South Dakota is the worst state for women’s reproductive rights, while Oregon ranks as the best, according to a new report.

The Institute for Women’s Policy Research (IWPR) released new data last week on reproductive rights, sexual violence, and women’s health as part of their “Status of Women in the States” series, which compares women’s well-being across the 50 U.S. states and the District of Columbia.

Other recent IWPR data has examined women’s earnings and opportunity.

IWPR looked at a broad spectrum of reproductive rights issues to give each state a letter grade: whether a state has certain anti-choice laws in place (parental notification laws for minors, waiting periods, or restrictions on public funding for abortions); whether the governor and legislature is pro- or anti-choice; whether the state has expanded Medicaid; what kind of coverage for infertility women get, whether same-sex couples can marry or adopt children; whether sex education is mandatory; and how many women in the state live in counties with at least one abortion provider.

Seventeen states got a B or higher, and the highest grade any state got was an A-minus. States in the Northeast and West scored the highest on reproductive rights, while states in the South and Midwest scored the lowest.

Oregon, with Democratic majorities in both legislative chambers, was one of the high achievers. The state has strong reproductive rights policies on every factor IWPR examined except requiring insurance companies to cover infertility treatments. Seventy-eight percent of women in Oregon live in counties that have an abortion provider.

South Dakota, dead last in the rankings, was a different story.

Twenty-three percent of women in South Dakota live in counties that have an abortion provider, and the GOP-dominated legislature has imposed severe restrictions on abortion, including an onerous 72-hour waiting period that doesn’t include weekends. The state’s anti-choice state government hasn’t expanded Medicaid, and same-sex couples can’t marry or do a second-parent adoption.

Eighty-one percent of legislators in the South Dakota house and senate are Republicans.

South Dakota lawmakers routinely try to restrict reproductive rights even further. One lawmaker who famously compared Planned Parenthood to the Islamic State recently introduced a bill that could eliminate second-trimester abortion, although it ultimately failed to gain support.

Even though states have passed a record number of anti-choice laws in the past four years, the report also shows that reproductive rights in the United States have been in trouble for longer than that.

Compared to 2004, the last time IWPR put out this report, more states have enacted waiting periods—but not many more. Thirty states have waiting periods on the books today, but 26 already had them in place in 2004.

The same number of jurisdictions (43) have forced parental notification laws for abortion today as did a decade ago, and there are remain only 17 states that will use Medicaid funds to pay for a medically necessary abortion for a low-income woman.

By other measures, women’s health has improved in some ways and worsened in others over the past decade.

Fewer women are dying of heart disease and lung or breast cancer, and the incidence of AIDS declined by 44 percent. But many more women have diabetes and chlamydia, and die by suicide. Women had more poor mental health days, and they are still more likely to suffer poor mental health than men.

The report also looked at the rates of violence against women. Nearly one in three women experience physical violence from an intimate partner in their lifetime, almost half experience psychological aggression from an intimate partner, and one in seven teen girls experience sexual dating violence.

A woman’s likelihood of experiencing sexual violence is closely related to her race or sexual orientation. Bisexual women were much more likely to experience sexual violence than either straight or lesbian women—almost half have reported being raped, and about three-quarter reported other sexual violence. And more than half of Native American and multiracial women experienced physical violence from an intimate partner.

“Good health is critical to women’s financial stability, educational attainment, and employment,” said IWPR president Heidi Hartmann. “It is great news that we have seen significant improvements in women’s mortality rates from some chronic diseases, but to improve women’s mental health and ensure that improved health outcomes extend to all women across race, ethnicity, and geography, we need to do more.”