Fifty-five percent of all reproductive-age U.S. women lived in a state hostile to abortion rights in 2011, up significantly from 31% in 2000, according to a new Guttmacher Institute policy analysis. The increase is the result of a dramatic shift in the abortion policy landscape at the state level over the past decade, including a record number of abortion restrictions that were enacted in 2011.

“In 2000, the country was more evenly divided: nearly a third of women lived in states solidly hostile to abortion rights, slightly more than a third in states supportive of abortion rights and close to a third in middle-ground states,” says Rachel Benson Gold, Guttmacher’s director of policy analysis. “By 2011, however, more than half of women of reproductive age lived in hostile states. This growth came largely at the expense of the states in the middle. Only one in 10 women lived in a middle-ground state by 2011.”

The analysis finds that most states—35 in total—remained in the same category in all three years (see below). However, of the 15 states whose abortion policy landscape changed substantially, all became more restrictive. Two formerly supportive states had moved to the middle-ground category by 2011, and one had become hostile. And 12 states that had been middle-ground in 2000 had become hostile by 2011. In 2000, 19 states were middle-ground and only 13 were hostile. By 2011, 26 states were hostile to abortion rights, and the number of middle-ground states had been cut in half, to nine (click here for a map illustrating the change over time).

“The regional differences are striking,” says Elizabeth Nash, Guttmacher’s state issues manager. “West Coast and Northeastern states remained consistently supportive of abortion rights. But a swath of states in the middle of the country moved from being middle-ground states in 2000 to hostile in 2011. And of the 13 states in the South, half were hostile in 2000—but all had become so by 2011.”

The authors conclude that shoring up the remaining states in the middle-ground group may be key to stopping the further national erosion of abortion rights—and that efforts to do so may well be successful. They also argue that these states may be ripe for progress on related reproductive and sexual health issues such as contraception and sex education.

“There is certainly ample precedent of reproductive rights supporters in those states stopping or blunting restrictive abortion bills,” says Gold. “And they have had some other noteworthy successes in recent years in enacting a proactive agenda to expand access to sexual and reproductive health-related services. For instance, Colorado has mandated contraceptive insurance coverage and Wisconsin has expanded access to comprehensive sex education.”

Categorizing states

Gold and Nash analyzed whether—in 2000, 2005 and 2011—states had in place at least one provision in any of 10 categories of major abortion restrictions. A state is considered “supportive” of abortion rights if it had enacted provisions in no more than one of these restriction categories, “middle-ground” if it had enacted provisions in two or three categories and “hostile” if it had enacted provisions in four or more. The categories include:

mandated parental involvement prior to a minor’s abortion;

required preabortion counseling that is medically inaccurate or misleading;

extended waiting period paired with a requirement that counseling be conducted in person, thus necessitating two trips to the facility;

mandated performance of a non-medically indicated ultrasound prior to an abortion;

prohibition of Medicaid funding except in cases of life endangerment, rape or incest;

restriction of abortion coverage in private health insurance plans;

medically inappropriate restrictions on the provision of medication abortion;

onerous requirements on abortion facilities that are not related to patient safety;

unconstitutional ban on abortions prior to fetal viability or limitations on the circumstances under which an abortion can be performed after viability; or

preemptive ban on abortion outright in the event Roe v. Wade is overturned.

Click here to read “Troubling Trend: More States Hostile to Abortion Rights as Middle Ground Shrinks",” by Rachel Benson Gold and Elizabeth Nash.

Also visit Guttmacher’s State Center featuring a wealth of information and analysis on sexual and reproductive health policies at the state level.