Women and Children Health Report 2023

2023 Health
of Women and
Children Report
Contents
Introduction 2
National Highlights 5
Findings 7
Health Outcomes 7
Social and Economic Factors 16
Clinical Care 19
Behaviors 21
State Rankings 25
Appendix 28
National Summary 28
Subpopulation Group Definitions 30
Limitations 30
References 31
Introduction
The United Health Foundation is proud to

release the America’s Health Rankings® 2023
Health of Women and Children Report, which
continues to provide a comprehensive look
at the health of these populations.
This report highlights the rising rates of mortality among women of

reproductive age and children across the nation and on a state-by-state basis,
as well as the stark disparities that exist by geography and race/ethnicity.
Monitoring the health and well-being of women of

reproductive age and children is a fundamental aspect
Despite negative trends in
of public health. Ensuring the health of these two mortality, the percentage
groups by preventing disease, improving access to
care, encouraging healthy behaviors and promoting
of women who reported
equity by addressing the social determinants of health their own health was very
can have a significant impact on the overall well-being
of individuals, families and communities. According to good or excellent improved,
the U.S. Census Bureau, in 2021 there were 58.7 million
women of reproductive age (18-44) and 73.6 million
reaching the highest level
children in the United States, representing roughly recorded by America’s
40% of the total population. These populations have
continued to grow and diversify in the past several
Health Rankings.
years; however, many of the challenges affecting their
The data also highlight several changes that occurred
health and well-being have remained consistent, and
during the COVID-19 pandemic. In some cases,
new challenges have emerged.
long-term improvements like the reduction in teen
For the second consecutive year, the mortality rate births continued; however, other measures shifted.
among both women and children continued to increase, For example, there was an encouraging decrease in
reaching new highs in America’s Health Rankings' history. the prevalence of electronic vapor product use among
This report highlights the rising rates of maternal mortality high schoolers, while there was a discouraging drop
and drug deaths among women and introduces two in the percentage of 3- and 4-year-olds enrolled in
new community and family safety measures that are early childhood education.
on the rise: injury deaths among both women and
children. Within these measures of mortality, stark
disparities exist by geography and race/ethnicity.
2023 Health of Women and Children Report AmericasHealthRankings.org 2

Introduction
The 2023 Health of Women and Children Report finds that:
• Mortality rates, including maternal mortality,

continued to increase among women of reproductive
age and children, while the infant mortality rate
declined. All mortality measures had wide disparities
by race/ethnicity and geography.
• Women’s mental and behavioral health

challenges continued to grow, with increases
in the drug death rate and prevalences of frequent
mental distress and depression, all with disparities
by age, race/ethnicity and geography.
• Despite troubling trends in women’s mortality

measures and mental health, the percentage
of women who reported their own health was
very good or excellent improved, along with
the percentage who reported frequent physical
distress. However, severe maternal morbidity
and the percentage of infants born with a low
birth weight significantly worsened.
We encourage
• Injury deaths, an indicator of community and
policymakers, advocates,
family safety, have been increasing among women community leaders and
of reproductive age and children.
• During the COVID-19 pandemic, early childhood

individuals to use these
education enrollment declined substantially findings to help target
and tailor public health
between 2019 and 2021.
• Many measures of individuals’ access to care

improved while the number of women’s health interventions that address
providers declined.
these concerning trends
• Among women of reproductive age, fruit and
vegetable intake decreased and the percentage
and their upstream causes.
of physically inactive women declined.
• The long-term successes in reducing smoking

and teen birth rates have continued.

Introduction | Objective
Objective
America’s Health Rankings aims to inform and drive action to build healthier communities by offering credible, trusted
data that can guide efforts to improve population health and health care. To achieve this, America’s Health Rankings
continues to collaborate with an advisory group to determine the selection of a comprehensive set of measures.
The 2023 Health of Women and Children Report is based on:
• 122 measures. These include 83 ranking and 39 • Providing a benchmark for states. Each year
additional measures (not included in overall rank). the report presents strengths, challenges and
Five new measures are introduced this year including highlights for every state using data dating back
high school completion, injury deaths among women, to the first Health of Women and Children Report.
injury deaths among children, housing cost burden in Public health advocates can monitor health trends
households with children and maternity care desert. over time and compare their state with other states
For a full list of measures, definitions and source or the nation. State summaries containing data on
details, see the Measures Table. all 83 ranking measures are available on the website
as a separate download.
• Five categories of health. These include health
outcomes and four other categories that are • Highlighting disparities. The report shows
determinants of health: social and economic factors, differences in health between states and among
physical environment, behaviors and clinical care. population groups at state and national levels,
with groupings based on race/ethnicity, gender,
• 34 data sources. Data are from many sources,
age, educational attainment, income level and
including CDC’s Behavioral Risk Factor Surveillance
metropolitan status. These analyses often reveal
System and Pregnancy Risk Assessment Monitoring
differences among groups that national or state
System, the March of Dimes and the U.S. Census
aggregate data may mask.
Bureau’s American Community Survey.
• Stimulating action. The report aims to drive
The America’s Health Rankings Health of Women and
change and improve health by promoting data-driven
Children Report aims to improve population health by:
discussions among individuals, community leaders,
• Presenting a holistic view of health. This report public health workers, policymakers and the media.
goes beyond measures of clinical care and health States can incorporate the report into their annual
behaviors by considering social, economic and review of programs, and many organizations use
physical environment measures, reflecting the it as a reference when assigning goals for health
impact of social determinants of health. improvement plans.
Model for Measuring

America’s Health
America’s Health Rankings is built upon the World Health
Organization’s definition of health: “Health is a state of complete
physical, mental and social well-being and not merely the absence
of disease or infirmity.” The model was developed under the
guidance of the America’s Health Rankings’ Advisory Council and
committees, with insights from other rankings and health models,
namely County Health Rankings & Roadmaps and Healthy People.
The model serves as a framework across all America’s Health
Rankings reports for identifying and quantifying health drivers
and outcomes that impact state and national population health.

National Highlights National Highlights
National Highlights
Health Outcomes
16% 16%
Mortality — Women Frequent Mental
increased from 117.3 to 136.4 Distress
deaths per 100,000 women ages
Recent notable 20-44 between 2020 and 2021.
increased from 18.1% to 21.0%
between 2018-2019 and 2020-2021.
shifts in key Source: CDC WONDER, Multiple
Cause of Death Files.
Source: CDC, Behavioral Risk Factor
Surveillance System.
health indicators
7% 10%
Child Mortality High Health Status
increased from 25.7 to 27.4 deaths increased from 53.8% to 59.0% of
per 100,000 children ages 1-19 women ages 18-44 between 2018-
between 2016-2018 and 2019-2021. 2019 and 2020-2021.
Source: CDC WONDER, Multiple Source: CDC, Behavioral Risk Factor
Cause of Death Files. Surveillance System, 2018-2021.
4% 9%
Infant Mortality Severe Maternal
Maternal Mortality decreased from 5.7 to 5.5 deaths Morbidity
22.4
per 1,000 live births between
increased from 81.0 to 88.3
2017-2018 and 2019-2020.
complications per 10,000 delivery
Source: CDC WONDER, Linked hospitalizations between 2019
Birth/Infant Death Files. and 2020.
Source: Federally Available Data,
27%
Maternal and Child Health Bureau,
deaths per 100,000 live Health Resources and Services
births in 2017-2021. Drug Deaths
Administration.
increased from 20.3 to 25.7 deaths

per 100,000 females ages 20-44
between 2016-2018 and 2019-2021.
Source: CDC WONDER, Multiple
Cause of Death Files.
High Health Status Social and Economic Factors
59.0%
of women ages 18-44
17%
Injury Deaths —
Women
11%
Injury Deaths —
Children
increased from 41.0 to 48.1 increased from 15.7 to 17.4
reported that their deaths per 100,000 females ages deaths per 100,000 children
health was very good or 20-44 between 2016-2018 and ages 1-19 between 2016-2018
2019-2021. and 2019-2021.
excellent in 2020-2021.
Source: CDC WONDER, Multiple Source: CDC WONDER, Multiple
Cause of Death Files. Cause of Death Files.
1 2023 Health of Women and Children Report AmericasHealthRankings.org 5

National
National Highlights
Highlights
Clinical Care
9% 5% Early Childhood
Education
18%
Uninsured Women Uninsured Children
decreased from 12.9% to 11.8% decreased from 5.7% to 5.4%
among women ages 19-44 among children ages 0-19
between 2019 and 2021. between 2019 and 2021.
Source: U.S. Census Bureau, Source: U.S. Census Bureau,
American Community Survey. American Community Survey.
decreased from 48.9%
to 40.2% of children
7% ages 3-4 between
Women’s Health 2019 and 2021.
Providers
decreased from 12.9% to 11.8%
among women ages 19-44
between 2019 and 2021.
Source: U.S. HHS, Centers for Medicare
& Medicaid Services, National Plan and
Provider Enumeration System.
Fruit and Vegetable
Consumption
Behaviors
20%
Fruit and Vegetable
7%
Physical Inactivity
1 in 10
women ages 18-44
Consumption decreased from 22.6% to 21.1%
reported consuming
decreased from 12.2% to 9.8%
of women ages 18-44 between two or more fruits
2018-2019 and 2020-2021. and three or more
of women ages 18-44 between
2017 and 2021. Source: CDC, Behavioral Risk
vegetables daily in 2021.
Factor Surveillance System.
Source: CDC, Behavioral Risk
Factor Surveillance System.
15% 10%
Smoking Teen Births
decreased from 14.3% to 12.1% decreased from 15.4 to 13.9 Electronic Vapor
of women ages 18-44 between births per 1,000 females ages
Product Use — Youth
45%
2018-2019 and 2020-2021. 15-19 between 2020 and 2021.
Source: CDC, Behavioral Risk Source: CDC WONDER, Natality
Factor Surveillance System. Public Use Files.
decreased from 32.7%

to 18.0% of high school
students between 2019
and 2021.

