Key Findings


The 2010 edition of Making the Grade on Women’s Health: A National and State-by-State Report Card shows that the nation and the states continue to fall short in meeting women’s health needs. Despite some progress on individual health status indicators, overall the nation is still so far from meeting key women’s health objectives that it receives a grade of “Unsatisfactory” in this fifth and last report for this decade. Additionally, the Report Card  shows that while states continue to adopt policies to advance women’s health, progress has slowed—and in some cases stagnated—at a time when they still have a long way to go. Fortunately, a new health policy landscape is forming as a result of the federal health care law (the Patient Protection and Affordable Care Act or ACA) that was enacted in March 2010. Many of the policy goals examined in the Report Card will be realized as the ACA is implemented. With the law’s emphasis on access to health care—including the critical preventive services that women need to stay healthy—the new law can, over time, lead to major improvements in the health status of women.

Summary Findings At-A-Glance

  • The nation continues to receive an overall grade of unsatisfactory.
  • No state receives an overall grade of satisfactory. Two states—Massachusetts and Vermont—receive the next highest grade of "S-."
  • The nation meets just three benchmarks. These benchmarks are the same as those that were met in the 2007 Report Card: the percentage of women getting mammograms regularly, the percentage of women visiting the dentist annually, and the percentage of women getting screened for colorectal cancer.
  • Compared to 2007, the nation received a higher grade for one indicator (moving from a “U” to an “S-” in cholesterol screening) and a lower grade for two indicators (moving from an “S-” to an “F” in binge drinking,1 and from a "U" to an "F" in Pap smear rates)—otherwise grades remained the same.
  • Most states show progress in status indicators such as death rates from stroke and coronary heart disease. Yet overall the country receives failing grades in these areas, demonstrating how much improvement is still needed.
  • Of the 68 policies that were assessed for the 2010 Report Card, only two policy goals are met by all states: Medicaid coverage for breast and cervical cancer treatment and participation in the Food Stamp Nutrition and Education Program (FSNEP). No state meets the policy goal of passing "clinic access" legislation that adequately protects women and health care providers from violence and harassment at reproductive health centers.
  • On average, states improved three policies and weakened only one policy.The most improved policies among states are coverage of smoking cessation services in Medicaid and increases in the excise tax on cigarettes. Notably, in 42 states the rate of smoking among women has declined, making this one of the most improved health status indicators.
  • Two-thirds of the Report Card’s policy indicators are addressed in some way by the federal health care law (the Affordable Care Act) that was enacted in March 2010. Because of the many policy improvements that the Affordable Care Act requires, the new law can, over time, lead to major improvements in the health status of women.


Women’s Health Status Indicators

Health objectives set for the nation by the U.S. Department of Health and Human Services’ Healthy People 2010 agenda, along with additional benchmarks adapted specifically for women’s health, have served as a roadmap for the Report Card by providing a set of targets to be achieved by the end of this decade. Now having reached 2010, the nation and individual states have failed to meet key health objectives for the bulk of women’s health status indicators. 

Nation's Performance

Nation's Grade U
Number of Benchmarks Met 3
Number of Benchmarks Missed 23

Overall, the nation is still so far from the Healthy People and related goals that it receives a grade of “Unsatisfactory.” With regard to individual status indicators, the country receives a “Satisfactory” in only three of the 26 graded indicators, just as it did when the Report Card was last published in 2007 (see National Report Card for a complete list of grades).  The three goals met by the nation—the percentage of women age 40 and older across the country getting mammograms regularly, the percentage of women visiting the dentist annually, and the percentage of women age 50 and older who receive screenings for colorectal cancer—are important achievements for women. However, the nation must improve considerably on every other goal. In fact, it receives a failing “F” grade in 13 of the 26 graded indicators. The most disturbing trends over the past three years have been a marked increase in the proportion of women who report binge drinking1—a dangerous form of alcohol abuse that involves having, for women, four or more drinks on one occasion—and a considerable decline in the percentage of women who get a regular Pap smear, the primary test to detect cervical cancer. (Chart 1 shows the most widely declined status indicators among the states.) The nation’s grade for binge drinking declined from “Satisfactory minus” to “Failing,” and the grade for Pap test rates dropped from “Unsatisfactory” to “Failing.” 

Cholesterol screening was the only area where women’s health improved enough to merit a higher grade when compared to 2007 (increasing 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. (Chart 1 shows the most widely improved status indicators among the states.)

When looking at each state, in none do women enjoy overall satisfactory health status, and just two states receive the next highest grade of “Satisfactory minus” (Vermont and Massachusetts), a decline since 2007 when three states had this distinction. The majority of states (37) receive an “Unsatisfactory” grade, and about a quarter of all states (12) receive an overall “Failing” grade. Compared to 2007, one state—Indiana—received a higher grade (increasing from “Failing” to “Unsatisfactory”) and two states received a lower grade. Minnesota’s grade declined from “Satisfactory minus” to “Unsatisfactory,” while Missouri’s grade declined from “Unsatisfactory” to “Failing.”

Only two benchmarks were met by all the states—the percentage of women visiting the dentist annually, and the percentage of women age 50 and older who are screened for colorectal cancer—representing some progress from 2007, when only one benchmark (annual dental visits) was met by all the states. Collectively, the states missed the same ten benchmarks as in 2007 plus an additional benchmark—the percentage of women with Chlamydia—for a total of eleven benchmarks missed by all states in 2010 (see Chart 2).  Just as in 2007, twelve states received an overall failing grade because their performance was so weak. As has been the case since the 2004 Report Card, Arkansas, Louisiana, and Mississippi receive the lowest rankings. 

On the whole, gains in meeting women’s health needs have been limited and are undermined by decline in other areas. It is also important to note that Report Card grades are based on data for women overall; given the disparities in health outcomes experienced by some populations (e.g., women of color, low-income women), the nation and individual states are undoubtedly failing many women by an even greater margin than the grades suggest. Read more about the importance of data collection to address health disparities among women.

Moreover, the 2010 Report Card uses the same grading scale—with the same “cut-off” points for failing, unsatisfactory, and other grades—as the previous Report Card, even though the nation and states have had an additional three years to meet the benchmarks upon which the grades are based. This is a change from 2007, when the Report Card held the nation and states to a higher standard than in 2004, under the assumption that as the decade progressed, they should be considerably closer to meeting Healthy People 2010 benchmarks and related goals than in earlier years. However, in view of the troubled economic environment that has plagued the country for the past several years, the 2010 Report Card maintains the grading scale for 2007.  If a more stringent grading scale had been adopted for 2010, the Report Card would have shown considerable declines and virtually no progress in grades.

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