New Report Shows Worsening Health Outcomes for Women in States With Abortion Bans

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Mississippi, Texas, Nevada, and Oklahoma are among the poorest-performing states overall for women’s health care access, quality, and outcomes, while Massachusetts, Vermont, and Rhode Island rank at the top, according to a new state-by-state scorecard. The scorecard examining women's health was released today by the Commonwealth Fund and revealed disparities in women’s health and reproductive care across the United States.¹

The findings raise concerns over the state of women’s health care in the US 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 US Supreme Court decision overturning Roe v Wade in June 2022 has significantly altered both access to reproductive health care services and how providers are able to treat pregnancy complications in the 21 states that ban or restrict abortion access," the report stated.

The 2024 State Scorecard on Women’s Health and Reproductive Care is the Fund’s first comprehensive examination of women’s health care in all 50 states plus the District of Columbia. The report, part of the Commonwealth Fund’s ongoing series on state health system performance, used 32 measures to evaluate each state on health care access, affordability, quality of care, and health outcomes for women nationwide.

Using the latest available data, the results demonstrate 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.

Earlier this year, during a Senate hearing led by the US Senate Committee on Health, Education, Labor, and Pensions (HELP), the Sen Laphonza Butler (D, California), emphasized the need to address gaps in maternal health care, especially among minority populations.²

“Our health care system and the state of maternal health in this country is at an inflection point that requires the urgent attention of this committee; the numbers should alarm all of us,” she said. “The United States has the highest rate of maternal mortality among high-income nations; within recent years, thousands of women have lost their lives due to pregnancy-related causes. And over the past decade, while the birth rate in this country has declined by roughly 20%, maternal mortality rates have steadily risen. The crisis is exacerbated in communities grappling with the lack of access to essential maternal health care.”

Notable Findings

The report highlights significant disparities in women's health system performance, showing the 5 lowest-ranked states are Mississippi, Texas, Nevada, Oklahoma, and Arkansas, while the highest-ranked are Massachusetts, Vermont, Rhode Island, Connecticut, and New Hampshire.¹ States with abortion restrictions often have fewer maternity care providers; for instance, Arkansas, Oklahoma, Alabama, and Idaho have the fewest, ranging from 52 to 56 providers per 100,000 women of reproductive age.

In contrast, the District of Columbia, Vermont, and Connecticut have more than double that amount, ranging from 128 to 160 providers. Women of reproductive age in Texas, Georgia, and Oklahoma have the highest uninsured rates, while those in Massachusetts; Washington, DC; and Vermont have the lowest. Women in states that have not expanded Medicaid eligibility are most at risk of lacking coverage and skipping needed care due to cost.

Since 2019, nearly all states have seen an upward trend in syphilis infections among women of reproductive age, with the highest rates in South Dakota, New Mexico, Mississippi, Arkansas, and Oklahoma. These infections are most prevalent among American Indian and Alaska Native women. Maternal death rates are highest in the Mississippi Delta region, encompassing Arkansas, Louisiana, Mississippi, and Tennessee, all of which had abortion restrictions prior to the Supreme Court's decision to overturn the constitutional right to an abortion and now have total abortion bans.

Conversely, Vermont, California, and Connecticut have the lowest maternal death rates. Deaths among women aged 15 to 44 are highest in southeastern states, with top causes including preventable factors such as pregnancy complications, substance use, COVID-19, and breast or cervical cancer. Death rates from all causes per 100,000 women of reproductive age range from 70.5 in Hawaii to 203.6 in West Virginia.

Mental health conditions, including suicide and substance use disorder overdoses, are the most frequently reported causes of preventable pregnancy-related deaths. States with the highest rates of postpartum depression screening also report the lowest rates of postpartum depression.

Ranking Methods

States were evaluated on 32 performance indicators grouped into 3 dimensions. The report generally reflects data from 2021 and 2022.

• Health Outcomes (12 indicators): includes indicators of all-cause, maternal, and infant mortality, breast and cervical cancer deaths, preterm births, mental health conditions, syphilis infections, and intimate partner violence.
• Coverage, Access, and Affordability (8 indicators): includes rates of uninsurance for women, indicators of forgone care due to cost, usual source of care, maternity care workforce, and abortion access.
• Health Care Quality and Prevention (12 indicators): includes measures of receipt of preventive care (flu shot, breast and cervical cancer screenings, postpartum depression screening, dental cleaning), and some measures of quality such as prenatal care and low-risk cesarean births.

Performance Metrics

The 32 metrics selected for this report span health care system performance, representing important dimensions and measurable aspects of care delivery and population health. Where possible, indicators align with those used in previous scorecards.

Data Sources

Indicators generally draw from publicly available data sources, including government-sponsored surveys, registries, publicly reported quality indicators, vital statistics, and mortality data. Data on abortion clinics were obtained upon request from the Advancing New Standards in Reproductive Health Abortion Facility Database at the University of California, San Francisco. The most current data available were used in this report whenever possible.

Scoring and Ranking Methodology

For each indicator, a state’s standardized z-score was calculated by subtracting the 51-state average (including the District of Columbia as if it were a state) from the state’s observed rate and then dividing by the standard deviation of all observed state rates. States’ standardized z-scores were averaged across all indicators within the performance dimension, and dimension scores were averaged into an overall score. Ranks were assigned based on the overall score. According to the report, this approach gives each dimension equal weight, and within each dimension, it weights all indicators equally, accommodating the different scales used across the scorecard indicators.

Urgent Need for Policy Interventions

In summary, the 2024 State Scorecard on Women’s Health and Reproductive Care by the Commonwealth Fund reveals major disparities in women’s health care across the country. Mississippi, Texas, Nevada, and Oklahoma rank lowest, while Massachusetts, Vermont, and Rhode Island rank highest. The report highlights how states with abortion restrictions have fewer maternity care providers and higher maternal mortality rates, especially in the Mississippi Delta. Rising syphilis infections and death rates among women of reproductive age, particularly in southeastern states, further underscore the need for policy interventions to address these growing health care inequities.

The Commonwealth Fund's evaluation of 32 performance indicators across health outcomes, coverage, access, and quality offers a comprehensive look at the state of women's health. Drawing from available data, the scorecard provides a clear ranking system, emphasizing the urgent need for improvements to close the gaps in health care access and outcomes, especially for women of color and those with low incomes.

References

1. Collins SR, Radley DC, Roy S, Zephyrin LC, Shah A. 2024 State Scorecard on Women’s Health and Reproductive Care. The Commonwealth Fund. July 18, 2024. https://www.commonwealthfund.org/publications/scorecard/2024/jul/2024-state-scorecard-womens-health-and-reproductive-care

2. Grossi G. Panel addresses minority physician shortage, maternal health at Senate committee hearing. AJMC^®. May 15, 2024. https://www.ajmc.com/view/panel-addresses-minority-physician-shortage-maternal-health-at-senate-committee-hearing