6
Findings | Health Outcomes
HEALTH OUTCOMES | MORTALITY
Mortality rates, including maternal

Findings mortality, continued to increase
among women of reproductive age
and children, while the infant mortality
Data show concerning rate declined. All mortality measures
had distressing disparities by race/
trends and disparities ethnicity and geography.
in mortality, rising
mental health Mortality Among Women
The death rate among women of reproductive age has
challenges among risen since 2011 after declining between 2003 and 2011.1
women — with
Between 2020 and 2021, the number of deaths from
accidents and COVID-19 increased, and COVID-19 moved
gains in some other from the fifth to the second leading cause of death. In
2021, the leading causes of death among women ages
health measures. 20-44 were accidents (unintentional injuries), COVID-19,

cancer, heart disease and suicide. In addition, the
maternal mortality rate in the U.S. has risen steadily
since 1990, and the U.S. had the highest rate among
high-income countries.2,3
Increases in Mortality Among Women Between 2020 and 2021
DC
RI
DE
Percent increase in deaths

per 100,000 females ages 20-44
8-16% 17-21% 22% 23-25% 26-32% Not

Significant
Source: CDC WONDER, Multiple Cause of Death Files, 2020-2021.

Significant changes over time. Nationally, the mortality Disparities in Maternal Mortality
rate increased 16% from 117.3 to 136.4 deaths per 100,000
women ages 20-44 between 2020 and 2021, a smaller
by Race/Ethnicity
increase than the 21% increase between 2019 and 2020. In
American Indian/Alaska Native
2021, about 74,400 U.S. women died, an increase of nearly
10,800 women compared with 2020. The mortality rate 60.6
increased in 27 states, led by 32% in Georgia (126.7 to 167.1),
Black
29% in Nevada (117.7 to 152.0) and 28% in Nebraska (86.7 to
111.0). The rate increased among every racial/ethnic group, 51.3
led by 43% among Hawaiian/Pacific Islander (168.9 to
Hawaiian/Pacific Islander
240.9), 21% among Hispanic (80.5 to 97.3) and 18% among
American Indian/Alaska Native (357.6 to 423.4) women. 49.5
Disparities. The mortality rate significantly varied by White

race/ethnicity and geography in 2021. The rate was: 19.6
• 9.9 times higher among American Indian/Alaska
Hispanic
Native (423.4 deaths per 100,000 women ages 20-44)
than Asian (42.6) women. 17.7
• 3.0 times higher in West Virginia (266.3) than Asian

Hawaii (87.5). 14.0
Related Measure: Maternal Mortality Multiracial
Nationally, the maternal mortality rate increased 29% from 13.6

17.3 to 22.4 deaths related to or aggravated by pregnancy
(excluding accidental or incidental causes) occurring 0 20 40 60
within 42 days of the end of a pregnancy per 100,000
Deaths per 100,000 live births
live births between 2014-2018 and 2017-2021. The rate
exceeded the Healthy People 2030 national target of 15.7
per 100,000.4 During this period, the maternal mortality Source: Federally Available Data, Maternal and Child Health
Bureau, Health Resources and Services Administration, 2017-2021.
rate increased in eight states, led by 148% in Mississippi
Note: All racial groups are non-Hispanic. Hispanic ethnicity
(15.3 to 38.0 deaths per 100,000 live births), 136% in
includes members of all racial groups. The estimates for American
Nevada (9.5 to 22.4) and 70% in California (5.6 to 9.5). Indian/Alaska Native, Black and Hawaiian/Pacific Islander women
The rate varied by race/ethnicity, geography, age and were not significantly different from each other based on
non-overlapping 95% confidence intervals; the same was
educational attainment in 2017-2021. The rate was: true for Hispanic, Asian and multiracial women. The rates among
American Indian/Alaska Native, Hawaiian/Pacific Islander and
• 4.5 times higher among American Indian/Alaska Native Black women were significantly higher than the other racial/ethnic
groups (Asian, Hispanic, multiracial and white).
(60.6) than multiracial (13.6), 4.3 times higher than
Asian (14.0), 3.4 times higher than Hispanic (17.7)
and 3.1 times higher than white (19.6) women.
Notably, the maternal mortality rate was also
2.6 times higher among Black (51.3) compared
Note: The 2014-2018 and 2017-2021 comparison
with white women.
contains overlapping 5-year estimates. Because of the
• 4.4 times higher in Alabama (41.9) than overlapping data years, the comparison is largely between
California (9.5). the non-overlapping years (2014-2016 and 2019-2021).
The estimates for women ages 20-24 and women less
• 3.5 times higher among women ages 35 and older
than 20 years (14.3) and the estimates for high school
(46.7) than women ages 20-24 (13.4).
graduates and women with less than a high school
• 2.9 times higher among women who graduated from education (31.7) were not significantly different based
high school (34.4) than college graduates (11.9). on non-overlapping 95% confidence intervals.

Child Mortality
Most deaths among children are preventable. Among
children ages 1-19, the top causes of death in 2019-2020
were accidents (unintentional injury), homicide, suicide,
cancer and congenital abnormalities. Since 2016-2018,
homicide has surpassed suicide as the second-leading
cause of death among children.
Significant changes over time. Nationally, the mortality

rate increased 7% from 25.7 to 27.4 deaths per 100,000
children ages 1-19 between 2016-2018 and 2019-2021.
That rate exceeded the Healthy People 2030 target of
18.4 deaths per 100,000.5 In 2019-2021, nearly 64,100 U.S.
children died, an increase of 3,700 children compared
with 2016-2018. The mortality rate increased in seven
states, led by 19% in Arizona (28.8 to 34.3 deaths per
100,000 children ages 1-19), 18% in Mississippi (40.6
7%
to 48.0) and 16% in Louisiana (37.7 to 43.7). Significant
increases occurred among the oldest age group and by
gender. The mortality rate increased 12% among children
ages 15-19 (50.6 to 56.5), 8% among boys (32.7 to 35.3)
and 3% among girls (18.5 to 19.1).
increase in the mortality Disparities. The mortality rate significantly varied by
rate among children ages age, race/ethnicity, geography and gender in 2019-2021.
1-19 between 2016-2018 The rate was:
and 2019-2021. • 4.1 times higher among children ages 15-19 (56.5
deaths per 100,000 children ages 1-19) than children
Source: CDC WONDER, Multiple Cause of
Death Files, 2016-2021.
ages 5-14 (13.8).
• 4.0 times higher among American Indian/Alaska Native

(55.5) than Asian (14.0) children.
• 3.3 times higher in Mississippi (48.0) than

Massachusetts (14.7).
Child Mortality
64,059
• 1.8 times higher among boys (35.3) than girls (19.1).
Note: The estimates for American Indian/Alaska

Native and Black (51.5) children were not significantly
different from each other based on non-overlapping
children in the U.S. died in 2019-2021. 95% confidence intervals.
Source: CDC WONDER, Multiple Cause of Death Files,

2019-2021.

Disparities in Infant Mortality by State
Mississippi
8.4
National Rate
5.5
Vermont
3.1 2.7x
0 5 10
Number of infant deaths (before age 1) per 1,000 live births
Source: CDC WONDER, Linked Birth/Infant Death Files, 2019-2020.
Infant Mortality
The infant mortality rate is consistently higher in Disparities. The infant mortality rate varied significantly
the U.S. than in other developed countries.6,7 Around by race/ethnicity, geography, age and metropolitan status
two-thirds of infant deaths occur during the neonatal in 2019-2020. The rate was:
period, birth to 27 days old.8 Research shows that
• 3.2 times higher among infants born to Black (10.5
socioeconomic inequality in the U.S. is a primary
deaths per 1,000 live births) than Asian (3.3) women.
contributor to its higher infant mortality rate.9
• 2.7 times higher in Mississippi (8.4) than Vermont (3.1).
Significant changes over time. Nationally, the infant
mortality rate decreased 4% from 5.7 to 5.5 deaths • 1.9 times higher among infants born to women ages
before age 1 per 1,000 live births between 2017-2018 15-19 (8.6) than women ages 30-34 (4.5).
and 2019-2020, moving closer to the Healthy People
• Higher among infants born to women in non-
2030 target of 5.0 per 1,000.10 In 2019-2020, approximately
metropolitan (6.3) areas than metropolitan (5.4) areas.
40,500 U.S. infants died, a decrease of about 3,300
infants compared with 2017-2018. The infant mortality
rate decreased in 33 states and the District of Columbia,
Related Measure: Neonatal Mortality
led by 35% in the District of Columbia (7.8 to 5.1 deaths Nationally, between 2017-2018 and 2019-2020 the
per 1,000 live births), 18% in Hawaii (6.1 to 5.0) and 13% neonatal mortality rate significantly decreased 5%
in both Nevada (6.0 to 5.2) and Rhode Island (5.6 to from 3.8 to 3.6 deaths during the first 28 days of life
4.9). During the same period, the infant mortality rate per 1,000 live births. During this timeframe, the rate
increased in seven states, led by 30% in North Dakota significantly decreased in 30 states and the District of
(5.0 to 6.5), 5% in Louisiana (7.4 to 7.8) and 4% in both Columbia, led by 41% in the District of Columbia (5.1 to
South Dakota (6.8 to 7.1) and Colorado (4.6 to 4.8). 3.0), 21% in Hawaii (3.9 to 3.1) and 17% in both Indiana
The rate decreased among every racial/ethnic and (4.7 to 3.9) and Oklahoma (4.7 to 3.9). During the same
age group. By group, the largest decreases were 11% period, the rate significantly increased in Louisiana,
among infants born to Hawaiian/Pacific Islander women Washington, Michigan, North Carolina, West Virginia
(8.5 to 7.6) and Asian women (3.7 to 3.3) and 6% among and Wisconsin. The rate of neonatal mortality was
infants born to women ages 35-39 (5.2 to 4.9). 2.6 times higher in Mississippi (5.0) than Vermont (1.9)
and higher among male (3.9) than female (3.3) neonates.

