A new report ranks the quality of the health care women receive in all 50 states.
The report, released Thursday by the Commonwealth Fund, a private foundation focused on health care, used three main metrics to measure the quality of health care in each state: health outcomes, health care quality and prevention, and access and affordability.
The top three performing states overall were all located in the Northeast -- Massachusetts, Vermont and Rhode Island.
The three lowest performing states were Oklahoma, Texas and Mississippi.
Overall, the report revealed critical gaps in reproductive health services across the United States.
States that scored poorly had counties that did not have a single hospital or birth center with obstetric doctors, the report found.
"We found a threefold difference across states with the highest rates of death concentrated in the southeastern states," David Radley, Ph.D., MPH, the fund's senior scientist of tracking health system performance, said in a news conference Thursday. "We also saw big differences across states in women's ability to access care."
He added, "Approximately 5.6 million women live in counties that are considered maternity care deserts."
The worst performing states for accessible and affordable healthcare included Nevada, Georgia, and Texas.
Up to 22% of reproductive aged women were uninsured in Texas, according to the report, which was not peer-reviewed but included data from governmental agencies such as the Centers for Disease Control and Prevention and state public health reports.
In the 10 states that did not expand Medicaid through the Affordable Care Act, the report found nearly 800,000 women were left uninsured.
"It's hard to stress how critical a source of coverage Medicaid is for pregnant women," Radley said. "Medicaid covers approximately 42% of all births in the US."
What women should ask their doctors in their 20s, 30s, 40s and 50sAlthough more than 10% of women experience postpartum depression, many states like Alabama and Mississippi had relatively low rates of screening for this extreme form of depression.
Left untreated, postpartum depression can lead to serious health consequences and even death for both moms and babies.
Another example of the wide disparities across states: California, which has strong health policies, reported 9.9 maternal deaths per 100,000 births. By contrast, Mississippi, with less supportive policies, reported 44.6 maternal deaths per 100,000 births.
The report uncovered some striking differences in cancer outcomes for women of color compared to white women.
Black women were more likely to be up-to-date on screening tests for breast cancer than white women, but less likely to be diagnosed with breast cancer and more likely to die from the disease compared to white women.
Black women were also less likely to receive follow up care and received poorer quality of care after an abnormal test, and they were often diagnosed at later stages of the disease, the report found.
What women should know about their reproductive system as they ageAdditionally, women of color were also more likely to die from cervical cancer White women in the U.S.
A 2022 Gynecologic Oncology Reports study backs up this assertion. It found that follow-up care after abnormal cervical cancer screening is lacking for all races, but Black women are the least likely to get timely care. A quarter of Hispanic and Black women experienced delays in follow-up, the study found.
The report's big takeaway: Improved health policies mean equitable care for all women.
Radley said the Commonwealth Fund plans to track women's health amid changing legislation and policies.
"While this is the first edition of the Women's and Reproductive Health Scorecard, we expect to update this report over time to track how state policy actions, specifically how new restrictions on access to abortion services, impact women's health and the care they receive," Radley said.
Jade March, M.D., a board-certified family medicine physician and current integrative medicine fellow at UCLA, is a member of the ABC News Medical Unit.
