A women's health report card issued Tuesday gave the U.S. an overall rating of "unsatisfactory" and issued failing grades on many specific public health goals, such as improving cervical cancer screenings, the New York Times reports.

The report card -- issued by the National Women's Law Center and Oregon Health and Science University -- is the fifth since 2000. It grades and ranks states and the District of Columbia based on how close they come to achieving the goals set by HHS on 26 health-status indicators included in the Healthy People 2010 initiative and various other policy indicators, such as whether insurance coverage of mammography is mandated.

Overall, Massachusetts and Vermont ranked highest on health status, receiving the grade of "satisfactory minus." Louisiana and Mississippi were ranked lowest, at 50th and 51st, respectively. Thirty-seven states received an "unsatisfactory," including New York, which ranked 22nd. California and New Jersey ranked highest on state health policies, while Idaho and South Dakota were ranked last on the list.

The report card showed a drop in cervical cancer screenings, with 78% of women ages 18 through 64 receiving pap tests in the last three years, compared with 84.8% in 2007. The Healthy People 2010 goal for cervical cancer screening is 90%, and it's not clear why the rate decreased, according to Michelle Berlin, an associate professor of obstetrics and gynecology at the Oregon Health and Science University School of Medicine and associate director of the university's Center for Women's Health. The drop is troubling and might reflect loss of health coverage or confusion over screening guidelines for women who have had the human papillomavirus vaccine -- a group that is supposed to be tested.

In addition, the report found an increase in positive tests for chlamydia, a sexually transmitted infection that can cause infertility if left untreated. Berlin said that the increase in reports of chlamydia infections might be attributed to more women being tested.

Berlin said the "takeaway message is that we're really not where we should be," adding, "We've had 10 years of doing this report card, and you would hope the needle would have moved more than this."

Judy Waxman, vice president of health and reproductive rights at NWLC, said the federal health reform law (PL 111-148) could help improve women's health through several provisions, including those that expand Medicaid eligibility and prohibit gender rating on health insurance policies (Rabin, New York Times, 12/9).

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