Iowa is one of the lowest-ranking states in the Midwest for LGBTQ+ equality, according to an annual index evaluating all 50 states on LGBTQ+ inclusion and its effect on business.

The state ranked No. 9 out of 12, with Illinois having the highest score of the region and South Dakota sitting at the bottom.

Out Leadership’s State LGBTQ+ Business Climate Index measures legislation impacting LGBTQ+ youth and adults in a state, access to health care, senior elected officials’ views and response to discriminatory legislation and other factors.

This is used to rank all U.S. states to display what states succeed, or fail, at LGBTQ+ equality and act as a resource for employers determining where to do business and how leaders can push for inclusion — which the Out Leadership organization believes benefits employers, employees and the communities they serve.

Here’s how the state performed in this year’s index.

How did Iowa rank nationally on LGBTQ+ index?

The state ranks No. 34 nationally with a score 49.60 out of 100. For context, neighboring Illinois scored 88.47. The higher the number, the better a state scored for providing protections for LGBTQ+ people.

Iowa’s score for 2024 dropped compared to last year’s index, when its score was 55. The state was ranked No. 24 with a score of 57.73 when the index was first released in 2019.

Iowa and Florida are tied for fourth place in states with the largest dip in scores in the State LGBTQ+ Business Climate Index. Indiana, Kansas and North Carolina followed as the states that saw the biggest declines in LGBTQ+ inclusion.

Lawmakers in Iowa passed bills in 2023 banning gender-affirming medical procedures for people under 18 and banning transgender youth from using school bathrooms that align with their gender identity. Last summer, a sweeping education law known as Senate File 496 went into effect, which bans instruction on gender identity and sexual orientation through the sixth grade in Iowa and prohibits books depicting sex acts in school libraries.

Two lawsuits were filed to block parts of the law, including that schools must inform parents if a student asks to use a different pronoun.

In February, Gov. Kim Reynolds introduced a bill that would define “sex,” “man” and “woman” in state law and what LGBTQ+ rights advocates described as “erasure” of transgender and nonbinary Iowans. The bill did not pass.

More: ‘It’s going to hurt so many people’: Iowa book ban law draws lawsuits from students, families

What is the best and worst state for LGBTQ+ equality in America?

New York scored the highest, 93.67 out of 100, across all 50 states. It’s the second year in a row that New York ranked the highest for LGBTQ equality.

The lowest-ranking state in LGBTQ+ equality is Arkansas. Its score of 27 is the lowest score a state has received in the index’s six-year history, according to Out Leadership.

Paris Barraza is a trending and general assignment reporter at the Des Moines Register. Reach her at pbarraza@registermedia.com. Follow her on Twitter @ParisBarraza.

This article originally appeared on Des Moines Register: LGBTQ+ equality ranking shows Iowa is slipping, New York as best state