US States That Rank Highest and Lowest for Women’s Health in New Report

First published: 19/07/2024

Women in the United States face a growing number of threats to their health and well-being, and vast disparities exist from state to state, according to a new report from the Commonwealth Fund. This inaugural state-by-state analysis on women's health evaluates healthcare quality, outcomes, and access across the US, highlighting significant regional differences.

Top and Bottom Performers

The report, released Thursday, reveals that states in the Northeast scored highest in overall women's health. Massachusetts ranked as the best-performing state, followed by Vermont, Rhode Island, Connecticut, and New Hampshire. In contrast, the poorest performers were primarily located in the southern half of the country, with Mississippi at the bottom, followed by Texas, Nevada, Oklahoma, and Arkansas.

“This is the very first time we at the Fund have created a scorecard exclusively focused on states’ performance in reproductive care and women’s health,” said Dr. Joseph Betancourt, president of the Commonwealth Fund. “While some states undoubtedly are championing women’s continued access to vital health and reproductive services, many others are failing to ensure that women can get and afford the health care they need. This failure is having a disproportionate impact on women of colour and women with low incomes.”

A Perilous State of Women's Health

The report underscores a troubling decline in women’s health across the nation, with life expectancy for US women now at its lowest in nearly two decades. The authors highlight increases in deaths from preventable causes and significant disparities in mortality rates for women of reproductive age, ranging from 204 deaths per 100,000 women in West Virginia to 71 deaths per 100,000 in Hawaii.

“We looked at deaths from all causes among women and girls ages 15 to 44, and we found a threefold difference across states, with the highest rates of death concentrated in the Southeastern states,” said David Radley, a senior scientist for the Commonwealth Fund’s Tracking Health System Performance initiative.

Impact of Abortion Laws and Medicaid Expansion

The report emphasises the influence of state policies on health outcomes, particularly noting the impact of abortion laws and Medicaid expansion. States that have not expanded Medicaid tend to have higher uninsured rates among women, fewer healthcare providers, and worse overall health outcomes. Notably, the 14 states that enacted near-total abortion bans following the Supreme Court's Dobbs decision saw significant declines in women’s health rankings.

“We found big differences across states in a woman’s ability to access reproductive health care services, the quality of care she’s likely to receive, and the outcomes she’s likely to experience,” Radley said. “Uninsured rates among women ranged from 2.5% to over 20%, with the highest uninsured rates in states that have not expanded their Medicaid programs.”

The Consequences of Policy Choices

The Commonwealth Fund's report links policy decisions directly to health outcomes, pointing to significant disparities in states with restrictive abortion policies and those that have not expanded Medicaid. These states often have the fewest maternity care providers, higher rates of maternal mortality, and broader disparities in health systems.

“Policy choices that state lawmakers put forth, including fully expanding Medicaid and imposing abortion restrictions, have clearly had implications for people in their states,” said Sara Collins, senior scholar and vice president for health care coverage and access at the Commonwealth Fund.

Future Directions

The report raises critical questions about the future of women’s health in the US, particularly in states with restrictive health policies. “Are those divides that we’re seeing going to continue into the future?” asked Collins. “Are there going to be more women who are living in states that don’t have full access to reproductive health care? Or are those trends going to reverse? A lot of that is tied to the politics, both in states and at the federal level.”

As policymakers and healthcare providers grapple with these findings, the report underscores the urgent need for comprehensive reforms to ensure equitable access to quality healthcare for all women, regardless of where they live.