A new report ranks the best and worst states for women’s health

Cancers and mental health conditions are increasingly going untreated in women of reproductive age. And a new report says the lack of Medicaid expansion and restrictions on reproductive health care in some states are largely at fault. 

The report released last month from The Commonwealth Fund, a health care policy research organization, illustrates the consequences of state policies affecting women’s health and reproductive care. The implications are far-reaching and severe: Girls and women between the ages of 15 and 44 are dying from preventable causes across the U.S. 

Health experts raised concerns about women’s health during the pandemic, after the Centers for Disease Control and Prevention reported a 38% increase in preventable pregnancy-related deaths between 2020 and 2021. 

The outlook is grimmer for women of color, who are also more likely to be low income. The maternal mortality rate for Black women is about three times that of white women, according to the CDC. Without intervention, the trends indicate widening health disparities, said Sara Collins, a senior scholar at The Commonwealth Fund.

“The choices that states make on a policy basis really do impact how their health systems are performing,” she said. States where legislators have “expanded their Medicaid programs and made reproductive health care legal and accessible” have “achieved lower maternal mortality rates, [and have] more maternal health care workers, more prenatal and postpartum checkups and higher rates of [health] screening,” she said 

Massachusetts, Rhode Island and Vermont, for example, were the leading states in women’s health and reproductive care, according to more than 30 metrics that researchers assessed. The metrics weighed included rates of uninsured women, the receipt of health screenings, reported mental health conditions and other factors. 

These states have adopted policies that provide insurance coverage for the bulk of their population and keep insurance costs low, Collins said. Massachusetts, Rhode Island and Vermont each expanded Medicaid in 2014, which has helped increase women’s access to and ability to afford pregnancy-related medical appointments and services.

The lowest overall ranking states were Mississippi, Nevada, Oklahoma and Texas. “We’re seeing a deep and likely growing geographic divide in U.S. women’s ability to access vital health services and maintain their health,” Collins said.

Indeed, Mississippi and Texas have not expanded Medicaid. Plus, states with the highest maternal death rates were located around the Mississippi Delta region, such as Arkansas, Louisiana, Mississippi and Tennessee. Those states had abortion restrictions prior to the overturning of Roe v. Wade in 2022, Collins said, and have moved to implement total abortion bans since then. 

Expanding affordable health coverage, Collins said, can increase women’s access to preventative screening for serious conditions like postpartum depression and breast or cervical cancer. 

In fact, states with a lower percentage of women who were screened for postpartum depression also had a higher percentage of individuals who reported experiencing the condition. In Louisiana, for instance, 76% of women who recently gave birth were screened for postpartum depression, compared with 12% who reported having it, according to 2021 data from the Pregnancy Risk Assessment Monitoring System. In contrast, 94% of women in Vermont were screened, and only 9% said they experienced postpartum depression. 

Preventative breast and cervical cancer screening rates are generally high nationally, as the Affordable Care Act requires private and public insurers to cover those services. However, coverage for follow-up screening appointments, where adverse results are more likely to be detected, is not required, Collins said. The gap in access to secondary screenings likely contributes to higher rates of breast and cervical cancer deaths among women. States should consider pouring more funding into preventative reproductive services, she added, and expanding insurance coverage for reproductive health services. 

Most states, for instance, have moved to expand postpartum coverage under Medicaid from 60 days to 12 months. Forty-seven states have implemented the expanded coverage option, with Idaho, Iowa and Wisconsin policymakers moving to adopt it as well, she said. 

But insurance coverage isn’t the only step needed to ensure women access the care they need. In some states, communities simply do not have medical facilities available for soon-to-be and new parents. Maternity care deserts, or communities without a facility providing obstetric care and obstetric providers, were prevalent in nearly 40% of U.S. counties, the report stated. 

The lack of maternal health providers is largely due to increasingly restrictive abortion and other reproductive health laws, Collins said. Twenty-four states, for instance, implemented tight limits on the procedure, 21 of which “have the fewest number of maternity care providers relative to the number of women who might need them,” the report stated. 

Plus, Collins said, fewer medical school graduates in obstetrics and gynecology are applying to residency programs in those states since 2023. That’s concerning because “there is a relationship with [maternal health outcomes] and the number of providers in the state.” 

Community-based care models, however, can help fill gaps in health care services and resources. “Research shows that community-based care provided through doulas, midwives, freestanding birth centers, group prenatal care [and] pregnancy medical homes have the capacity to reduce maternal mortality,” Collins said. 

Alaska, for instance, generally ranks lower in health care and outcomes, but has the most midwife-attended births in the U.S., according to the report. Midwives can provide additional supports to new parents, such as providing prenatal care, performing ultrasounds and other exams like pap smear tests, and other services. 

Ultimately, the maternal and reproductive health policies state officials determine “will continue to affect the number of people that get care throughout their pregnancy,” Collins said. “There’s a linkage between policy choice and the ripple effects through states’ health systems.”