Methodology

For the report, researchers evaluated all 50 U.S. states and the District of Columbia on 32 measures across three key dimensions:

• Health outcomes, which includes all-cause, maternal, and infant mortality, breast and cervical cancer deaths, and mental health conditions
• Coverage, access, and affordability, which includes rates of uninsurance for women, usual source of care, and abortion access
• Healthcare quality and prevention, which includes receipt of preventive care and measure of quality like prenatal care and low-risk cesarean births

Data for these measures covered 2021 and 2022 and generally came from publicly available data sources, including government-sponsored surveys and registries.

For each measure, a state's standardized z-score was calculated, and the z-scores were averaged across all measures within each dimension. Dimension scores were then averaged into an overall score, which was used to assign each state a rank.

The state of women's health in the US

Overall, the five highest-ranked states for women's health were:

• Massachusetts
• Vermont
• Rhode Island
• Connecticut
• New Hampshire

In comparison, the five lowest-ranked states for women's health were:

• Mississippi
• Texas
• Nevada
• Oklahoma
• Arkansas

According to the report, a key measure of health outcomes is the all-cause mortality rate for women of reproductive age, or between ages 15 and 44. The top causes of mortality for women in these age groups include pregnancy-related deaths, substance use, breast and cervical cancer, and COVID-19. In 2022, all-cause mortality rates for women of reproductive age were highest in Southeastern U.S. states.

Currently, maternal mortality rates in the United States are higher than those in other high-income countries, largely driven by inadequate access to health services before, during, and after pregnancy and ongoing health disparities.

In the United States, maternal mortality rates are highest among Black and American Indian/Alaska Native women. Hispanic women also saw their maternal mortality rates increase during the COVID-19 pandemic.

The states with the highest maternal mortality rates were Arkansas, Louisiana, Mississippi, and Tennessee. According to the report, a significant percentage of counties in these states don't have a single hospital or birth center with obstetric providers.

Southern states are also more likely to have higher mortality rates from breast and cervical cancer, which are considered preventable and treatable with timely screening and care. Southern states have higher-than average mortality rates from these cancers and lower screening rates. 

However, the report also found that there are significant inequities in breast and cervical cancer rates despite Black women having similar or higher screening rates compared to white women. Although Black women are more likely to be up to date with breast cancer screenings and less likely to be diagnosed with the disease, they are more likely to die from breast cancer than white women.

Similarly, Black women are more likely to die from cervical cancer than white woman. Although all women experience delays in follow-up care after an abnormal cervical cancer screening, Black women experience the highest rates of delays.

Commentary

Although the United States has focused more on addressing social factors that impact health outcomes, social determinants of health can vary significantly based on where you are in the United States, Axios writes.

"We have to start really looking at … specific communities when we're determining delivery of care," said Irene Aninye, director of science programs at the Society for Women's Health Research.

"It's great we have guidelines" on screening and treatment, Aninye added. "But then we actually need to get specific on how we're going to deliver it to these populations in these communities."

Similarly, William Dahut, chief scientific officer at the American Cancer Society, said that more resources are needed to help improve screening and HPV vaccination rates in areas where they're currently lacking.

According to the report, better data collection on race and ethnicity and more research that includes Black, Hispanic, and Native American women could also help reduce racial disparities in cancer deaths.

The federal government has also made efforts to address women's health issues. Earlier this year, the Biden administration pledged to invest hundreds of millions of dollars in women's health research. The administration also called on Congress to appropriate another $12 billion for women's health.

Advisory Board's women's health resources

To better understand how to support women's health, check out these Advisory Board resources:

Organizations must make an effort to address inequities in women's care and improve their health outcomes. This cheat sheet outlines how organizations can improve care for menopause symptoms.

Similarly, this expert insight explains five practical ways employers can improve women's health and well-being in midlife, as well as foster a supportive work environment.

More broadly, this report outlines six key factors impacting women's health in the United States, including the roles of various healthcare stakeholders and the importance of cross-industry collaboration. We also have resource libraries on both women's health and clinical technology for women's services. (Goldman, Axios, 7/18; Collins et al., Commonwealth Fund, 7/18)