WalletHub last week released its 2022 list of the "Best & Worst States to Have a Baby," ranking Massachusetts as No. 1.

Cheat sheet: Infant health inequity

Methodology

For the report, WalletHub used 32 measures to assess the 50 states and the District of Columbia in four areas, including:

1. Cost, which determined 20% of a state's overall score

2. Health care accessibility, which determined 40% of a state's overall score

3. Baby-friendliness, which determined 20% of a state's overall score

4. Family-friendliness, which determined 20% of a state's overall score

Each category received a grade on a 100-point scale, with a score of 100 representing the best conditions for expecting parents and newborns.

Findings

According to WalletHub, after Massachusetts, which scored 71.11 out of 100, the top states to have a baby in 2022 were:

2. Vermont, which scored 69.28

3. Rhode Island, which scored 67.11

4. Minnesota, which scored 66.17

5. New Hampshire, which scored 65.78

By contrast, the states at the bottom of the rankings were:

51. Alabama, which scored 24.89

50. Mississippi, which scored 25.34

49. South Carolina, which scored 26.31

48. Louisiana, which scored 29.62

47. Georgia, which scored 32.08

WalletHub also ranked the states individually on the four categories, with:

• Ohio ranking first for cost and California ranking last
• Vermont ranking first for health care accessibility and Alabama ranking last
• The District of Columbia ranking first for baby-friendliness and West Virginia ranking last
• Massachusetts ranking first for family-friendliness and Mississippi ranking last

In addition, WalletHub highlighted the highest- and lowest-performing states on various metrics. For instance:

• The average annual cost of infant care was lowest in Mississippi and tied for highest in Washington, Massachusetts, and the District of Columbia
• The infant mortality rate was lowest in Vermont and highest in Mississippi
• Alaska had the most pediatricians and family medicine physicians per capita, and Louisiana had the fewest
• Vermont, Colorado, Montana, and Tennessee tied for the most child-care centers per capita, and Utah had the fewest

Expert insights

WalletHub spoke with nine health care experts and asked them five "key questions" to assist "expectant parents with the planning process and provide policy insight to local governments."

When asked what is driving the ongoing decline in the U.S. birth rate, experts cited economic challenges, a decline in fertility among women in their teens and 20s, changes in marriage trends, inadequate parental leave, and an increase in the number of women prioritizing educational and career goals over having children.

"I think we are still seeing a long-term process of change, which started in the second half of the 20th century, in which fewer and fewer Americans - and particularly women - invest their identities in full-time parenthood," said Matthew Weinshenker, the chair of sociology and anthropology and an associate professor at Fordham University.

"We are the only advanced economy in the world that does not have a national paid parental leave benefit, our childcare system is private and costly, and only about half the states guarantee paid sick leave," Weinshenker added. "Absent these supports, while people still want children, they tend to have fewer, and have them later in life, compared to the past."

Separately, Tovah Klein, director of the Barnard College Center for Toddler Development and an associate professor of psychology, noted that "[h]aving children is expensive. And working parents need child care."

"So, a combination of low minimum wages, lack of affordable child care, more options for women to decide if and when they want to have a baby (or at least that was the case before Roe fell) and more job opportunities for women could all be factors," Klein added. "The high and rising costs of medical care may be another factor." (McCann, "2022's Best & Worst States to Have a Baby," WalletHub, 8/8)