FRANKFORT, Ky. — A new report demonstrates the divide between states that prioritize reproductive health and those that do not - and Kentucky is among of the latter.
The Population Institute's annual report card on reproductive health and rights gave 19 states, including the Commonwealth, a failing grade. The findings are not a surprise to Marcie Crim, executive director at the Kentucky Health Justice Network.
"Kentucky is a birth-control desert, meaning that our publicly funded clinics are not offering all forms of contraception. That's a problem,” Crim said. “And 76 out of our 120 counties don't even have an OB-Gyn. So we're just a mess in Kentucky in terms of reproductive health."
Kentucky scored poorly for mandating abstinence as part of the sexual education in public schools, while not requiring contraception or HIV education. The state also has no laws affirming a woman's right to emergency contraception in an emergency room.
Overall, the country received a "D-minus," with the research noting declining overall reproductive health and rights, and increasing disparity between states. Twenty-two states received a "B-minus" or higher, while the other 27 received a "D" or lower.
Kentucky fared well in the report for its teen pregnancy rate, the number of unintended pregnancies, and for allowing minors to consent to contraceptive services. However, Crim pointed out that just because it's permitted, that doesn't mean it's accessible.
"This person was 19, 20 years old, went to go see their family doctor to get on birth control and the family doctor refused to give them a prescription because the doctor said, 'You're not married, and it's against my beliefs to give you birth control,’” Crim said. “And so that's obviously a huge problem."
Abortion access is another problem area, with the report showing that about 3-in-4 women live in a county without an abortion clinic. Kentucky also has several laws that make it unnecessarily difficult to obtain an abortion, and Crim said lawmakers are trying to pass more.
"It feels like there's an overall wish to dominate Kentuckians' bodies without actually doing the research into how you would bring down numbers of abortions through access to sex education and contraception,” she said. “It is to just stop abortions and damn the consequences."
The report added a "minus" to Kentucky's failing grade because the state's "Choose Life" license plates fund anti-choice organizations.
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Next week, Kentucky lawmakers are expected to consider a bill that would lift legal red tape that backers say makes it difficult to open up freestanding birth centers.
The Commonwealth is among 10 states with no independent nurse midwife-run facilities that provide prenatal and birth services and postpartum care. So, many people travel to Indiana or Tennessee to give birth, said Trimble County resident Paige Thompson, who went out of state to give birth in 2021. She said her friends have made similar trips, but she worries about those in other rural counties who have no options for a natural birth in a home-like environment.
"They offer the freedom to move around during labor," she said. "They offer the option to eat and drink whenever you're hungry or thirsty. And there's also the option to birth in the water."
Senate Bill 17 would exempt freestanding birth centers from the state's certificate-of-need requirements, rules that regulate health-care facilities. The Kentucky Hospital Association opposes freestanding birth centers, arguing that hospitals are better equipped to handle unpredictable medical complications.
The bill's sponsor, state Sen. Shelley Funke Frommeyer, R-Alexandria, said people should have access to the prenatal and delivery care they feel is best for them, noting there are around 800 home births in Kentucky each year.
"I want to recognize that we are not trying to do anything so complicated, other than remove barriers to wellness," she said, "and we believe that this is a very important barrier to remove."
Thompson said more than one in three Kentuckians give birth by cesarean-section, a rate among the highest in the nation.
"I think that people are waking up to the truth that midwives and midwifery care are safer, and produce better outcomes for low-risk pregnancy, in women who want a natural vaginal delivery," she said.
Data show access to birth centers is linked to fewer medical interventions and lower cesarean rates than in hospitals, and can reduce racial disparities, including fewer low birthweight babies for Black women.
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Gov. Gretchen Whitmer recently signed landmark legislation to expand access to essential OB/GYN services across Michigan.
Between 2018 and 2022, about 19 mothers per 100,000 live births in Michigan died from pregnancy-related issues, mostly in marginalized communities. The new legislation aims to expand maternal and prenatal care.
Rep. Julie Rogers, D-Kalamazoo, a former health policy chair, sponsored several bills in the package, including one to reduce government red tape for breast milk donors.
"That required HIV testing for breast milk donors every 90 days, and to contrast that with the rest of the United States, we're the only state that requires that," Rogers pointed out. "Forty-nine other states do a one-and-done test at the onset of donations."
Data from 2022 showed white mothers having the highest number of maternal transfusions, followed by Black mothers.
A new report from the American College of Obstetricians and Gynecologists revealed a startling statistic: More than 60% of pregnancy-related deaths could have been prevented with improved quality and safety in the maternal care system.
Rogers noted the new law mandates insurance companies to provide support for people without health coverage or access to care.
"Often times people that are not able to access primary care or obstetrics care," Rogers observed. "This would require insurance coverage for blood pressure monitors, so mothers can check their blood pressure at home."
Rogers stressed the legislation expands access to postpartum mental health screenings. She added most bills in the package received strong bipartisan support in the Legislature.
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There are growing concerns about the prevalence of Christian Nationalism, an ideology that seeks to establish a theocracy rooted in Christian principles. Research indicates that about one-in-three Pennsylvanians support Christian Nationalist views, which opponents argue challenge the American ideal of separation of church and state.
Rachel Tabachnick, an independent researcher and former political research associate fellow, said the rise of Christian Nationalism, seen during the 2024 elections, threatens reproductive healthcare access.
"This is supposed to be a bottom-up theocracy based on biblical law being enforced at the family,
church and local civil government level. So, in order for this to work, women must stay in their God given roles, which is to have children and raise her family," she said.
On a recent episode of the "(In)Accessible" podcast, Tabachnick spoke about the history of Christian Nationalism, and how Theocratic Libertarianism advocates for laws based on biblical principles.
Tabachnick said that movement seeks minimal federal government and governance based on biblical law, aiming to dismantle institutions like the IRS and Department of Education.
Rebecca Susman, communications and development director with Keystone Progress, added that Project 2025, a 900-page guide by the Heritage Foundation, is intended as a blueprint for another Trump administration. The guide covers numerous issues, which Susman argues pose threats to basic rights and freedoms, particularly reproductive rights. She added that aspects of the plan were proposed last year.
"Conservatives have already begun implementing it, with one example being the addition of an anti-trans health care rider in a military spending act that was right out of the Project 2025 playbook, and it passed out of committee," Susman explained.
Tabachnick pointed out that in the 1970s and 1980s, the founders of Christian Reconstructionism wrote thousands of pages detailing how to reshape society and government under Old Testament law. Decades later, these blueprints remain relevant, as they were designed for a long-term transformation. Like Project 2025, most Americans reject these ideas, but they still need greater exposure and scrutiny.
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