Findings | Commentary
To Improve Maternal and Child

Health Outcomes, Holistic and
Family-Based Approach Needed
Veronda L. Durden
President & CEO, Any Baby Can
At Any Baby Can, we work with clients in central Texas to pregnant women may not know their likelihood of
build stability in families. We help parents develop skills developing preeclampsia or the early symptoms, so
to navigate complex systems, advocate for themselves to reduce risk, we provide clients with blood pressure
and reach their full potential, one family and one child at cuffs and training on how to monitor at home. We help
a time. We work on the ground with parents and children mothers know their baseline metrics, advocate for their
who face medical, educational and financial obstacles. own health and understand what to do if something
changes. Through these and other programs, we seek to
The Health of Women and Children Report’s findings are
meet each family where they are — including physically
not a surprise to me, unfortunately. In fact, I see it as
meeting directly in their homes — and equip them with
confirmation of the urgency of our work. The challenges
the tools they need.
it outlines — high maternal mortality rates, rising mental
health concerns among women, and increasing health We know that a child’s ability to have a healthy and happy
disparities among underserved populations — are what future is based on the well-being of the whole family and
we seek to improve daily. those surrounding them. At Any Baby Can, we provide
holistic programming to help address stressors, including
As a mom and grandma, I know children don’t
case management, mental health care and support for a
come with instructions. Our Nurse-Family Partnership
family’s everyday needs. If you’re focusing on keeping a
program — supported in part by a grant from the United
roof over your head and food on the table, it’s hard to be
Health Foundation — pairs each client with a clinician to
fully present for the joys and challenges of parenting.
walk beside them through the journey of motherhood,
from 28 weeks to age 2, or longer. Together we help While the report’s findings are tragic, the positive
achieve a mentally and physically healthy pregnancy, outcomes I see among the families we serve gives me
birth and postpartum period. As a result of this grant, hope. They have hope for a better future, and we hold
we implemented innovations in maternal health to our that hope with them. I’ve had countless mothers over
home visiting program. All clients are now screened decades tell me how our work has been valuable to them,
to identify mental health needs, and women at risk for the humans behind the worrisome data in the report.
preeclampsia are provided with and trained on using
I’m also heartened by the high rates of healthy birth
blood pressure monitors.
weight babies, moms initiating breastfeeding and
This report also reinforces the need for approaching immunization rates among our families. We are extremely
maternal and child health with a prevention lens. We proud, too, that according to our surveyed clients,
empower women with knowledge and self-confidence 99% are more knowledgeable about child development,
to understand their own needs and act, and build 94% more prepared to plan their families’ futures and
awareness of risk factors for negative health outcomes. 98% better able to handle stress.
Our population of lower-income, first-time pregnant
To improve maternal and childhood health outcomes,
mothers often face higher risk for pregnancy
there is much work to be done to address barriers to care
complications, pre-term labor, low birth weight babies
and services. My hope is that we all reflect on and use this
and maternal mortality. This includes preeclampsia,
data; that we link arms and join together to help transform
characterized by high blood pressure and can potentially
lives — because healthy families raise healthy children,
lead to organ failure and maternal mortality. First-time
and that leads to healthier communities for everyone.

HEALTH OUTCOMES | BEHAVIORAL HEALTH

Disparities in Drug Deaths Among
Women’s mental and behavioral health Women by Race/Ethnicity
challenges continued to grow, with
increases in drug deaths, frequent American Indian/Alaska Native
mental distress and depression, all 56.0

with disparities by age, race/ethnicity White
and geography. 33.9
Drug Deaths Black
25.5
Drug overdose deaths have risen steadily in the U.S. over
the past two decades, becoming a leading cause of injury Multiracial
death and contributing to the decline in life expectancy.11
18.1
Significant changes over time. Nationally, the drug death
Hispanic
rate — deaths due to drug injury (unintentional, suicide,
homicide or undetermined) per 100,000 females ages 11.6
20-44 — increased 27% from 20.3 to 25.7 between 2016-
2018 and 2019-2021. This increase was larger than the Hawaiian/Pacific Islander
19% increase in the 2022 Health of Women and Children 9.8

Report. The rate exceeded the Healthy People 2030 target
Asian
18.1x
of 20.7 deaths per 100,000.12 In 2019-2021, nearly 41,900
women in the U.S. died from a drug overdose, an increase 3.1
of slightly more than 9,200 women since 2016-2018. The
drug death rate increased in 30 states and the District of
0 25 50
Columbia, led by 90% in North Dakota (10.7 to 20.3 deaths
per 100,000 females ages 20-44), 89% in Mississippi (12.0 Deaths per 100,000 females ages 20-44
to 22.7), 82% in the District of Columbia (9.2 to 16.7) and

77% in Louisiana (24.2 to 42.8). Source: CDC WONDER, Multiple Cause of Death Files, 2021.
Note: All racial groups are non-Hispanic. Hispanic ethnicity
Disparities. The drug death rate significantly varied
includes members of all racial groups.
by race/ethnicity, geography and age in 2019-2021;
all disparities were larger than those in the 2022
Health of Women and Children Report. The rate was:

Native (56.0 deaths per 100,000 females ages 20-44)
than Asian (3.1) women.
• 8.8 times higher in West Virginia (84.6) than

Hawaii (9.6).
• 2.3 times higher among women ages 35-44 (31.3)

than women ages 20-24 (13.9).

Frequent Mental Distress
21.0%
of women ages 18-44 reported their mental health was not
good 14 or more days in the past 30 days in 2020-2021.
Source: CDC, Behavioral Risk Factor Surveillance System, 2020-2021.
Frequent Mental Distress

Frequent mental distress is a self-reported measure • Higher among women living in non-metropolitan
that captures the population experiencing persistent (23.6%) than metropolitan (20.7%) areas.
and severe mental health issues.
Note: The estimates for multiracial women, women who
Significant changes over time. Nationally, the percentage identify their race as other (28.2%) and American Indian/
of women ages 18-44 who reported their mental health Alaska Native women (25.4%) were not significantly
was not good 14 or more days in the past 30 days different from each other based on non-overlapping
increased 16% from 18.1% to 21.0% between 2018-2019 95% confidence intervals; the same was true for
and 2020-2021, a larger increase than seen in last year’s estimates for Asian, Hispanic (15.5%) and Hawaiian/
report. During this timeframe, the prevalence of frequent Pacific Islander (16.4%) women.
mental distress increased in 12 states, led by 38% in
Colorado (16.0% to 22.1%), 32% in Iowa (18.0% to 23.7%) Related Measures: Depression
and 30% in Connecticut (15.1% to 19.6%). The prevalence and Postpartum Depression
increased across all income and age groups and among
Nationally, the percentage of women ages 18-44 who
some educational attainment and racial/ethnic groups
reported being told by a health professional that they
during this timeframe. By group, the largest increases were
had a depressive disorder — including depression, major
42% among women with a household income of $75,000
depression, minor depression or dysthymia — significantly
or more (9.9% to 14.1%), 40% among college graduates
increased 8% from 25.3% to 27.4% between 2018-2019
(11.1% to 15.5%), 21% among women ages 35-44 (14.6% to
and 2020-2021; this exceeded the 5% increase in the
17.6%) and 19% among white women (20.7% to 24.7%).
2022 Health of Women and Children Report. During this
Disparities. Frequent mental distress significantly timeframe, the prevalence significantly increased 36% in
varied by race/ethnicity, geography, income, educational Connecticut (20.9% to 28.4%), 30% in Colorado (23.1% to
attainment, age and metropolitan status in 2019-2021. 30.1%), 26% in Indiana (28.5% to 35.9%) and 17% in Virginia
The prevalence among women ages 18-44 was: (23.8% to 27.9%). The prevalence increased among some
income, age, racial/ethnic and educational attainment
• 2.3 times higher among multiracial (28.9%) than
groups. It was 2.4 times higher in New Hampshire (38.7%)
Asian (12.7%) women.
than Hawaii (15.9%) and significantly varied by race/
• 1.9 times higher in Arkansas (28.7%) than Hawaii (15.5%) ethnicity, income, educational attainment, age and
and 1.9 times higher among women with an annual metropolitan status.
household income less than $25,000 (26.3%) than
Nationally, the prevalence of postpartum depression
women with an income of $75,000 or more (14.1%).
among women with a recent live birth was 12.7% in 2021.
• 1.5 times higher among women with some post-high Evaluating the 34 states with data, the prevalence was
school education (23.4%) than college graduates 2.9 times higher in Idaho (25.4%) than Vermont (8.7%).
(15.5%) and 1.5 times higher among women ages
18-24 (26.1%) than women ages 35-44 (17.6%).

HEALTH OUTCOMES | PHYSICAL HEALTH
The percentage of women who reported their own health was very good or
excellent improved, along with the percentage who reported frequent physical
distress. However, severe maternal morbidity and the percentage of infants born
with a low birth weight significantly worsened.
High Health Status

