Women’s health is in a ‘dangerous’ position, with deep and growing disparities across regions of the US. new report of the Commonwealth Fund has found. The report ranks states based on 32 indicators, ranging from insurance coverage to breast and cervical cancer to Covid-19.
Massachusetts, Rhode Island and Vermont ranked highest on a range of health issues. Southeastern states — most of which now have near-total abortion bans — ranked lowest on a wide range of women’s health indicators.
“Where you live matters to your health and health care,” said Dr. Joseph Betancourt, president of the Commonwealth Fund. “This disproportionately impacts women of color and low-income women.”
The report’s goal was to inform policy “to ensure that all women in the U.S. have access to quality, affordable health care — regardless of where they live.”
The report is based largely on public data from 2022, a pivotal year in women’s health, when the Supreme Court overturned Roe v Wade. For nearly 50 years, Roe v Wade provided a federal right to terminate a pregnancy. When the decision was overturned, regulation of abortion was returned to the states. Fourteen states quickly enacted near-total abortion bans, including many in the Southeast.
A map of the nation’s worst-performing states resembles a belt across the American South, stretching from Nevada to Florida and north to Tennessee. Notably, Nevada has no abortion ban but has worse health records overall due to a large first-generation immigrant population.
“There are clear differences between states and delivery systems that are performing well for women,” said Sara Collins, vice president at Commonwealth and a senior researcher who studies health care access and quality.
States that performed worst had not expanded Medicaid, a public health insurance plan for low-income Americans. They also tended to have fewer health care providers, particularly gynecologists. Those regional disparities are likely to be exacerbated by abortion bans, which make it legally dangerous for doctors to practice.
Deaths from all causes were highest in the southeastern states, including from preventable causes such as substance abuse, COVID-19, pregnancy-related deaths, and chronic treatable conditions.
Poorly performing states also often missed opportunities to identify and treat high-risk women. They screened fewer women for postpartum depression, had higher rates of syphilis and congenital syphilis (when the disease is passed to a baby), and higher rates of cancer. They had higher rates of cesarean sections in low-risk pregnancies, and the highest maternal mortality rates, with particularly large disparities between black and white women.
Also striking is how these trends have become increasingly apparent over the past four decades. other reportsResearchers have found that health disparities narrowed between the 1960s and 1980s. Now, poorer health outcomes in the South are forming what some researchers call the “multiples” belt, where a litany of health outcomes are worse — from cancer to diabetes to HIV infection rates.
Yet the prospects of state legislatures or Congress finding common ground to improve women’s health seem bleak. Many of the issues that most affect women’s health are also the most politically contentious.
For example, Republicans have actively sought abortion bans for decades and have opposed Medicaid expansion since the Obama administration. Republicans have also undermined public health officials, the type of workers who are crucial to preventing the transmission of diseases like syphilis.
Some researchers, such as health equity expert Daniel Dawes, have described these outcomes as the “political determinants of health” – in other words, the way in which policy shapes the health and well-being of the population.
“When you think about the structural circumstances that many people find themselves in, there are underlying policies — political action or inaction — that have shaped those circumstances and structured the resources that made those circumstances possible,” said Dawes, founding dean of the School of Global Health at Meharry Medical College in Nashville, Tennessee.
If you don’t address those policies, Dawes says, “you’re just going to keep nibbling at the edges of the problem.”