Women in the US face increasing health threats, with significant disparities between states, according to a new report by the Commonwealth Fund. This inaugural state-by-state analysis assesses healthcare quality, outcomes, and access for women across 32 specific metrics, sourced from entities including the U.S. Centres for Disease Control and Prevention.
The report, released Thursday, ranks Massachusetts as the top state for women's health, followed by Vermont, Rhode Island, Connecticut, and New Hampshire. In contrast, the poorest performers were predominantly in the South, with Mississippi, Texas, Nevada, Oklahoma, and Arkansas at the bottom.
“This is the first time we 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. He emphasized that while some states are ensuring women’s access to vital health and reproductive services, many are failing, disproportionately impacting women of color and those with low incomes.
The report reveals alarming trends, including the lowest life expectancy for U.S. women in nearly two decades and significant variations in mortality rates among women of reproductive age across states. For instance, the mortality rate ranges from about 204 deaths per 100,000 women in West Virginia to around 71 per 100,000 in Hawaii.
Key factors contributing to these disparities include deaths related to pregnancy, substance use, COVID-19, and treatable chronic health conditions. The maternal death rate nearly doubled between 2018 and 2022, with the highest increases among Black, American Indian, and Alaska Native women.
Preventable deaths from breast and cervical cancer are also notably higher in Southern states, where timely screening and healthcare access are less available. The fractured landscape of health policies, including Medicaid coverage and access to reproductive care, contributes to these significant state-level inequalities.
“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,” said David Radley, a senior scientist for the Commonwealth Fund’s Tracking Health System Performance initiative.
Expanding Medicaid is linked to lower maternal mortality rates, reduced racial and ethnic disparities in maternal health, and broader use of reproductive health services. States with the lowest maternal mortality rates—Vermont, California, and Connecticut—have all expanded Medicaid. Conversely, the ten states that have not expanded Medicaid, including Alabama, Florida, Georgia, and Texas, rank below average on women's health.
The report also highlights that over 5 million women live in "maternity care deserts," areas with no hospitals, birth centres, or obstetric providers. States with restrictive abortion policies tend to have fewer maternity care providers and higher maternal mortality rates, exacerbating the challenges for women in those areas.
Fourteen states have enacted near-total bans on abortion since the Supreme Court's Dobbs decision, which revoked the federal right to abortion. Most of these states rank poorly in the new women’s health rankings, with several among the lowest performers.
“Policy choices at the state level, including Medicaid expansion and abortion restrictions, have clear implications for women’s access to healthcare,” said Sara Collins, senior scholar at the Commonwealth Fund. She questioned whether the current divides will continue or if trends might reverse, influenced by both state and federal politics.
As the nation grapples with these disparities, the report calls for policymakers to address the gaps in care, ensuring that all women, regardless of where they live, have access to quality, affordable healthcare.