Self-reported health status is a measure of how individuals Note: The estimates for white, Asian (62.3%) and
perceive their health.13 It is a subjective measure of health- Hawaiian/Pacific Islander women were not significantly
related quality of life that is not limited to specific health different from each other based on non-overlapping
conditions or outcomes but also factors in social support, 95% confidence intervals; the same was true for American
ability and ease of functioning, and other socioeconomic, Indian/Alaska Native and Hispanic (47.9%) women.
environmental and cultural aspects.14
Related Measure: Frequent
Significant changes over time. Nationally, the percentage
of women ages 18-44 who reported their health is
Physical Distress
very good or excellent increased 10% from 53.8% to Nationally, the percentage of women ages 18-44
59.0% between 2018-2019 and 2020-2021. During this who reported their physical health was not good
timeframe, the prevalence of high health status increased 14 or more days in the past 30 days significantly
in 20 states, led by 22% in both New Mexico (46.0% to decreased 15% from 8.4% to 7.1% between 2018-2019
56.3%) and Hawaii (53.5% to 65.1%) and 21% in Nevada and 2020-2021. Frequent physical distress significantly
(47.8% to 57.7%). The prevalence increased among most decreased 40% in Oregon (12.3% to 7.4%), 32% in
racial/ethnic, all educational attainment, some income Arizona (10.7% to 7.3%), 28% in Virginia (8.1% to 5.8%)
and all age groups. By group, the largest increases were and 24% in New York (7.5% to 5.7%). The prevalence
29% among Hawaiian/Pacific Islander women (46.9% to significantly decreased among some racial/ethnic,
60.5%), 27% among women with less than a high school age and educational attainment groups. It was 2.1
education (25.9% to 32.9%), 18% among women with an times higher in Kentucky (11.0%) than Hawaii (5.2%)
annual income less than $25,000 (32.5% to 38.5%) and and varied significantly by income, race/ethnicity,
12% among women ages 18-24 (56.7% to 63.4%). educational attainment, age and metropolitan status.
Disparities. The prevalence of high health status

among women significantly varied by educational
attainment, income, race/ethnicity, geography, age
and metropolitan status in 2020-2021. It was:
High Health Status
10%
• 2.2 times higher among college graduates
(71.7%) than women with less than a high school
education (32.9%).
• 1.9 times higher among women with an annual

income of $75,000 or more (73.2%) than women
increase in women ages 18-44 who
with an income less than $25,000 (38.5%).
reported their health was very good
• Higher among white (64.7%) compared with or excellent, from 53.8% to 59.0%
American Indian/Alaska Native (47.2%) women, between 2018-2019 and 2020-2021.
higher in South Dakota (65.5%) than Mississippi
(53.4%), higher among women ages 18-24 (63.4%) Source: CDC, Behavioral Risk Factor Surveillance System,
than women ages 35-44 (55.6%) and higher among 2018-2021.
women living in metropolitan (59.3%) compared
with non-metropolitan (56.7%) areas.

Severe Maternal Morbidity
2.8x
higher in New York (112.1 complications
per 10,000 delivery hospitalizations)
than Wyoming (40.3) in 2020.
Low Birth Weight
311,900
Source: Federally Available Data, Maternal and Child Health
Bureau, Health Resources and Services Administration, 2020.
Note: Data are missing for Alabama and Idaho.
infants were affected in 2021,

an increase of 14,300 compared
with 2020.
Source: CDC WONDER, Natality Public Use Files, 2021.
Severe Maternal Morbidity Disparities. Severe maternal morbidity varied significantly

by geography, race/ethnicity, age, income and metropolitan
Severe maternal morbidity includes serious and status in 2020. The rate was:
potentially life-threatening events and outcomes,
• 2.8 times higher in New York (112.1 complications per
such as hemorrhage, eclampsia or hysterectomy.15,16
10,000 delivery hospitalizations) than Wyoming (40.3).
Significant changes over time. Nationally, severe maternal
• 2.0 times higher among Black (139.0) than white
morbidity — life-threatening maternal complications during
(69.9) women.
delivery — increased 9% from 81.0 to 88.3 complications
per 10,000 delivery hospitalizations between 2019 and • 1.8 times higher among women ages 35 and older
2020. This is larger than the increase between 2018 and (127.9) compared with women ages 20-24 (72.3).
2019 and exceeded the Healthy People 2030 target of
• Higher among women in the poorest income quartile
64.4 per 10,000.17 In 2020, approximately 29,600 women
(100.6) compared with women in the wealthiest
experienced significant life-threatening complications
income quartile (79.8), and higher among women in
during delivery, an increase of about 1,400 women
metropolitan (96.0) than non-metropolitan (74.7) areas.
compared with 2019. Severe maternal morbidity
increased 22% in New York (92.2 to 112.1 complications Note: Data are missing for Alabama and Idaho. The
during delivery per 10,000 delivery hospitalizations), estimates for women ages 20-24 and women ages 25-
21% in Tennessee (73.1 to 88.6), 15% in both Michigan 29 (75.7) were not significantly different from each other
(78.3 to 89.9) and Florida (81.8 to 94.1) and 10% in Texas based on non-overlapping 95% confidence intervals.
(72.4 to 79.5). The rate increased among some racial/ethnic
groups and all age and income groups. By group, the
largest increases were 15% among Hispanic women
Low Birth Weight
(82.2 to 94.6), 12% among both women younger than Low birth weight infants (weighing less than 2,500 grams
20 (77.8 to 86.9) and women in the poorest income at birth) are at increased risk of several short- and long-
quartile (89.6 to 100.6) and 10% among women in term complications.18 Low birth weight and preterm birth
metropolitan (87.0 to 96.0) areas. are leading causes of infant mortality.6

Significant changes over time. Nationally, the Disparities. Low birth weight varied significantly by
percentage of infants weighing less than 2,500 grams race/ethnicity, geography, educational attainment
(5 pounds, 8 ounces) at birth increased 4% from 8.2% and age in 2021. It was:
to 8.5% between 2020 and 2021. In 2021, approximately
• 2.1 times higher among infants born to Black (14.7%)
311,900 infants were born with a low birth weight, an
than white (7.0%) women.
increase of about 14,300 infants compared with 2020.
The low birth weight rate increased in eight states, led • 1.9 times higher in Mississippi (12.3%) than North
by 8% in Nevada (9.0% to 9.7%) and 7% in Minnesota Dakota (6.6%).
(6.7% to 7.2%), Kentucky (8.5% to 9.1%), Georgia (9.9%
• Higher among infants born to women with less than a
to 10.6%) and Arizona (7.4% to 7.9%). The prevalence
high school education (10.1%) compared with college
increased among some racial/ethnic, all age and some
graduates (7.0%) and higher among infants born to
educational attainment groups. By group, the largest
women ages 40-44 (11%) compared with women ages
increases were 8% among infants born to Asian women
30-34 (7.9%).
(8.5% to 9.2%), 5% among infants born to both women
ages 20-24 (8.6% to 9.0%) and women ages 40-44 Note: The estimates for women ages 30-34 and women
(10.5% to 11.0%) and 4% among infants born to women ages 25-29 (8.0%) were not significantly different from each
with a high school diploma or GED (9.4% to 9.8%). other based on non-overlapping 95% confidence intervals.
SOCIAL AND ECONOMIC FACTORS | COMMUNITY AND FAMILY SAFETY
Injury deaths, an indicator of community and family safety, have been increasing
among women of reproductive age and children. During the COVID-19 pandemic,
early childhood education enrollment declined substantially.
Injury Deaths — Women

Injuries are the leading cause of death among women Injury Deaths Among
ages 20-44. In 2021, the top causes of injury death among
women of reproductive age were poisoning (including
Women Increased 17%
drug deaths), motor vehicle traffic accidents and firearms.
Firearm violence is a serious and deadly public health
issue, especially for women. Women in the U.S. are
21 times more likely to die by firearm than women in 40
Deaths due to injury per 100,000
comparable countries.19 Most injury deaths were accidents

(unintentional), followed by suicide and homicide.
females ages 20-44
30
Significant changes over time. Nationally, injury deaths
among women increased 17% from 41.0 to 48.1 deaths
per 100,000 females ages 20-44 between 2016-2018 and 20
2019-2021. In 2019-2021, approximately 78,200 women
died because of injury in the U.S., an increase of 12,400
women compared with 2016-2018. Injury deaths among 10
women increased in 27 states and the District of Columbia,
led by 64% in the District of Columbia (21.0 to 34.4 deaths
per 100,000 females ages 20-44), 46% in Mississippi 0
(48.1 to 70.0) and 42% in Delaware (55.8 to 79.0). The rate 2012-2014 2016-2018 2019-2021
increased among all age groups: 20% among women ages Data Years
35-44 (44.3 to 53.2), 16% among women ages 25-34 (41.6
to 48.4) and 11% among women ages 20-24 (33.2 to 36.9).

Findings | Social and Economic Factors
Disparities. The injury death rate among women Note: Data for Hawaii, Rhode Island and Vermont were
significantly varied by race/ethnicity, geography suppressed because 20 or fewer deaths were recorded.
and age in 2019-2021. The rate was: The estimates for women ages 20-24 and women ages
25-34 were not significantly different from each other
• 12.1 times higher among American Indian/Alaska Native
based on non-overlapping 95% confidence intervals.
(137.4 deaths per 100,000 females ages 20-44) than
Asian (11.4) women.
• 4.3 times higher in West Virginia (116.1) than

Injury Deaths — Children
Hawaii (27.3). Accidents (unintentional injuries) are the leading cause
of death among U.S. children ages 1-19, followed by
• Higher among women ages 35-44 (53.2) than
homicide and suicide, all of which are considered injury
women ages 20-24 (36.9).
deaths. In 2019-2021, the leading cause of injury deaths
was firearms, followed by motor vehicle accidents and
Related Measure: Firearm Deaths — Women poisoning. The U.S. is the only nation among its peers
Nationally, firearm deaths among women significantly where firearms are the leading cause of child mortality.20
increased 14% from 4.9 to 5.6 deaths due to firearm
Significant changes over time. Nationally, injury
injury of any intent (unintentional, suicide, homicide or
deaths among children increased 11% from 15.7 to
undetermined) per 100,000 females ages 20-44 between
17.4 deaths due to injury per 100,000 children ages
2016-2018 and 2019-2021. This increase is larger than the
1-19 between 2016-2018 and 2019-2021. In 2019-2021,
increase in the 2022 Health of Women and Children Report.
approximately 40,600 U.S. children died because of
In 2019-2021, 9,100 women died from firearms, an increase
injury, an increase of 3,800 children compared with
of approximately 1,300 women compared with 2016-2018.
2016-2018. Injury deaths among children increased in
Between 2016-2018 and 2019-2021, the rate significantly
nine states and the District of Columbia, led by 71% in
increased 47% in Maryland (3.6 to 5.3 deaths per 100,000
the District of Columbia (15.0 to 25.6 deaths per 100,000
females ages 20-44), 39% in Mississippi (10.8 to 15.0), 33% in
children ages 1-19), 25% in Arizona (18.7 to 23.4) and
Tennessee (7.5 to 10.0) and 25% in Georgia (6.8 to 8.5). The
23% in both Mississippi (25.6 to 31.6) and Minnesota
rate of firearm deaths among women varied significantly
(12.1 to 14.9) between 2016-2018 and 2019-2021. The rate
by geography, race/ethnicity and age in 2019-2021. It was
also increased among the following age groups and by
13.6 times higher in Mississippi (15.0) than Massachusetts
gender: 13% among children ages 15-19 (38.7 to 43.7),
(1.1), 10.1 times higher among Black (13.1) than Asian (1.3)
10% among children ages 5-14 (5.9 to 6.5), 12% among
women and higher among women ages 20-24 (5.9) and
boys (21.7 to 24.4) and 5% among girls (9.5 to 10.0).
25-34 (5.8) compared with women ages 35-44 (5.2).
Significant Changes in Injury Deaths Among Children

