Reproductive care and women’s health are worse in Texas than in nearly every other U.S. state, according to a new health system ranking by The Commonwealth Fund.
The Lone Star State ranked 49th among the 50 states and the District of Columbia, beating out only Mississippi and New Mexico for the bottom spot in women’s health. This year marks the first time reproductive and women’s health had its own category in the annual scorecard, compiled by the nonprofit foundation that promotes “a high-performing, equitable health care system.”
Texas fared about the same overall, ranking 48th when researchers took all seven broad health categories into account. Arkansas came in 47th while Oklahoma, West Virginia and Mississippi rounded out the rest of the bottom five states.
The 2023 scorecard, which uses most-recently-available 2021 data, does not include data to reflect the implications of abortion restrictions or bans that states enacted after the fall of Roe vs. Wade in June of last year. The state of women’s health in the year before abortion bans went into place still speaks to potential future findings, Commonwealth Fund researchers said.
“We see wide state variations in reproductive care and women’s health. Ultimately, we see states with the worst outcomes are also implementing and considering further restrictions on reproductive health care,” said Dr. Laurie Zephyrin, study co-author and Commonwealth Fund senior vice president for advancing health equity.
Access to usual and preventive care for women of reproductive age heavily contributed to the state’s poor women’s health showing. Texas came dead last in the share of births without prenatal care in the first trimester, with nearly 30% of women receiving no early prenatal care. The state did not report the share of women without a postpartum checkup.
Texas also came in above average for its share of births born “preterm,” or before 37 weeks of pregnancy. Preterm births come with increased risks of death or severe complications for the baby.
“It’s all connected,” said Dr. Angela Burgess, a maternal-fetal medicine specialist at UTHealth Houston and maternal medical director of labor and delivery at Memorial Hermann Southwest Hospital.
Pregnant women without early prenatal care often don’t catch medical complications until later in their pregnancy, which can cause problems for the mother and the baby.
“All of this contributes to not only preterm birth, but also babies who are not healthy enough to survive in the womb and outside of the womb,” Burgess said.
Not everyone is impacted equally by the state of women’s health. Black Texans represent a disproportionately high percentage of complications in labor and delivery, infant deaths and share of births without prenatal care in the first trimester.
Hispanic Texans also saw higher rates of labor complications, infant deaths and share of births without early prenatal care, although those rates were not as high as those for Black women.
Black Texans died from breast and cervical cancer at a rate of 32 deaths per 100,000 women, while white Texans died from those diseases at a rate of 24 per 100,000 women.
Texas’ high uninsured rate certainly doesn’t help the problem. The state consistently ranks last in health insurance. At least 12% of Texas children are uninsured, while nearly one-quarter of adults lack coverage. Hispanic Texans were even less likely to have insurance, with nearly 40% of Hispanic adults lacking coverage.
About 18% of Texas women between the ages of 18 and 44 went without a routine checkup in the two years prior, according to 2021 data, compared to a national average of 13%.
Health insurance rates in Texas rose during the pandemic, thanks to a COVID-era rule prohibiting states from disenrolling people from Medicaid, although that number is expected to drop by more than 1 million people after such protections ended in May.
Researchers have long decried the implications of high uninsured, especially for pregnant women and new mothers. A recent UT Southwestern Medical Center study found new moms experienced better health outcomes when enrolled in Parkland Health’s program to expand maternal care to one year after birth.
The Texas Senate agreed this legislative session to give low-income women a full year of health coverage after birth. More than 30 states already have such Medicaid expansions.
Low-income pregnant women can qualify for coverage through a few federal insurance programs, but signing up for the temporary coverage can be a long and difficult process.
“If they do actually get insurance, it can take a very long time, a number of weeks or months that we then lose from their pregnancy,” Burgess said. “And then that also, of course, complicates the care or delays the care.”
The Commonwealth Fund pointed to a number of solutions that specifically address gaps in reproductive and women’s health care, including increased investment in the maternal health and community health workforces.
Interventions, both in the short and long term, should be tailored to communities most affected by negative health outcomes, Zephyrin said.
“When we think about maternal health outcomes between mortality and morbidity, it is increasing for everybody, but we have significant inequities by race and ethnicity that persist regardless of income,” Zephyrin said.
