Women seeking abortions in South Dakota face a three-day waiting period and must undergo in-person counseling that necessitates two trips to the clinic. Nearly a quarter of women in the state live in a county that doesn’t have an abortion provider.

The state does not require insurers to cover infertility treatments, nor does it mandate sex education in schools.

The Institute for Women’s Policy Research says those reasons and more are why it considers South Dakota the worst state in the nation for reproductive rights, according to a recently released ranking.