It looks like America is going to have to hit the books a little harder. According to a new report released by the Population Institute , the United States gets a D grade when it comes to reproductive health. Some more bad news? Last year, the U.S. got a D+. In addition to looking at the nation as a whole, the Population Institute gave each state a letter grade, too, and that news is a little more positive: a total of five states earned an A. In its analysis, the Population Institute looked at four different factors of reproductive health: effectiveness, which takes into account the number of teen pregnancies and percentage of unintended pregnancies; prevention, such as education programs, access to emergency contraception, and allowing minors to have access to contraception; affordability, including access to birth control for those without insurance and low-income individuals; and access, which looks at how "burdensome" it is to seek family planning and abortion services. The Population Institute adds that "the political outlook for 2017 is bleak," so things may not get better anytime soon. It cites the general atmosphere around reproductive health being "hostile" and adds that well as the nation's teen pregnancy rate , which is the highest in the developed world. A total of 20 states failed. Alabama, Arkansas, Florida, Georgia, Tennessee, Texas, Utah, and Virginia had some of the lowest scores. The five states at the top of the class? California, New Jersey, New Mexico, Oregon, and Washington state. Interested in seeing exactly how your home state measured up? Check out all 50 report cards at the Population Institute