Report sheds light on deepening disparities in women’s health, reproductive care

The Commonwealth Fund's 2024 Scorecard on State Health System Performance offers a sobering post-pandemic snapshot of health care access, quality, and outcomes for women across the United States.

"We've gone backward on life expectancy and avoidable deaths, and women's health, mental health, and substance use disorder ring loudly as critical issues that require urgent attention," Commonwealth Fund President Joseph Betancourt, M.D., M.P.H., said during a July webinar unveiling the findings.

The report evaluates 58 health care indicators, highlights critical gaps in reproductive care, women's health and mental health services.

Massachusetts, Connecticut, New Hampshire, Rhode Island and Vermont topped the rankings for overall health system performance, while Arkansas, Texas, Oklahoma, Nevada and Mississippi were ranked lowest.

As journalists, we can use the scorecard's data to provide a comprehensive analysis of state performance on health care indicators, and highlight disparities in health care performance across states.

"Comparing states on how well their health care systems support people of all ages, races, ethnicities, and income levels is critical to our understanding of what is and isn't working in American health care," Sara R. Collins, Commonwealth Fund Senior Scholar said during the webinar.

Creating visual aids such as charts and maps to illustrate disparities may be better ways to show where a particular state stands. It's one thing to list the states that rank the highest and the lowest in health care for women, but showing a map helps audiences process patterns.

Here's one by the Commonwealth Fund, where we see that most of the highest performing states are located in the northeast, while the lowest performing states are mostly in the south. This map also helps us visualize how stark the disparities may be between two neighboring states.

It's also up to journalists to go beyond the numbers by sharing narratives that further illustrate the disparities, or initiatives underway that can offer solutions.

Key findings

Maternal health disparities. The maternal mortality rate for American Indian and Alaska Native women increased by nearly 70 deaths per 100,000 live births between 2019 and 2021, significantly higher than other racial and ethnic groups. Consider exploring the systemic issues contributing to these disparities and potential policy solutions.

Mental health care access. Nationally, 60% of adolescents ages 12 to 17 who had a major depressive episode could not get the treatment they needed, with South Carolina having the highest rate at nearly 80%. What the report doesn't answer is why? The complexity in the answer to that question may offer reportable insights. But there are also initiatives that are helping tackle this issue. In July, I reported on the opening of pediatric mental health urgent care centers that are popping up across the nation.

Medical debt. "Rates of medical debt are especially high in the South; in West Virginia, nearly one-quarter of residents are struggling to pay off medical debt," the report states. Consider reporting on the high rates of medical debt including the people struggling with it and its broader economic impact.

Reproductive health access. Investigate how restricted access to reproductive health services in various states; perhaps there are efforts underway in restrictive states to improve access. "Our country's fractured landscape of reproductive health access will only make it more difficult to close these widening gaps, especially for women of color and women with low incomes in states that have restricted access to reproductive care," Dr. Laurie C. Zephyrin, Commonwealth Fund senior vice president for Advancing Health Equity said during the webinar.

The scorecard also revealed significant variations in prenatal care access. In Vermont, only 11% of women giving birth in 2021 did not receive prenatal care during the first trimester, compared to 29% in Texas and Florida.

To address these issues, the report recommends several policy strategies including lowering barriers to addiction treatment and investing in primary care, improving coverage affordability and care accessibility; and, extending postpartum Medicaid coverage and supporting comprehensive reproductive care policies.

Additional resources

• Kaiser Family Foundation (KFF) - Women's Health Policy.
• National Institute of Mental Health (NIMH) - Mental Health Information.
• Urban Institute - Wealth and Medical Debt in America.