The United States has failed to meet most goals for women's health -- largely federal objectives drawn from the U.S. Department of Health and Human Services' Healthy People 2010 agenda --according to a report released on the status of women's health by the National Women's Law Center (NWLC) and Oregon Health & Science University (OHSU).

Overall, the nation is so far from meeting the Healthy People and related goals that it receives a general grade of "Unsatisfactory." Of the 26 health indicators that were graded, the country received a "Satisfactory" grade in only three and received a failing grade in half.

Released in "Making the Grade on Women's Health: A National and State-by-State Report Card," this is the fifth in a series of reports since 2000. It grades and ranks each state based on 26 health status benchmarks and also identifies whether states have met 68 health policy goals. NWLC and OHSU developed the report as a resource for advocates, policymakers, and health experts to assess women's health at the federal and state levels. The Report Card provides comprehensive data for researchers to analyze changes in women's health and well-being. This edition of the Report Card includes an analysis of the current status of women's health, a 10-year look back at progress and setbacks, and a comparison to women's health status in 2007, when the Report Card was last published.

10-year Look Back

Less Smoking, More Colorectal Cancer Screening, Lower Heart Disease and Cancer Death Rates; but More Chlamydia, Diabetes, High Blood Pressure and Binge Drinking, Fewer Pap Tests

In the years since the original Report Card was published, the nation has made notable progress on several women's health indicators, including lower death rates from coronary heart disease, stroke, and breast and lung cancer. In addition, fewer women are smoking and more women are being screened for colorectal cancer. Unfortunately, however, there are now greater proportions of women with high blood pressure and who haven't had a recent Pap test. Since 2000, declines in women's health status have been most pronounced in the areas of diabetes, chlamydia and binge drinking.

"The good news is that when the nation rallies around a health problem with federal and state policies and programs as well as public attention, we can achieve real progress," said Judy Waxman, NWLC Vice President for Health and Reproductive Rights. "Unfortunately, we have much more work to do in many areas of women's health."

Key Findings from 2007-2010

Improvements in Cholesterol Screening, but Fewer Women Having Regular Pap Tests and More Reporting Binge Drinking

The most disturbing trends in the past three years (since the Report Card was last published) have been a marked increase in the proportion of women who report binge drinking -- a dangerous form of alcohol abuse that involves having five or more drinks on one occasion -- and a considerable decline in the percentage of women who get a regular Pap smear, the primary test todetect cervical cancer. The nation's grade for binge drinking declined from a "Satisfactory minus" to an "F," and the grade for Pap test rates dropped from an "Unsatisfactory" to an "F."

Cholesterol screening was the only area where women's health improved enough to merit a higher grade when compared with 2007 (moving from an "Unsatisfactory" to a "Satisfactory minus"). Other gains -- including lower proportions of women dying from heart disease, stroke, lung cancer, breast cancer, and during or shortly after pregnancy -- fell far short of the national goals and were not enough to generate better grades on the 2010 Report Card.

State-by-State Grades

In 2010, not one state received an overall "Satisfactory" grade for women's health and just two states received the next highest grade of "Satisfactory minus" -- Vermont and Massachusetts -- a decline from the 2007 edition of the Report Card, when three states received this grade. A majority of states (37) receive an "Unsatisfactory" grade and nearly a quarter of all states (12) receive an overall failing "F" grade. Nine of the 10 states that ranked at the bottom in the original Report Card in 2000 continue to rank at the bottom today; these include Alabama, West Virginia, Oklahoma, Arkansas, Louisiana, and Mississippi. The only state that moved out of the bottom 10 over the course of the decade was Texas, which nonetheless receives an "F" in 2010.

"It is shocking that there is not a single state in this country where women enjoy overall satisfactory health status," said Michelle Berlin, M.D., M.P.H., Vice Chair and Associate Professor of Obstetrics and Gynecology, OHSU School of Medicine; and Associate Director, OHSU Center for Women's Health, a National Center of Excellence in Women's Health.