13%
40
Ages 15-19
per 100,000 children
Deaths due to injury
30
20
11%
Ages 1-19
10
10%
Ages 5-14
0
2016-2018 2019-2021
Data Years

Findings | Social and Economic Factors
Disparities. Injury deaths among children significantly Early Childhood Education

varied by age, race/ethnicity, geography and gender in
2019-2021. The rate was:
Enrollment Decreased 18%
• 6.7 times higher among children ages 15-19 50%
(43.7 deaths per 100,000 children ages 1-19)
than children ages 5-14 (6.5).
40%
• 5.9 times higher among American Indian/
Percentage of children ages 3-4

Alaska Native (40.8) than Asian (6.9) children.
• 4.4 times higher in Alaska (32.9) than 30%

Massachusetts (7.5).
• 2.4 times higher among boys (24.4) than 20%

girls (10.0).
Related Measure: Firearm 10%

Deaths — Children
Nationally, firearm deaths among children significantly 0%
increased 26% from 4.2 to 5.3 deaths due to firearm 2016 2019 2021
injury per 100,000 children ages 1-19 between 2016-2018
Data Years
and 2019-2021. This is a larger increase than the increase
in last year’s report. In 2019-2021, approximately 12,500
U.S. children died by firearm, about 2,600 more deaths Source: U.S. Census Bureau, American Community Survey, 2016-2021.
than in 2016-2018. Between 2016-2018 and 2019-2021,
the rate significantly increased in 14 states, led by 61% SOCIAL AND ECONOMIC FACTORS | EDUCATION
in Kansas (4.9 to 7.9 per 100,000 children ages 1-19)
and 55% in both North Carolina (4.4 to 6.8) and Louisiana
(8.6 to 13.3). The rate of firearm deaths among children Early Childhood Education
varied significantly by age, race/ethnicity and geography The COVID-19 pandemic severely disrupted early
in 2019-2021. It was 23.4 times higher among children childhood education and exacerbated already present
ages 15-19 (16.4) than children ages 1-4 (0.7), 15.0 times disparities.21 For many, the path to higher educational
higher among Black (18.0) than Asian (1.2) children attainment starts with early childhood education.
and 12.1 times higher in Louisiana (13.3) than There is sound evidence that early childhood education
Massachusetts (1.1). leads not only to higher educational attainment but also
contributes to better health and promotes health equity.22
Related Measure: Teen Suicide
Significant changes over time. Nationally, the
Nationally, the teen suicide rate was 10.6 deaths percentage of children ages 3-4 who are enrolled in
per 100,000 adolescents ages 15-19 in 2019-2021, nursery school, preschool or kindergarten decreased
or approximately 6,800 deaths. The rate did not 18% from 48.9% to 40.2% between 2019 and 2021.
significantly differ from the 2016-2018 rate. However, In 2021, approximately 3,150,000 U.S. children were
the teen suicide rate significantly decreased 27% in enrolled in early childhood education, a decrease of
Missouri (17.2 to 12.5 deaths per 100,000 adolescents 838,000 compared with 2019. Early childhood education
ages 15-19) between 2016-2018 and 2019-2021. In enrollment decreased in 28 states, led by 44% in New
2019-2021, the teen suicide rate was 8.6 times higher Mexico (46.1% to 25.6%), 34% in Mississippi (60.4% to
in Alaska (41.3) than in Massachusetts (4.8) and 5.0 times 39.9%) and 31% in New Hampshire (58.2% to 40.1%).
higher among American Indian/Alaska Native (39.9) than
Hispanic (8.0) teens. Disparities. Early childhood education was 2.4 times
higher in Connecticut (55.5%) than West Virginia (23.5%)
Note: Teen suicide data for Delaware, Rhode Island in 2021.
and Vermont were suppressed because 20 or fewer
deaths were recorded.

Findings | Clinical Care
CLINICAL CARE | ACCESS TO CARE
Many measures of individuals’ access to care improved, while the number of

women’s health providers declined.
Uninsured Women and Children

Health insurance is a critical factor in ensuring women Nationally, the percentage of children younger than
and children receive the preventive and medical care 19 years not covered by private or public health insurance
they need to achieve and maintain good health.23 decreased 5% from 5.7% to 5.4% between 2019 and 2021.
Benefits of health insurance coverage among children The uninsured rate among children decreased 20% in
include increased access to and use of preventive, Illinois (4.0% to 3.2%) and 7% in Texas (12.7% to 11.8%).
primary and specialty health care, as well as higher During this same period, the uninsured rate among
quality of care and improved health outcomes.24,25 children increased 40% in Idaho (5.0% to 7.0%).
Significant changes over time. Nationally, the percentage Disparities. In 2021, the uninsured rate among
of women ages 19-44 not covered by private or public women was 8.8 times higher in Texas (25.6%) than
health insurance decreased 9% from 12.9% to 11.8% Massachusetts and Vermont (both 2.9%) and the
between 2019 and 2021. In 2021, approximately 6,641,000 rate among children was 9.1 times higher in Texas
U.S. women were uninsured, a decrease of 550,000 (11.8%) than Massachusetts (1.3%).
compared with 2019. The uninsured rate among women
decreased in 12 states, led by 49% in Vermont (5.7% to
2.9%), 41% in Idaho (18.3% to 10.8%) and 36% in Maine
(10.7% to 6.9%).
Uninsured Women Uninsured Children

The uninsured rate among women was highest The uninsured rate among children was highest
in Texas and lowest in Massachusetts and Vermont. in Texas and lowest in Massachusetts.
25.6%
Percentage of women ages 19-44
Percentage of children ages 0-18
20% 20%
8.8x
10% 11.8% 10% 11.8%
9.1x
5.4%
2.9% 2.9%
1.3%
0% 0%
Texas National Massachusetts Vermont Texas National Massachusetts
Rate Rate
Source: U.S. Census Bureau, American Community Survey, 2021. Source: U.S. Census Bureau, American Community Survey, 2021.

Findings | Clinical Care
4,600 fewer women’s

health providers
in 2022 than 2021.
Source: U.S. HHS, Centers for Medicare & Medicaid Services, National Plan
and Provider Enumeration System, September 2021-September 2022.
4.7x
higher number of pediatricians per 100,000
children ages 0-21 in Massachusetts (214.0)
than Wyoming (45.6). The number, however,
was highest in the District of Columbia (564.4).
Source: U.S. HHS, Centers for Medicare & Medicaid Services, National Plan
and Provider Enumeration System, September 2022.
Women’s Health Providers Pediatricians

Women’s health providers — such as obstetricians, Pediatricians are physicians who specialize in treating
gynecologists and midwives — specialize in reproductive mental and physical illness in children from birth through
topics including pregnancy, contraception (birth control) young adulthood.28 They also monitor the development
and menopause.26 They also advise on long-term health of children and provide preventive care, including
and wellness as well as provide important preventive vaccinations, through wellness exams.29
health services for women like cancer screening,
Changes over time. Nationally, the number of
contraception counseling and well-woman visits.27
pediatricians per 100,000 children ages 0-21 increased
Changes over time. Nationally, the number of 2% from 107.2 to 109.3 between September 2021 and
obstetricians, gynecologists and midwives per 100,000 September 2022. As of September 2022, there were
females ages 15 and older decreased 7% from 49.5 to approximately 99,300 pediatricians in the U.S., an
46.0 between September 2021 and September 2022, increase of 2,900 compared with September 2021. The
the first decline since this measure was added to the supply of pediatricians increased at a rate greater than
report in 2020. As of September 2022, there were or equal to the nation in 30 states and the District of
approximately 63,500 women’s health providers in the Columbia, led by 8% in Oklahoma (67.6 to 72.9 providers
U.S., a decrease of 4,600 compared with September per 100,000 children ages 0-21), Alaska (86.6 to 93.7) and
2021. The supply of women’s health providers decreased the District of Columbia (524.2 to 564.4) between 2021
at a rate greater than or equal to the nation in 20 states, and 2022. During this same period the supply decreased
led by 16% in Rhode Island (72.2 to 60.4 providers per 4% in Rhode Island (191.9 to 183.3) and 2% in Delaware
100,000 females ages 15 and older) and 13% in both (176.5 to 172.1), New Jersey (123.3 to 120.6), Vermont
Nebraska (46.8 to 40.6) and New Jersey (52.2 to 45.5). (145.1 to 142.4) and Wisconsin (104.5 to 102.9).
Disparities. The supply of women’s health providers Disparities. The supply of pediatricians was 4.7 times
was 3.8 times higher in Alaska (103.8 providers per higher in Massachusetts (214.0 providers per 100,000
100,000 females ages 15 and older) than Alabama (27.5) children ages 0-21) than Wyoming (45.6) in September
in September 2022. The supply was highest in the District 2022. The supply was highest in the District of
of Columbia (107.0). Columbia (564.4).

