Over 90 percent of transgender youth in the United States are living in states that have either passed or proposed legislation restricting their rights, according to a new study.

The alarming report from the Williams Institute at UCLA School of Law found that 93 percent of transgender minors ages 13 to 17 — approximately 280,300 people — live in states that have considered or enacted laws restricting their access to health care, sports, and school facilities. There are only an estimated 300,100 children ages 13 to 17 in the U.S. who identify as transgender.

A large percentage of trans youth live in states where such laws have been enacted, including 85 percent of trans youth in the South and 40 percent in the Midwest. 

Conversely, nearly half of all trans youth live within the 14 states that have enacted shield laws that protect access to gender-affirming care and prohibit conversion therapy. This includes all trans youth in the Northeast and 97 percent of those in the West. 

“For the second straight year, hundreds of bills impacting transgender youth were introduced in state legislatures,” lead author Elana Redfield, Federal Policy Director at the Williams Institute, said in a statement. “The diverging legal landscape has created a deep divide in the rights and protections for transgender youth and their families across the country.”

Almost 240,000 trans youth live in the 40 states that have considered bans on gender-affirming care, 24 of which have enacted such bans, impacting 113,900 children. Gender-affirming care bans are currently pending in 16 states, where 123,600 trans youth live. Forty-one states have also proposed or passed laws restricting participation in school sports, with 30 states vying to restrict transgender students’ bathroom use. 

“A growing body of research shows that efforts to support transgender youth are associated with better mental health,” said co-author Kerith Conron, Research Director at the Williams Institute. “Restrictions on medically appropriate care and full participation at school exacerbate the stress experienced by these youth and their families.”