State Policy Indicators

In addition to health status indicators, the report also assesses 68 health and health-related policies. Of these, only two policy goals were met by all the states: Medicaid coverage for breast and cervical cancer treatment and participation in the Food Stamp Nutrition and Education Program. Only nine states meet a majority (35 or more) of the policy goals, with California (44), New Jersey (43), Massachusetts (40), and New York (39) meeting the most. The four states that meet the fewest policy indicators are Mississippi (10), Idaho (11), South Dakota (11), and Alabama (12).

Though most states have made only piecemeal progress in adopting policies to improve women's health, many of the policy goals examined in the Report Card will be realized with the implementation of the new federal health care law, the Patient Protection and Affordable Care Act. For example, four Medicaid eligibility and enrollment policy goals will be accomplished when new Medicaid eligibility rules take effect in 2014. Several of the Report Card's policy goals for private insurance coverage of preventive services (such as Pap smears, mammograms and osteoporosis screenings) were achieved when a provision of the law that requires all new health plans to cover recommended preventive care with no cost-sharing took effect on Sept. 23.

"The Affordable Care Act emphasizes access to health care, including the critical preventiveservices that women need to stay healthy," said Waxman. "There is no doubt that it will make an enormous difference in addressing the problems identified in the 2010 Report Card."

Women need better access to health insurance to get necessary health care.

• One in 5 women aged 18 to 64 is uninsured, representing a considerable increase since 2007, the highest rate since the Census Bureau began reporting such data.
• No state meets the Healthy People 2010 goal of 100 percent of women having health insurance; Massachusetts comes the closest with 95 percent of women insured.
• The disparities in insurance coverage between White women and women of color are alarming. Nationwide, 37.6 percent of Hispanic women, 32 percent of American Indian/Alaska Native women, and 23.4 percent of Black women do not have health insurance coverage, compared with 13.9 percent of White women.

Access to reproductive health services is insufficient.

• Nearly half of all pregnancies are unintended, thereby missing -- by a substantial margin -- the national goal to reduce unintended pregnancies to 30 percent or less of all pregnancies.
• Just seven states recognize the importance of access to comprehensive maternity care by requiring that these services be covered in all individual and group health plans. Only eight states meet the policy goal of requiring that private insurers cover contraceptives as they do other prescription drugs.
• Nineteen states restrict private insurers' ability to cover abortion services, and 26 states diminish women's access to abortion care by requiring that they receive biased counseling and endure a mandatory delay before receiving an abortion.

Gaps in economic security continue to compromise women's health.

• The number of women living in poverty has increased in 33 states, with 13.4 percent of women living in poverty nationwide. Even the top-ranked (i.e., lowest poverty level) state of New Hampshire experienced a considerable rise in poverty -- from 6.3 percent in the 2007 Report Card to 8.5 percent in 2010. In bottom-ranked Mississippi, 21.1 percent of women live in poverty.
• Poverty rates for women of color are markedly higher than for White women with 23.7 percent of Black women and 23.1 percent of Hispanics living in poverty compared with 9.7 percent of White women.
• As in 2007, only Washington and Oregon have a minimum wage that allows a family of three to reach the federal poverty threshold ($8.31/hour). Sixteen states did worse on this policy indicator when compared with the previous Report Card.

A woman's health varies depending on where she lives.

• The District of Columbia has the highest heart disease death rate at 174.8 deaths per 100,000; Hawaii, which ranks first, has a heart disease death rate of 60.9 per 100,000. More than one third of women in Mississippi (36.8%) are obese, compared with fewer than 1 of 5 in Colorado (19.4%).
• West Virginia has the highest rate of diabetes, with 12.9 percent of women diagnosed with this condition compared with 5 percent of women in Alaska.

For more information on the Oregon Health & Science University, visit www.ohsu.edu and for more information on the National Women's Law Center visit, www.nwlc.org.