Findings | Behaviors
Fruit and Vegetable Disparities in Physical

Consumption Inactivity by State
Less than 1 in 10 women ages 18-44 met fruit and Physical inactivity was highest in
vegetable consumption recommendations in 2021. Mississippi and lowest in Vermont.
Mississippi
27.4%
National Rate
21.1%
Vermont
9.8% 13.6%
2.0x
0% 10% 20% 30%
Percentage of women ages 18-44
Source: CDC, Behavioral Risk Factor Surveillance System, 2021.
Source: CDC, Behavioral Risk Factor Surveillance System, 2020-2021.
BEHAVIORS | NUTRITION AND PHYSICAL ACTIVITY
Among women of reproductive age, fruit and vegetable intake decreased and
the percentage of physically inactive women declined. The long-term successes
in reducing smoking and teen birth rates have continued.
Fruit and Vegetable Disparities. Fruit and vegetable consumption varied

significantly by geography, age and income in 2021.
Consumption The prevalence was:
Diets high in fruits and vegetables reduce the risk • 4.4 times higher in Vermont (16.8%) than
of many chronic diseases such as Type 2 diabetes, Mississippi (3.8%).
obesity, heart disease and stroke.30,31 Consuming fruits
• Higher among women ages 35-44 (10.7%) than
and vegetables three or more times daily is associated
women ages 18-24 (8.1%) and higher among
with a lower overall mortality risk.31
women with an annual income of $75,000 or
Significant changes over time. Nationally, the percentage more (11.7%) than women with an income of
of women ages 18-44 who reported consuming two or $50,000-$74,999 (8.8%).
more fruits and three or more vegetables daily decreased
Note: Data were not available for Florida. The estimates for
20% from 12.2% to 9.8% between 2017 and 2021. Fruit
women ages 25-34 (10.1%) were not significantly different
and vegetable consumption decreased in nine states,
from the other age groups based on non-overlapping
led by 60% in Mississippi (9.5% to 3.8%), 59% in Oregon
95% confidence intervals; the same was true for the
(15.7% to 6.5%) and 56% in Idaho (16.0% to 7.0%). The
three lowest annual household income groups.
prevalence decreased among some income, educational
attainment, racial/ethnic and age groups. By group,
the largest decreases were 39% among women with Physical Inactivity
an income of $50,000-$74,999 (14.5% to 8.8%), 31%
Physical inactivity, or a sedentary lifestyle, can
among college graduates (15.7% to 10.9%), 23% among
increase the risk of several health consequences
white women (12.8% to 9.9%) and 21% among women
such as cardiovascular disease, hypertension,
ages 35-44 (13.5% to 10.7%).
cancer, obesity, diabetes and premature death.32–35


of women ages 18-44 who reported doing no physical
activity or exercise other than their regular job in the
past 30 days decreased 7% from 22.6% to 21.1% between
2018-2019 and 2020-2021. The prevalence decreased Despite large declines in
among some educational attainment, racial/ethnic and
age groups. By group, the largest decreases were 14% smoking among women
among college graduates (13.2% to 11.4%), 12% among of reproductive age, the
white women (17.8% to 15.7%) and 8% among women
ages 35-44 (24.2% to 22.2%).
12.1% prevalence is still
Disparities. Physical inactivity varied by educational
nearly double Healthy
attainment, income, geography, race/ethnicity and People 2030’s goal to
age group in 2020-2021. The prevalence was:
reduce current smoking
• 3.6 times higher among women with less than
a high school education (41.0%) than college
among adults to 6.1%.
graduates (11.4%).
• 3.0 times higher among women with an annual

income less than $25,000 (34.9%) than women
with an income of $75,000 or more (11.6%).
• 2.0 times higher in Mississippi (27.4%) than

Vermont (13.6%). Significant Changes in Smoking
Among Women by Age
• 1.9 times higher among Hispanic (29.5%) than
white (15.7%) women.
Ages
• Higher among women ages 35-44 (22.2%) than 25-34
women ages 18-24 (19.5%). 15%
Note: The estimates for Hispanic and Black (28.2%)

17%
women were not significantly different from each other Ages
15%
Percentage of women
based on non-overlapping 95% confidence intervals; the 18-44

same was true for white, multiracial (16.4%) and Hawaiian/
Pacific Islander (21.5%) women. The estimates for women 10%
ages 25-34 (21.2%) were not significantly different from
the estimates for women ages 18-24 or ages 35-44.
BEHAVIORS | SMOKING AND TOBACCO USE Ages

18-24
34%
Smoking 5%
Smoking cigarettes is the leading cause of preventable

death in the U.S.36 It is responsible for more than 480,000
American deaths yearly, including nearly 201,800 women.36

of women ages 18-44 who reported smoking at least 0%
100 cigarettes in their lifetime and currently smoke daily 2018-2019 2020-2021
or some days decreased 15% from 14.3% to 12.1% between Data Years
2018-2019 and 2020-2021, exceeding the decrease in
last year’s report. Despite this progress, the current
prevalence remains higher than the Healthy People 2030 Source: CDC, Behavioral Risk Factor Surveillance System,
2018-2021.
target of 6.1%.37 The prevalence of smoking decreased in

six states, led by 32% in Maryland (11.6% to 7.9%) Related Measure: E-Cigarette Use
and 31% in both Delaware (17.8% to 12.2%) and Oregon
(16.6% to 11.5%). The prevalence decreased among Nationally, 8.8% of women ages 18-44 reported that they
some age, educational attainment and one racial/ethnic had used e-cigarettes or other electronic vaping products
group. By group the largest decreases were 34% among at least once in their lifetime and currently use daily or
women ages 18-24 (9.2% to 6.1%), 19% among college some days in 2020-2021. The prevalence was 2.7 times
graduates (5.9% to 4.8%) and 14% among white women higher in Kentucky (15.5%) than California and Maryland
(18.0% to 15.4%). (both 5.8%). The District of Columbia (4.0%) had the
lowest prevalence. It also varied significantly by age,
Disparities. The prevalence of smoking varied educational attainment, race/ethnicity, income and
significantly by race/ethnicity, educational attainment, metropolitan status.
geography, income, age and metropolitan status in
2020-2021. The prevalence was: Related Measure: Electronic Vapor
• 7.7 times higher among American Indian/Alaska Native Product Use — Youth
(25.3%) than Asian (3.3%) women. Nationally, the percentage of high school students
• 4.7 times higher among women with less than a high who reported using an electronic vapor product in
school education (22.5%) than college graduates (4.8%). the past 30 days significantly decreased 45% from
32.7% to 18.0% between 2019 and 2021. In 2021,
• 4.4 times higher in West Virginia (26.2%) than approximately 16,100 high school students reported
California (5.9%). using an electronic vapor product, a decrease of
• 3.5 times higher among women with an annual 3,300 students compared with before the COVID-19
income less than $25,000 (24.0%) than women pandemic in 2019. Electronic vapor use decreased
with an income of $75,000 or more (6.9%). significantly in 16 states, led by 61% in Connecticut
(27.0% to 10.6%) and 52% in both Hawaii (30.6% to 14.8%)
• 2.5 times higher among women ages 35-44 (15.4%) and New Hampshire (33.8% to 16.2%). Assessing the
than women ages 18-24 (6.1%). 43 states with data, electronic vapor use was 2.8 times
higher in West Virginia (27.5%) than Utah (9.7%).
• 1.9 times higher among women living in non-
metropolitan (20.2%) areas than metropolitan Note: Minnesota, Oregon, Washington, Wyoming and
(10.9%) areas. D.C. did not participate in the 2019 or 2021 Youth Risk
Behavior Surveillance System. In addition, data were
Note: The estimates for women with less than a high
missing for Alaska, California and Florida in 2021 and
school education and high school graduates (22.3%)
Delaware, Florida and Indiana in 2019.
were not significantly different from each other based
on non-overlapping 95% confidence intervals.
Related Measure: Smoking

During Pregnancy
Nationally, the percentage of women who reported Electronic Vapor Product
smoking cigarettes during pregnancy decreased 16% Use — Youth
45%
from 5.5% to 4.6% between 2020 and 2021, exceeding
the decrease in the 2022 Health of Women and Children
Report. In 2021, approximately 168,100 U.S. women
reported smoking during pregnancy, a decrease of
31,500 women compared with 2020. Smoking during
pregnancy decreased at a rate greater than or equal to decrease from 32.7% to 18.0%
the nation in 33 states and the District of Columbia, led between 2019 and 2021.
by 28% in Vermont (13.1% to 9.4%), 27% in Connecticut
(3.3% to 2.4%) and 26% in Delaware (7.0% to 5.2%). Source: CDC, Youth Risk Behavior Surveillance System,
2019-2021.
Smoking during pregnancy was 22.8 times higher
in West Virginia (18.2%) than California (0.8%).

Teen Births Decreased 10%

BEHAVIORS | SEXUAL HEALTH
Teen Births The teen birth rate decreased 10% between

2020 and 2021, and 65% since 2008.
Substantial social, economic and health costs are
associated with teen pregnancy and childrearing.38
40
Teen mothers are more likely to drop out of high
Births per 1,000 females ages 15-19

school and experience unemployment.39
30
Changes over time. Nationally, the teen birth
rate decreased 10% from 15.4 to 13.9 births per
1,000 females ages 15-19 between 2020 and 2021, 20
continuing a long-term downward trend and exceeding
the decrease between 2019 and 2020. In 2021, there
were approximately 147,000 births among U.S. teens, 10
a decrease of 11,100 births compared with 2020.
The teen birth rate decreased 10% or more in 19 states
0
and the District of Columbia, led by 26% in Maine
2008 ′20 ′21
(10.6 to 7.8 births per 1,000 females ages 15-19) and
Data Years
18% in Idaho (14.6 to 12.0), Illinois (13.6 to 11.1) and
New Hampshire (6.6 to 5.4). During the same period,
the rate decreased 15% among Asian teens (2.0 to 1.7) Source: CDC WONDER, Natality Public Use Files, 2008-2021.
and 10% among Black (24.2 to 21.7), Hispanic (23.5 to
21.1) and white (10.3 to 9.3) teens.
Disparities. The teen birth rate varied by race/ethnicity Disparities in Teen Birth by State
and geography in 2021. The rate was: The teen birth rate was highest in
Arkansas and lowest in New Hampshire.
Native (23.9 births per 1,000 females ages 15-19)
Arkansas
than Asian (1.7) teens.
26.5
• 4.9 times higher in Arkansas (26.5) than New
Hampshire (5.4).
National Rate
13.9
New Hampshire
5.4
4.9x
0 10 20 30
Births per 1,000 females ages 15-19
Source: CDC WONDER, Natality Public Use Files, 2021.

