How Does Your State Rank on Women’s Health and Reproductive Care?
A new state-by-state women’s health scorecard released this week by the Commonwealth Fund reveals mounting disparities in women’s health and reproductive care across the United States. The findings raise concerns over the state of women’s healthcare and the ripple effects of the Supreme Court’s 2022 decision to overturn Roe v. Wade, which has significantly altered access to critical reproductive health care services.
The 2024 State Scorecard on Women’s Health and Reproductive Care is the Commonwealth Fund’s first comprehensive examination of women’s healthcare in all 50 states and the District of Columbia. Using the latest available data, the scorecard findings show significant disparities between states in reproductive care and women’s health, as well as deepening racial and ethnic gaps in health outcomes, with stark inequities in avoidable deaths and access to essential health services. The findings suggest these gaps could widen further, especially for women of color and those with low incomes in states with restricted access to comprehensive reproductive health care.
The following is an excerpted version of The Commonwealth Fund’s 2024 State Scorecard on Women’s Health and Reproductive Care. Explore the full report, including methodology, here.
Scorecard Highlights
Massachusetts, Vermont and Rhode Island top the rankings for the 2024 State Scorecard on Women’s Health and Reproductive Care, which is based on 32 measures of healthcare access, quality and health outcomes.
The lowest performers were Mississippi, Texas, Nevada and Oklahoma.
Deaths from all causes among women of reproductive age—15 to 44—were highest in southeastern states. Causes of death include pregnancy and other preventable causes such as substance use, COVID-19 and treatable chronic conditions.
The highest maternal death rates were in Tennessee, Mississippi and Louisiana. Vermont, California and Connecticut had the lowest rates. Nationally, rates were highest for Black and American Indian and Alaska Native (AIAN) women.
The highest rates of maternal mortality can be found in the Mississippi Delta, which includes Arkansas, Louisiana Mississippi and Tennessee. A substantial percentage of counties in all these states don’t have a single hospital or birth center with obstetric providers offering obstetric care.
These states also rank low on other potential contributors to maternal mortality: low rates of postpartum depression screening, high rates of low-risk cesarean births, and high uninsured rates prior to pregnancy. All four states had abortion restrictions prior to Dobbs, and they all now have full bans on abortion.
Mental health conditions are the most frequently reported cause of preventable pregnancy-related death, including deaths by suicide and overdoses related to substance use disorders. States that screened for postpartum depression at the highest rates also had lowest rates of postpartum depression.
Among women of reproductive age (ages 15–44), those in Texas, Georgia and Oklahoma were uninsured at the highest rates; those in Massachusetts, the District of Columbia and Vermont had the lowest uninsured rates. Women in states that had not expanded Medicaid eligibility were among those most at risk of lacking coverage.
The U.S. Supreme Court decision overturning Roe v. Wade in June 2022 has significantly altered both access to reproductive healthcare services and how providers are able to treat pregnancy complications in the 21 states that ban or restrict abortion access.
Nearly one-third of U.S. births are performed through a cesarean section surgery, or C-section. While cesarean delivery can be lifesaving in certain situations, the procedure is also associated with increased maternal morbidity and mortality, longer recovery, adverse outcomes in subsequent births, and negative impacts on infant health. As such, high rates of cesarean births for low-risk pregnancies are a key indicator of lower-quality healthcare.
The U.S. Department of Health and Human Services set a goal of 23.6 percent or lower C-sections for low-risk births by 2030. It was 26.3 percent in 2022.
Low-risk cesarean births are performed at the highest rates in the Deep South and in a few states in the Northeast, including New York and Connecticut. A county-level analysis found that rates of C-sections in the South were high in both urban and rural areas. This research also found that regions with the highest rates of cesarean births were home to more Black and Hispanic people.
Deaths from breast and cervical cancer are considered preventable and treatable with timely screening and health care. There is significant regional variation in death rates from both cancers.
- States with among the highest rates are clustered in the Southeast.
- Northeastern states generally have the highest breast and cervical cancer screening rates and the lowest mortality rates from these cancers.
