Mississippi ranks last in women’s health and reproductive care outcomes, according to a 2024 report released Thursday by the Commonwealth Fund, a nonprofit dedicated to independent research on health policy. 

The study’s authors pointed to the state’s lack of Medicaid expansion and strict abortion ban as two major causes. 

The report, which evaluates states on health care access, affordability, quality of care and health outcomes, found “mounting disparities in women’s health and reproductive care across the United States,” with Mississippi, Texas, Nevada, Oklahoma and Arkansas scoring the worst overall. 

By contrast, Massachusetts, Vermont, Rhode Island, Connecticut and New Hampshire scored the highest. 

“This scorecard yet again reminds us that where you live matters to your health and health care,” said Dr. Joseph Betancourt, Commonwealth Fund president, in a press release. “While some states are championing women’s continued access to vital health and reproductive services, many others are failing to ensure women can get and afford the health care they need. And this failure is having a disproportionate impact on women of color and women with low incomes.”

The national maternal mortality rate nearly doubled between 2018 and 2021, rising from 17.4 to 32.9 deaths per 100,000 live births, with the highest spikes among Black and American Indian and Alaska Native women. In 2022, that rate went down to 22.3, according to the report. 

Mental health and cardiovascular problems were the leading underlying causes of maternal death – which was most prevalent in the Mississippi Delta, including Arkansas, Louisiana, Mississippi and Tennessee, where maternity care deserts – areas with no hospital offering labor and delivery and no practicing OB-GYNs – pervade counties. 

Southeastern states had the highest rates of deaths among women of reproductive age from 15 to 44 in addition to having the highest rates of maternal deaths. The study said top causes of death included preventable factors such as pregnancy complications, substance use, COVID-19, and breast or cervical cancer.

In June 2022, Jackson was at the center of the historic U.S. Supreme Court ruling that abolished the constitutional right to an abortion. This decision had a profound impact on the state of women’s health care, researchers found – not only in what services are offered to women, but also how pregnant women access care. 

“Many experts are concerned that abortion bans or limits may inadvertently reduce the number of providers offering maternity care, owing to increased risk of legal action that practices face,” the study read. 

Other studies have shown that the number of medical residency applications has declined more in states with bans than those without. 

Turning Mississippi’s health metrics around will be “very difficult” to do, authors of the report said in a media briefing Wednesday, without changing the larger, politically divisive policies. The authors referenced abortion access and Medicaid expansion as two of those policy issues.

“There are things delivery systems can do despite the policy choices Mississippi has made, but it is hard to do without the additional, in large part, resources – including Medicaid which would bring an influx of resources into the state were it to expand,” explained Sara Collins, the study’s lead author.

Mississippi is one of only 10 states not to expand Medicaid in the decade since the Affordable Care Act made it an option for states. This year, the Legislature came close to passing a version of the policy, which would have expanded income eligibility for Medicaid and provided health care to tens of thousands of Mississippians. The bill died in the last week of the legislative session after a saga of partisan politics. 

Last week, Mississippi Today unveiled a digital tracker reflecting how much federal money the state has turned down since July 1 – the date expansion likely would have gone into effect had it been passed. On Thursday, that number was $97 million. 

Mississippi scored well on the number of women insured during pregnancy, since Medicaid eligibility is significantly more inclusive for pregnant women. Federal law mandates all Medicaid programs cover pregnant women whose household income is less than 138% of the federal poverty level. But states can increase that eligibility, and Mississippi covers pregnant women making up to 194% of the federal poverty level, which is about $29,000 annually for an individual.

Collins referenced preventative measures such as screenings for postpartum depression and breast and cervical cancer as one way to affect change at the local level in spite of state politics.

While southeastern and northeastern states differed on most measures, both areas had high rates of cesarean sections among low-risk pregnancies – which the study says is a “key indicator of lower-quality maternal health care.”

In the Northeast – particularly in New York and Connecticut, which had the worst rates in their region – that could be due to individual hospitals not having a “culture of care” supporting vaginal delivery. For example, turning to interventions too quickly, simply because they are available or efficient. 

Low-risk cesareans are more common in women who are admitted to hospitals during the week, which the study said “may reflect scheduling preferences.”

Mississippi also ranked in the top five in an increase in syphilis cases among women of reproductive age, with the highest rates found in South Dakota, New Mexico, Mississippi, Arkansas and Oklahoma. 

The State Health Department last year began requiring medical providers to test pregnant women for syphilis after the state saw an alarming increase in babies born with the disease. 

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