State Rankings
State Rankings
Rankings included in the 2023 Health of Women and Children Report are derived from 83 measures across
five categories of health: social and economic factors, physical environment, behaviors, clinical care and health
outcomes. For a more detailed description of how the overall rank is calculated, visit the America’s Health Rankings
Methodology page.
Comprehensive State Rankings

2023 Health of Women and Children Report
DC
RI
DE
Ranking
1-10 11-20 21-30 31-40 41-50 Not

Ranked
Source: America's Health Rankings composite measure, 2023.

State Rankings
Minnesota Ranks No. 1 Mississippi Ranks No. 50

Minnesota is the healthiest state in this year’s report for Mississippi is the least healthy state in this year’s
both women and children. It ranks among the top five report, ranking number 50 for children and number
states in social and economic factors (No. 1), physical 48 for women. It ranks in the bottom five states in social
environment (No. 4), behaviors (No. 2) and health and economic factors (No. 46), physical environment
outcomes (No. 3). Minnesota is number 15 in clinical care. (No. 50), behaviors (No. 49) and health outcomes
Strengths: Low infant mortality rate, high prevalence (No. 47). Mississippi is number 41 in clinical care.
of high school completion and high voter participation Strengths: High enrollment in early childhood education,
among women. high prevalence of well-woman visits and low prevalence
Challenges: High prevalence of excessive drinking of excessive drinking among women.
among women, high racial disparity among children
Challenges: High infant mortality rate, high mortality
in poverty and low prevalence of well-woman visits.
rate among women ages 20-44 and high percentage
Massachusetts (No. 2), Vermont (No. 3), New Hampshire of children in poverty.
(No. 4) and Hawaii (No. 5) complete the top five
healthiest states. Arkansas (No. 49), Louisiana (No. 48), Oklahoma (No. 47) and
West Virginia (No. 46) complete the five least healthy states.
Women’s State Rankings

DC
RI
DE
Ranking
1-10
11-20
Children’s State Rankings 21-30
2023 Health of Women and Children Report 31-40
41-50
Not ranked
DC
RI Source: America's Health

DE Rankings composite
measure, 2023.

State Rankings
Measure Impact
This graph displays the state scores in order of rank, To further explore state-level data, see Explore Data.
with the least healthy states on the left and the healthiest The website features downloadable State Summaries
states on the right. The distance between bars shows for each state and the District of Columbia. Each summary
the difference between state scores. For example, describes state-specific strengths, challenges, trends
Louisiana (No. 48) and Oklahoma (No. 47), while close and rankings for individual measures, allowing users
in ranking, have a sizable difference in score, meaning to identify which measures positively or negatively
a lot of progress would need to be made in order for influenced each state’s overall rank. This can be visualized
Louisiana to improve its score and move up in the by selecting a state in the Explore Data section. The
rankings. There is also a large gap in score between website also features an Adjust My Rank tool that allows
Illinois (No. 15) and the next highest state, Virginia users to explore how progress and challenges across
(No. 14). key measures can affect a state’s overall rank.
Comprehensive State Rankings and Scores*

Least Healthy Healthiest
States States
Mississippi 50 1 Minnesota
Arkansas 49 2 Massachusetts
Louisiana 48 3 Vermont
Oklahoma 47 4 New Hampshire
West Virginia 46 5 Hawaii
Alabama 45 6 Utah
Kentucky 44 7 New Jersey
New Mexico 43 8 Connecticut
South Carolina 42 9 Colorado
Tennessee 41 10 Washington
Nevada 40 11 Maryland
Indiana 39 12 Nebraska
Missouri 38 12 Rhode Island
Ohio 37 14 Virginia
Texas 36 15 Illinois
Georgia 35 16 Iowa
Arizona 34 17 California
Wyoming 33 18 New York
Alaska 32 19 North Dakota
Montana 31 20 Oregon
North Carolina 30 21 Maine

Delaware 29 22 Wisconsin
Michigan 28 23 Pennsylvania
Florida 27 24 Idaho
25 Kansas
26 South Dakota
-0.8 -0.6 -0.4 -0.2 0 0.2 0.4 0.6 0.8
Summation Scores
Ranking
1-10 11-20 21-30 31-40 41-50
Source: America's Health Rankings composite measure, 2023.
*Sum of weighted z-scores of all ranked measures.

Appendix | National Summary
United States
Health Department Website: hhs.gov
Summary
Highlights
Mortality Early Childhood Education Enrollment Frequent Mental Distress
40% 
from 97.2 to 136.4 deaths per
18% 
from 48.9% to 40.2% of children
16% 
from 18.1% to 21.0% of women
100,000 women ages 20-44 ages 3-4 between 2019 and 2021. ages 18-44 between 2018-2019
between 2019 and 2021. and 2020-2021.
Injury Deaths High Health Status Teen Births
11% 
from 15.7 to 17.4 deaths per
10% 
from 53.8% to 59.0% of women
10% 
from 15.4 to 13.9 births per
100,000 children ages 1-19 ages 18-44 between 2018-2019 1,000 females ages 15-19
between 2016-2018 and 2019-2021. and 2020-2021. between 2020 and 2021.
Measures
U.S. U.S.
Women Value Children Value
Social & Economic Factors* Social & Economic Factors*
Community Firearm Deaths† 5.6 Community Child Victimization† 8.1
and Family Injury Deaths 48.1 and Family Firearm Deaths† 5.3
Safety Safety
Intimate Partner Violence 2.6% Injury Deaths 17.4
Before Pregnancy†
Economic Concentrated Disadvantage 25.9% Economic Children in Poverty 16.9%
Resources Food Insecurity 10.4% Resources Children in Poverty Racial Disparity 3.0
Gender Pay Gap† 81.5% High-Speed Internet 95.3%
Poverty 15.5% Students Experiencing Homelessness 2.2%
Unemployment 5.2% WIC Coverage 48.3%
Education College Graduate 36.8% Education Early Childhood Education 40.2%
Fourth Grade Reading Proficiency 32.1%
High School Completion 89.4%
Social Support Infant Child Care Cost† 11.7% Social Support Adverse Childhood Experiences 14.0%
and Residential Segregation – Black/White — and Foster Care Instability 15.2%
Engagement Engagement
Voter Participation 60.7% Neighborhood Amenities 35.5%
Reading, Singing or Storytelling 57.2%
Physical Environment*
Air and Water Air Pollution 7.8
Quality Drinking Water Violations 0.8%
Household Smoke 13.8%
Water Fluoridation 72.7%
Climate and Climate Change Policies —
Health Transportation Energy Use† 8.2
Housing and Drive Alone to Work 66.0%
Transportation Housing Cost Burden (households with children)† 31.2%
Housing With Lead Risk 16.9%
Severe Housing Problems 17.0%

Appendix | National Summary
United States
Health Department Website: hhs.gov
Measures
U.S. U.S.
Women Value Children Value
Clinical Care* Clinical Care*
Access to Adequate Prenatal Care 74.7% Access to ADD/ADHD Treatment 2.8%
Care Avoided Care Due to Cost 14.6% Care Pediatricians 109.3
Maternity Care Desert† 3.1 Uninsured 5.4%
Uninsured 11.8%
Women's Health Providers 46.0
Preventive Cervical Cancer Screening 77.1% Preventive Childhood Immunizations 70.0%
Clinical Dental Visit 65.5% Clinical HPV Vaccination 61.7%
Services Services
Flu Vaccination 38.9% Preventive Dental Care 75.1%
Postpartum Visit† 90.9% Well-Child Visit 76.7%
Well-Woman Visit 70.5%
Quality of Breastfeeding Initiation† 83.7% Quality of Adequate Insurance 68.2%
Care Dedicated Health Care Provider 79.2% Care Developmental Screening 34.8%
Low-Risk Cesarean Delivery 26.3% Medical Home 46.0%
Maternity Practices Score 81
Behaviors* Behaviors*
Nutrition Exercise 21.5% Nutrition Breastfed 24.9%
and Physical Fruit and Vegetable Consumption 9.8% and Physical Food Sufficiency 71.9%
Activity Activity
Physical Inactivity 21.1% Physical Activity 20.5%
Soda Consumption – Youth† 8.5%
Sexual Chlamydia 1,563.1 Sexual Health – Dual Contraceptive Nonuse† 89.8%
Health High-Risk HIV Behaviors 9.6% Youth Teen Births 13.9
Unintended Pregnancy† 25.5%
Sleep Insufficient Sleep 33.4% Sleep Adequate Sleep 66.6%
Health Health Sleep Position† 81.4%
Smoking E-Cigarette Use† 8.8% Smoking and Electronic Vapor Product Use† 18.0%
and Tobacco Smoking 12.1% Tobacco Use – Tobacco Use 4.0%
Use Youth
Smoking During Pregnancy 4.6%
Health Outcomes* Health Outcomes*

Behavioral Drug Deaths† 25.7 Behavioral Alcohol Use – Youth 9.2%
Health Excessive Drinking 18.8% Health Anxiety 9.2%
Frequent Mental Distress 21.0% Depression 4.2%
Illicit Drug Use 10.8% Flourishing 66.6%
Postpartum Depression† 12.7% Illicit Drug Use – Youth 8.4%
Teen Suicide† 10.6
Mortality Maternal Mortality† 22.4 Mortality Child Mortality 27.4
Mortality Rate 136.4 Infant Mortality 5.5
Neonatal Mortality† 3.6
Physical Depression† 27.4% Physical Asthma 6.9%
Health Frequent Physical Distress 7.1% Health High Health Status† 90.2%
High Blood Pressure 10.8% Low Birth Weight 8.5%
High Health Status† 59.0% Low Birth Weight Racial Disparity 2.1
Multiple Chronic Conditions 4.2% Neonatal Abstinence Syndrome† 6.2
Obesity 31.5% Overweight or Obesity – Youth 33.5%
Severe Maternal Morbidity† 88.3
* The value assigned to a summation score is a sum of weighted, ranking measure z-scores (the number of standard deviations a state value was above or below the U.S. value).
Higher summation scores are better. Scores are not calculated for the District of Columbia.
† Additional measure.
— Data not available, missing or suppressed.
For measure descriptions, source details and methodology, visit AmericasHealthRankings.org.
Ranks are calculated for each measure, ordered by the states’ values, with 1 corresponding to the healthiest value and 50 the least healthy value. Ties in value are assigned equal ranks.