- Southern states tend to have higher-than-average mortality from these cancers and lower screening rates.
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Sara R. Collins, Ph.D., is senior scholar and vice president for health care coverage and access and tracking health system performance at The Commonwealth Fund. An economist, Dr. Collins directs the Fund’s program on insurance coverage and access and the research initiative on tracking health system performance which produces the Fund’s annual scorecard on state health system performance. Since joining the Fund in 2002, Dr. Collins has led several multi-year national surveys on health insurance and authored numerous reports, issue briefs, blog posts, and journal articles on health insurance coverage, health reform, the Affordable Care Act, and state health system performance. She has provided invited testimony on 17 occasions before several Congressional committees and subcommittees. Prior to joining the Fund, Dr. Collins was associate director/senior research associate at the New York Academy of Medicine, Division of Health and Science Policy. Earlier in her career, she was an associate editor at U.S. News & World Report, a senior economist at Health Economics Research, and a senior health policy advisor in the New York City Office of the Public Advocate. She holds an A.B. in economics from Washington University and a Ph.D. in economics from George Washington University.
David C. Radley, Ph.D., M.P.H., is a senior scientist for the Commonwealth Fund’s Tracking Health System Performance initiative and director of data and analytics at the Center for Evidence-Based Policy at Oregon Health and Science University (OHSU). He is a health services researcher with expertise in small-area analysis and in the design, implementation, and interpretation of observational studies that take advantage of large administrative and survey-based datasets. Prior to joining OHSU, he help positions at Westat, the Institute for Healthcare Improvement, and Abt Associates. Radley received his Ph.D. in health policy from the Dartmouth Institute for Health Policy and Clinical Practice. He holds a B.A. from Syracuse University and an M.P.H. from Yale University.
Laurie C. Zephyrin, M.D., M.P.H., M.B.A., is senior vice president for Advancing Health Equity at the Commonwealth Fund. She has extensive experience leading the vision, design, and delivery of innovative health care models across national health systems. From 2009–2018, she was the first national director of the Reproductive Health Program at the Department of Veterans Affairs, spearheading the strategic vision and leading systems change through the implementation of evidence-based policies and programs to improve the health of women veterans nationwide. In 2016–2017, she served as acting assistant deputy under secretary for Health for Community Care, and later in 2017, as acting deputy under secretary for Health for Community Care. While directing the VA’s Community Care program, a key component of VA’s high-performance network with an operating budget of over $13 billion, Zephyrin spearheaded efforts to implement legislation, develop internal governance structures, and address patient outcomes through systemwide optimization of care delivery. As part of the leadership team, she also represented VA before Congress and other internal and external stakeholders. Zephyrin is a board-certified clinician. She is a clinical assistant professor of Obstetrics and Gynecology at NYU Langone School of Medicine (2013–present) and was previously an assistant professor at Columbia University, College of Physicians and Surgeons (2007–2012). She earned her M.D. from the New York University School of Medicine, M.B.A. and M.P.H. from Johns Hopkins University, and B.S. in Biomedical Sciences from the City College of New York. She completed her residency training at Harvard’s Integrated Residency Program at Brigham and Women’s Hospital and Massachusetts General Hospital.
Arnav Shah, M.P.P., is senior research associate for the Commonwealth Fund’s policy and research department. In this role, Mr. Shah provides support to a department charged with adding value to the Fund’s work in all of its core areas, working with staff to develop the research design of grant proposals and future publications, as well as reviewing those proposals or publications. He contributes research and analytic support to publications across the Fund’s program areas. Mr. Shah came to the Fund from the University of Michigan’s Gerald R. Ford School of Public Policy, where he completed a master’s degree in public policy. During graduate school, he worked for the Center for Healthcare Research and Transformation and the University of Michigan’s Center for Value-Based Insurance Design. Prior to graduate school, Mr. Shah was a research assistant in the Health Policy Center of the Urban Institute and a health policy intern for the Center on Budget and Policy Priorities. A native of New York City, Mr. Shah obtained his B.A. in political science at George Washington University.
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