This analytics can lead policy and advocacy work.

Where the deserts are

Where the deserts are

Where the deserts are

First Illinois, 89%

Illinois is the best state from a rights and access perspective. Sixteen of the eighteen subtopics are available, and it carries no restriction in force.
Illinois is the best state from a rights and access perspective. Sixteen of the eighteen subtopics are available, and it carries no restriction in force.

Second California, 83%

California follows, strong on both sides: protection for pregnancy and motherhood, and control over whether and how she reproduces.
California follows, strong on both sides: protection for pregnancy and motherhood, and control over whether and how she reproduces.

Third the floor, 17%

Alabama, Mississippi and South Dakota sit at seventeen per cent each, all three with a ban in force.
Alabama, Mississippi and South Dakota sit at seventeen per cent each, all three with a ban in force.

And the twelve

And the twelve

Twelve states carry both a ban in force and ten or more subtopics with no state law at all: Alabama, Florida, Idaho, Indiana, Iowa, Mississippi, Nebraska, North Dakota, Pennsylvania, South Carolina, South Dakota and Wisconsin.
Twelve states carry both a ban in force and ten or more subtopics with no state law at all: Alabama, Florida, Idaho, Indiana, Iowa, Mississippi, Nebraska, North Dakota, Pennsylvania, South Carolina, South Dakota and Wisconsin.

The pattern

The pattern

The pattern

22 of the 50 states ban or materially limit abortion 13 Illegal and 9 Hostile.

Those same states keep the laws that support pregnancy and motherhood. They score higher on motherhood support than on control over reproduction. Nebraska and Indiana are sharpest.

22 of the 50 states ban or materially limit abortion 13 Illegal and 9 Hostile.

Those same states keep the laws that support pregnancy and motherhood. They score higher on motherhood support than on control over reproduction. Nebraska and Indiana are sharpest.

Example questions we will be able to address

Example questions we will be able to address

Example questions we will be able to address

Which state is strongest for women's reproductive health?

Which states are weakest?

Which states give the best protection for pregnancy and motherhood?

Which states give a woman the most control over whether and how she reproduces?

Where should funding go first?

Which right has no federal floor at all?

How much of this has anyone mapped before?

What we would build

What we would build

What we would build

Take IVF. A woman needs four separate answers: is it legally available, must her plan cover it, can she take paid leave for it, can she ask for an accommodation. Each of the four can differ by state, and answering one of them tells her nothing about the other three.

Take IVF. A woman needs four separate answers: is it legally available, must her plan cover it, can she take paid leave for it, can she ask for an accommodation. Each of the four can differ by state, and answering one of them tells her nothing about the other three.

With this built

She asks in her own words, in her own situation.
She asks in her own words, in her own situation.
She gets yes or no, and the one condition that decided it.
She gets yes or no, and the one condition that decided it.
She gets the statute, the section, and the date it took effect.
She gets the statute, the section, and the date it took effect.
This is the difference between telling her the law exists and telling her whether it reaches her.
This is the difference between telling her the law exists and telling her whether it reaches her.

Around 44 million women aged 15 to 44 in the United States receive sexual and reproductive health services each year roughly seven in ten women of reproductive age. Guttmacher Institute, service-receipt data 20152019.

Around 44 million women aged 15 to 44 in the United States receive sexual and reproductive health services each year roughly seven in ten women of reproductive age. Guttmacher Institute, service-receipt data 20152019.

Ready to see it against your own footprint?

Ready to see it against your own footprint?

Ready to see it against your own footprint?