Appendix | Subpopulation Group Definitions and Limitations
Subpopulation Group Definitions Metropolitan Status. Metropolitan status data in this

report were available for measures from BRFSS and FAD
Subpopulation analyses were performed to illuminate data sourced from HCUP. BRFSS groupings were coded
disparities by gender, race/ethnicity, education, income based on residence geography. Identification as large
and metropolitan status. Not all subpopulations were central metro, large fringe metro, medium metro and
available for all data sources and measures. Individual small metro were classified as Metro, and identification
estimates were suppressed if they did not meet the as micropolitan and noncore were classified as Non-
reliability criteria laid out by the data source or by Metro. FAD groupings were based on the 2013 National
internally established criteria. Some values had wide Center for Health Statistics Urban-Rural Classification
confidence intervals, meaning the true value may be Scheme for Counties. Metro was defined as metropolitan
far from the estimate listed. areas with at least 1 million residents. Small to medium
Gender. This report highlights data on women and includes metro was defined as metropolitan areas of fewer than
gender stratification as female and male for youth and 1 million residents. Non-metro was defined as micropolitan,
children’s measures as available through public data sources non-metropolitan and non-micropolitan areas.
— even though not all people identified with these two Race and Ethnicity. Data were provided where
categories. Data did not differentiate between assigned sex available for the following racial and ethnic groups:
at birth and current gender identity. While sex and gender American Indian/Alaska Native, Asian, Black or African
influence health, the current data collection practices of American (classified in this report as Black), Hispanic
many national surveys limited the ability to describe the or Latino (classified as Hispanic), Native Hawaiian or
health of transgender or gender nonbinary individuals. Other Pacific Islander (classified as Hawaiian/Pacific
Age. Age data in this report were available for measures Islander), white, multiracial and those who identify as
from the Centers for Disease Control and Prevention’s other race. Hispanic ethnicity includes members of
(CDC) Behavioral Risk Factor Surveillance System (BRFSS) all racial groups. Racial/ethnic groups were defined
and the Maternal and Child Health Bureau’s Federally differently across data sources. In summary, BRFSS,
Available Data (FAD), which were sourced from the CDC WONDER and FAD race data were presented as
National Vital Statistics System (NVSS) and the Healthcare non-Hispanic, while the American Community Survey
Cost Utilization Project (HCUP). BRFSS groupings in this data were presented as Hispanic-inclusive (except for
report were limited to females of childbearing age and white, which is non-Hispanic).
included the following self-reported age ranges: 18-24,
25-34 and 35-44. FAD groupings were based on maternal Limitations
age and were grouped into five age ranges: <20; 20-24; Data presented in this report were aggregated at the
25-29; 30-34; and ≥35. state level and cannot be used to make inferences at
Education. Education data in this report were available the individual level. Additionally, estimates cannot be
for measures from BRFSS and FAD data sourced from extrapolated beyond the population upon which they
NVSS. BRFSS groupings were based on responses to were created.
the question, “What is the highest grade or year of Caution is suggested when interpreting data on certain
school you completed?” FAD groupings were based health and behavioral measures. Many were self-reported
on the education level that best described the highest and relied on an individual’s perception of health and
degree or level of school completed at the time of death. behaviors. Additionally, some health outcome measures
Income. Income data in this report were available were based on respondents being told by a health care
for measures from BRFSS and FAD data sourced from professional that they had a disease and may have
HCUP. BRFSS groupings were based on responses to excluded those who have not received a diagnosis
the question, “[What] is your annual household income or sought or obtained treatment.
from all sources?” FAD groupings were based on quartiles
(poorest to wealthiest) of current year median zip code
household income obtained from Claritas, a data-driven
marketing company.

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35. Carlson, Susan A. et al. “Percentage of Deaths https://www.cdc.gov/teenpregnancy/about/
Associated With Inadequate Physical Activity in index.htm.
the United States.” Preventing Chronic Disease 15
(March 29, 2018): 170354. https://doi.org/10.5888/
pcd18.170354.

Appendix | Copyright
The America’s Health Rankings® Health of Women and Children Report is

available in its entirety at AmericasHealthRankings.org. Visit the site to request
or download additional copies. The America’s Health Rankings 2023 Health of
Women and Children Report is funded entirely by the United Health Foundation,
a recognized 501(c)(3) organization. An Advisory Committee provided expertise
and guidance in the design and selection of measures for this report.
United Health Foundation encourages the distribution of information in this

publication for non-commercial and charitable, educational or scientific
purposes. Please acknowledge America’s Health Rankings Health of Women
and Children Report as the source and provide the following notice: ©2023
United Health Foundation. All Rights Reserved. Please acknowledge the
original source of specific data as cited.
Data contained within this report were obtained from and used with
permission of:
Center for Climate and Energy Solutions
Child Care Aware
March of Dimes
U.S. Department of Agriculture
Economic Research Service
U.S. Census Bureau
American Community Survey
Current Population Survey, Voting and Registration Supplement
U.S. Department of Education
National Center for Education Statistics
National Center for Homeless Education
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention
Centers for Medicare & Medicaid Services
Children’s Bureau
Health Resources & Services Administration
Maternal and Child Health Bureau
Substance Abuse and Mental Health Services Administration
U.S. Department of Housing and Urban Development
Office of Policy Development and Research
U.S. Department of Labor
Bureau of Labor Statistics
U.S. Energy Information Administration
U.S. Environmental Protection Agency
Arundel Metrics, Inc. of Saint Paul, Minnesota, conducted this project

for and in cooperation with United Health Foundation with design by
Wunderman Thompson.
Questions and comments on the report should be directed to the United

Health Foundation at unitedhealthfoundationinfo@uhg.com.
Copyright ©2023 United Health Foundation

About the United Health Foundation
Through collaboration with community partners,

grants and outreach efforts, the United Health
Foundation works to improve our health system,
build a diverse and dynamic health workforce
and enhance the well-being of local communities.
The United Health Foundation was established
by UnitedHealth Group (NYSE: UNH) in 1999 as
a not-for-profit, private foundation dedicated to
improving health and health care. To date, the
United Health Foundation has committed more
than $700 million to programs and communities
around the world. To learn more, visit
UnitedHealthFoundation.org.
For more information, contact:

The United Health Foundation
Jenifer McCormick
jenifer_mccormick@uhg.com
(952) 936-1917
AmericasHealthRankings.org

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2023 Health

Social and Economic Factors 16

Subpopulation Group Definitions 30

The United Health Foundation is proud to

This report highlights the rising rates of mortality among women of

Monitoring the health and well-being of women of

2023 Health of Women and Children Report AmericasHealthRankings.org 2

The 2023 Health of Women and Children Report finds that:

• Mortality rates, including maternal mortality,

• Women’s mental and behavioral health

• Despite troubling trends in women’s mortality

• During the COVID-19 pandemic, early childhood

• Many measures of individuals’ access to care

• The long-term successes in reducing smoking

2023 Health of Women and Children Report AmericasHealthRankings.org 3

Model for Measuring

2023 Health of Women and Children Report AmericasHealthRankings.org 4

increased from 20.3 to 25.7 deaths

High Health Status Social and Economic Factors

1 2023 Health of Women and Children Report AmericasHealthRankings.org 5

decreased from 32.7%

2023 Health of Women and Children Report AmericasHealthRankings.org 2

HEALTH OUTCOMES | MORTALITY

Mortality rates, including maternal

health measures. 20-44 were accidents (unintentional injuries), COVID-19,

Increases in Mortality Among Women Between 2020 and 2021

Percent increase in deaths

8-16% 17-21% 22% 23-25% 26-32% Not

Source: CDC WONDER, Multiple Cause of Death Files, 2020-2021.

2023 Health of Women and Children Report AmericasHealthRankings.org 7

Disparities. The mortality rate significantly varied by White

• 3.0 times higher in West Virginia (266.3) than Asian

Related Measure: Maternal Mortality Multiracial

Nationally, the maternal mortality rate increased 29% from 13.6

2023 Health of Women and Children Report AmericasHealthRankings.org 8

Significant changes over time. Nationally, the mortality

• 4.0 times higher among American Indian/Alaska Native

• 3.3 times higher in Mississippi (48.0) than

Note: The estimates for American Indian/Alaska

Source: CDC WONDER, Multiple Cause of Death Files,

2023 Health of Women and Children Report AmericasHealthRankings.org 9

Disparities in Infant Mortality by State

Number of infant deaths (before age 1) per 1,000 live births

Source: CDC WONDER, Linked Birth/Infant Death Files, 2019-2020.

2023 Health of Women and Children Report AmericasHealthRankings.org 10

To Improve Maternal and Child

2023 Health of Women and Children Report AmericasHealthRankings.org 11

HEALTH OUTCOMES | BEHAVIORAL HEALTH

mental distress and depression, all 56.0

Drug Deaths Black

19% increase in the 2022 Health of Women and Children 9.8

to 22.7), 82% in the District of Columbia (9.2 to 16.7) and

• 18.1 times higher among American Indian/Alaska

• 8.8 times higher in West Virginia (84.6) than

• 2.3 times higher among women ages 35-44 (31.3)

2023 Health of Women and Children Report AmericasHealthRankings.org 12

Frequent Mental Distress

Source: CDC, Behavioral Risk Factor Surveillance System, 2020-2021.

Frequent Mental Distress

2023 Health of Women and Children Report AmericasHealthRankings.org 13

HEALTH OUTCOMES | PHYSICAL HEALTH

High Health Status

Disparities. The prevalence of high health status

High Health Status