As the worst of COVID-19 subsided in 2022 and a trigger law banning most abortions went into effect upon the fall of Roe v. Wade, Kentucky was already among the worst-performing states for women’s health.?

This insight comes from The Commonwealth Fund’s 2024 State Scorecard on Women’s Health and Reproductive Care, a first-of-its kind ranking that examined health outcomes, insurance coverage, abortion restrictions and other measures in all states and Washington D.C.?

Data is mostly from 2021 and 2022 and was collected primarily from public sources like the Centers for Disease Control and Prevention.?

Released Thursday, the report shows Kentucky had many fewer maternity care providers than the national average in 2022 — 69 per 100,000 women ages 15–44 compared with an average of 79 nationally.?

Kentucky women between the ages of 18 and 44 are also less likely than the national average to report seeing a medical provider for a routine checkup, the report shows.?

“Based on the evidence and data, one thing is absolutely clear: women’s health in the U.S. is in a very fragile state,”? Dr. Joseph Betancourt, the Commonwealth Fund president, said during a Wednesday press call.?

“There are stark disparities in women’s access to quality health care among states, across racial, ethnic and socio economic lines,” Betancourt said. “These inequities are long standing no doubt, but recent policy choices and judicial decisions for restricting access to reproductive care have and may continue to exacerbate them.”??

The report’s goal, Betancourt said, is to offer states and the nation a “vital baseline for tracking the ripple effects” of the United States Supreme Court’s 2022 decision to overturn the constitutional right to abortion as well as “impacts of new policy restrictions on reproductive care.”?

Researchers said Wednesday on a national press call that where a woman lives can indicate a lot about her ability to access and afford all kinds of health care.?

“We are seeing a deep and likely growing geographic divide in U.S. women’s ability to access vital health services and maintain their health, particularly among women of reproductive age,” said Sara Collins, one of the research authors.?

In Kentucky, a“trigger law” went into effect upon the high court’s Roe reversal. Now, abortions in the state are banned in most cases.?

Also in 2022, Kentucky voters rejected an anti-abortion amendment that would have stated definitely that? there is no right to an abortion in Kentucky’s Constitution.

Kentucky does not have exceptions for rape or incest, though both Republican and Democratic lawmakers have filed unsuccessful bills to change that in recent years. There is an exception in cases where the life of the pregnant person is at risk.

The scorecard report is “generally reflecting what was happening in 2022,” explained David Radley, one of the research authors. “So, after the main impacts of COVID, but largely before or concurrent … with the implementation of state abortion bans immediately following the Dobbs decision.”?

“We expect to update this report over time to track how state policy actions — specifically how new restrictions on access to abortion services — impact women’s health and the care they receive,” Radley said during a Wednesday press call.?

Maternal, infant death rates higher in Kentucky than nation

Some key takeaways from the report include:

• From 2020-2022, Kentucky had a rate of 31.4 maternal deaths while pregnant or within 42 days of termination per 100,000 live births. That’s higher than the national average of 26.3.?
• In 2021, Kentucky’s infant mortality rate was higher than the national average — 6.2 per 1,000 live births compared with 5.4 nationally.?
• All-cause mortality among women ages 15-44 in 2022 was 176.3 per 100,000, far higher than the national average of 110.3. Kentucky is one of the worst in the nation on this point. “Suicide, cancer and complications from pregnancy are among the leading causes of death for women in this age range,” Radley said. If you or someone you know is contemplating suicide, call or text the Suicide Prevention Lifeline at 988.?

Some data was not available for Kentucky, including the percentage of women who were asked about depression in their postpartum care or the percentage of women who got a flu shot within a 1-year time span before or after delivery.?

The report also does not show the percentage of women who self-reported having postpartum depression symptoms or the percentage of women who experienced intimate partner violence around delivery.?

Other takeaways from the report include:?

• 73% of Kentucky women between the ages of 50-74 reported getting a mammogram in the last two years compared with 77% nationally.?
• 80% of Kentucky women ages 21-65 reported getting a pap smear in the past three years, compared with 82% nationally.?
• 69% of Kentucky women 65 and older received a pneumonia vaccine, compared with 73% nationally.?
• 33% of Kentucky women between the ages of 18-64 have received an HIV or AIDS test, compared with 44% nationally.?
• 65% of Kentucky women between 45-74 reported getting a sigmoidoscopy or a colonoscopy in the past decade or a fecal occult blood test in the past two years, compared with 60% nationally.

Bright spots

While Kentucky performed poorly overall, data shows a few points where the state did better than the national average.

In 2022, for example, 6% of women in Kentucky between 19-64 reported not having health insurance. That’s lower than the 10% national average.?

Additionally, 12% of Kentucky women between 18-44 said in 2022 they’d needed to see a doctor in the past year but couldn’t afford to. That’s lower than the national average of 17%. Kentucky also has a higher rate of women in this age group who have someone they think of as their health care provider.?

Dr. Laurie C. Zephyrin, one of the study authors and the senior vice president for advancing health equity at The Commonwealth Fund, said in a statement that “it is disheartening to see the rising disparities in women’s health across the nation.”?

“Our country’s fractured landscape of reproductive health access will make it even more difficult to close these widening gaps, especially for women with low incomes and women of color in states with restricted access to reproductive care,” said Zephyrin. “Instead of limiting care, federal and state policymakers should work to ensure that women have access to the full continuum of care throughout their lives.”

The Commonwealth Fund, founded in 1918, is a charitable foundation focused on promoting “a high-performing, equitable health care system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including people of color, people with low income, and those who are uninsured.”