Since the Supreme Court overturned Roe v. Wade, many have waited to see to what degree states might either restrict or ban abortions and, if they did, how problematic that would be for women’s health. Now we know. The Commonwealth Fund has released its annual study on women’s health, entitled, 2024 State Scorecard on Women’s Health and Reproductive Care, which includes an analysis of the effects of the Roe decision.
The Study validates what many foresaw happening: Women’s health, especially reproductive health, has become worse in the 21 states that now restrict or ban abortion following the demise of Roe. Bottom line: Women have died.
Scorecard Highlights
- Massachusetts, Vermont, and Rhode Island top the rankings for the 2024 State Scorecard on Women’s Health and Reproductive Care, which is based on 32 measures of health care access, quality, and health outcomes. The lowest performers were Mississippi, Texas, Nevada, and Oklahoma.
- Deaths from all causes among women of reproductive age — 15 to 44 — were highest in southeastern states. Causes of death include pregnancy and other preventable causes such as substance use, COVID-19, and treatable chronic conditions.
- The highest maternal death rates were in Tennessee, Mississippi, and Louisiana. Vermont, California, and Connecticut had the lowest rates. Nationally, rates were highest for Black and American Indian and Alaska Native (AIAN) women.
- Mental health conditions are the most frequently reported cause of preventable pregnancy-related death, including deaths by suicide and overdoses related to substance use disorders. These results include both deaths occurring during pregnancy and in the postpartum period following birth. States that screened for postpartum depression at the highest rates also had lowest rates of postpartum depression.
- Among women of reproductive age (ages 15–44), those in Texas, Georgia, and Oklahoma were uninsured at the highest rates; those in Massachusetts, the District of Columbia, and Vermont had the lowest uninsured rates. Women in states that had not expanded Medicaid eligibility were among those most at risk of lacking coverage and most at risk of increased maternal mortality.
- The U.S. 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 now ban or restrict abortion access.
Massachusetts is the best-performing health system for women overall, ranking among the top states on each of the three dimensions of health system performance: Heath Outcomes, Health Care Quality and Prevention, and Coverage, Access and Affordability. Vermont, Rhode Island, Connecticut, and New Hampshire rounded out the top five.
The lowest-ranked states overall are Mississippi, Texas, Nevada, Oklahoma, and Arkansas. The highest-ranked states are concentrated in New England, the Mid-Atlantic, and the northern Midwest. The lowest-ranked states fan out across the Southeast and Southwest.
As I have written before, the highest rates of maternal mortality continue to be found in the Mississippi Delta, which includes Arkansas, Louisiana, Mississippi, and Tennessee. A substantial percentage of counties in these four states don’t have a single hospital or birth center with obstetric providers offering obstetric care. All four states now ban all abortions.
These states also rank low on other potential contributors to maternal mortality: low rates of postpartum depression screening, high rates of low-risk cesarean births, and high uninsured rates prior to pregnancy. All four states had abortion restrictions prior to Dobbs, and they all now have full bans on abortion.¹ This is proving a disaster for women’s health care.
Women know all of this, and they know it viscerally. Many men do not. The data in the Commonwealth Fund’s study should give these men the knowledge they need to understand why women feel so strongly about the Supreme Court’s misguided decision.
As Joe Paduda noted yesterday in Managed Care Matters, Kamala Harris has an enviable record in health care policymaking, especially reproductive freedom and abortion rights. Paduda writes, “Harris is no newcomer to healthcare; her mother was a medical researcher and Harris has focused on various healthcare issues throughout her 35+ year career.”
With abortion rights being a singularly important issue for most American women, Harris, as the presumptive presidential nominee of the Democratic Party, can argue persuasively that Republicans have cruelly and diabolically stolen reproductive freedom from the women of America.
That, along with the Commonwealth Fund’s damning Scorecard with respect to the state of women’s health in red states, is a very potent health care message for the electorate.
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¹ Along with their neighbors Texas, Oklahoma, Alabama, Louisiana, Missouri, Tennessee, Kentucky and West Virginia.
