Mounting disparities in women's health, reproductive care found across U.S.

NEW YORK, July 18 (UPI) -- A state-by-state report released Thursday by a private foundation casts the spotlight on widening disparities in women's health and reproductive care across the United States.

Produced by the New York-based Commonwealth Fund, which conducts independent research on key health care issues, the 2024 State Scorecard on Women's Health and Reproductive Care examines the consequences of the Supreme Court 's 2022 decision to overturn Roe vs. Wade, which has reduced access to services.

As the fund's first extensive review of women's health care in all 50 states and the District of Columbia, the report relies on 32 measures to assess each state on health care access, affordability, quality of care and outcomes. It includes the most recent data available, from 2022, when the high court reversed the landmark Roe vs. Wade decision.

Massachusetts, Vermont and Rhode Island were the top states for protecting women's health, while Oklahoma, Texas and Mississippi ranked last, according to the report.

These gaps could widen even more, particularly for women of color and those with low incomes in states where comprehensive reproductive health care is difficult to obtain, leading to striking inequities in preventable deaths, said Dr. Joseph Betancourt, president of The Commonwealth Fund.

"These inequities are longstanding, no doubt, but recent policy choices and judicial decisions, restricting access to reproductive care have and may continue to exacerbate them," Betancourt said at a media briefing Wednesday.

"Our hope is that these in-depth, state-by-state findings will help inform federal and state policymakers and health care delivery system leaders, and their efforts to strengthen women's health and ensure that all women can get the health care they need when they need it," added Sara Collins , the fund's senior scholar and vice president of healthcare coverage and access and tracking health system performance.

The scorecard examined deaths from all causes among women and girls ages 15 to 44, a common way to identify females of reproductive age. In 2022, roughly 70,000 deaths from all causes occurred in this age group, said David Radley, a senior scientist tracking health system performance at the fund.

"Suicide, cancer and complications from pregnancy are among the leading causes of death for women in this age range," Radley said.

In providing "a vital baseline for tracking the ripple effects" of the Supreme Court's decision, he added that the scorecard "also serves as a glaring reminder that where you live matters to your health and health care."

For example, the report found a threefold difference in all-cause mortality between Hawaii, the state with the lowest rate, and West Virginia, the state with the highest rate.

The researchers factored in insurance coverage and found that uninsured rates among women ranged from 2 1/2% to more than 20%. The highest uninsured rates were among those states that have not expanded their Medicaid programs.

However, access isn't only about having coverage -- it's also about being able to reach a service provider when care is needed, Radley noted.

"It's estimated that over 5 million women already live in a county that's considered a maternity care desert, meaning there's no hospital or birth center offering obstetric care, and there are no obstetric providers."

The report found that states with the most restrictive abortion policies also tended to have the fewest maternity care providers.

"There's concern among experts that abortion bans and restrictions may reduce the number of maternity care providers even further," Radley said.

The report also provides maternal mortality rates across all states in which data are available. (It was missing eight states because of small counts.) These deaths are specifically associated with pregnancy or occur within 42 days of being pregnant.

"Combined with disparities and socioeconomic status, underlying health and quality of care have helped to drive the maternal mortality rate in the U.S. higher than that of other high-income countries," Radley said.

The highest rates of maternal mortality were in the Mississippi Delta states, including Arkansas, Louisiana, Mississippi and Tennessee.

"These are also states where a large number of counties don't have even a single hospital or birth center with providers who offer obstetric care," Radley said.

A commonly used quality measure of maternity care is the frequency of birth by Caesarean section among low-risk pregnancies, which includes full-term pregnancies, among women giving birth for the first time and when the child is not in breech.

While Cesarean delivery can be a lifesaver in certain situations, Radley said that the procedure also is associated with increased maternal death, greater likelihood of infection, longer recovery and greater pain.

Caesarean deliveries were highest among a few northeastern states and across several southern states, according to the report. While rates in these states are still above the national quality targets, low-risk Caesarean deliveries have fallen nationally in recent years.

Another key quality measure associated with pregnancy that the report assessed is how often women who recently gave birth are screened for postpartum depression. Women were least likely to report being screened in Mississippi, Arkansas and Alabama, the report said.

"Conversely, many states with the lowest rates of postpartum depression are also the states where the highest share of women who recently gave birth reported being screened, including Vermont, Massachusetts and Minnesota," Radley said.

The report also looked at the share of women in each state who are up to date with age-appropriate breast and cervical cancer screening.

"We see a distinct regional pattern with women in southern states experiencing the highest mortality from these treatable cancers," Collins said.

"While both breast and cervical cancer screening rates are relatively high in all states, there's still room to improve," Radley added.

He singled out Wyoming as an example. There, 65% of women are up to date with breast cancer screening but 35% are not. Overall, 18% to 23% of eligible women in all states are not up to date with recommended screenings.

Although the Affordable Care Act has improved access for people across the income spectrum, "women's health is in a fragile place," Collins said. "We are seeing a deep and likely growing geographic divide."