Women seeking abortions in South Dakota face a three-day waiting period and must undergo in-person counseling that necessitates two trips to the clinic. Nearly a quarter of women in the state live in a county that doesn’t have an abortion provider.

The state does not require insurers to cover infertility treatments, nor does it mandate sex education in schools.

The Institute for Women’s Policy Research says those reasons and more are why it considers South Dakota the worst state in the nation for reproductive rights, according to a recently released ranking.

Rounding out the bottom five were Nebraska, Kansas, Idaho, and Tennessee.

States Ranked by Reproductive-Rights Composite Scores

IWPR

Included in the organization’s analysis was South Dakota’s decision not to adopt the Obamacare Medicaid expansion, which would have increased the number of women eligible to receive family-planning services. So far, 29 states have gone through with the expansion.

Oregon is the best state for reproductive rights, according to the report, followed by Vermont, Maryland, New Jersey, and Hawaii. Oregonian women don’t face waiting periods, and the state provides public funding for abortions. The state also got points for having a “pro-choice” governor.