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Executive BriefIntroductionNational SnapshotFindingsHealth OutcomesSocial and Economic FactorsClinical CareBehaviorsState RankingsAppendixMeasures Table – WomenMeasures Table – ChildrenData Source DescriptionsMethodologyState Summaries
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US SummaryAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingWomen face challenges in maternal mortality and health outcomes, while bright spots in children’s health are offset by increases in the child mortality rate
In 2022, women and children comprised a large percentage of the demographic profile of the United States. Women ages 18-44 comprised 17.8% of the total population — over 59 million people — while children under 18 years old made up 21.7%, totaling more than 72 million individuals. These large populations are essential to the overall well-being of communities across the country.
The America’s Health Rankings® 2024 Health of Women and Children Report examines 123 measures of health from 33 data sources. It builds on previous America’s Health Rankings analyses to provide a holistic understanding of the health of these populations and track trends over time.
This year’s report finds worsening challenges affecting women across multiple categories of health outcomes, including measures of mental and behavioral health and physical health. Key clinical care measures among women fell short of the targets for the Healthy People 2030 objectives.
There were several bright spots in children’s health, including decreases in the teen suicide rate and overweight or obesity prevalence among youth, as well as continued challenges like the increasing child mortality rate. The number of pediatricians rose but may not meet the national need.
Analysis of factors that impact health outcomes shows that some socioeconomic indicators — like unemployment among women and early childhood education enrollment — have improved, returning toward pre-pandemic levels.
Additionally, the report finds that women faced significant disparities by disability status, and both women and children faced significant disparities by geography and race/ethnicity. In addition to the disparities noted in the 2024 Maternal and Infant Health Disparities Data Brief, this report spotlights striking differences between states in several measures of mental and behavioral health.
This report is complemented by the 2024 Maternal and Infant Health Disparities Data Brief, which sought to more deeply understand disparities in several of the key outcome measures included in this report, such as maternal mortality and severe maternal morbidity. The brief provides detailed State Profiles which include disparities and trends over time in these and other measures.
For the first time, the Health of Women and Children Report examines health disparities among women by disability status, sexual orientation and veteran status. The report also explores new indicators of health through measures of mental health conditions and mental health treatment among children, congenital syphilis among live births and mentorship for children.
Please view the full 2024 Health of Women and Children Report for more information on sources and methodology.
Maternal Mortality and Severe Maternal Morbidity Worsened Among Women
Maternal mortality — defined here and by the World Health Organization as deaths related to or aggravated by pregnancy occurring within 42 days of the end of pregnancy per 100,000 live births — is a critical indicator of the health of women, children and communities nationwide. Despite a 12% decrease in the overall mortality rate among women ages 20-44 between 2021 and 2022, largely driven by a reduction in COVID-related deaths, maternal mortality increased. It rose 34%, from 17.3 to 23.2 deaths per 100,000 live births between 2014-2018 and 2018-2022, remaining above the Healthy People 2030 target of 15.7 per 100,000. Additionally, severe maternal morbidity — significant life-threatening maternal complications during delivery — increased 14%, from 88.3 to 100.3 complications per 10,000 delivery hospitalizations between 2020 and 2021, moving away from the Healthy People 2030 target of 64.4 per 10,000. The 2024 Maternal and Infant Health Disparities Data Brief benchmarks state progress against these Healthy People 2030 targets and provides additional insights into maternal mortality and severe maternal morbidity at the state level.
Clinical Care Measures Fell Short of Healthy People 2030 Goals
Minimizing low-risk cesarean deliveries and ensuring adequate prenatal care can prevent injury and death among women and reduce the risk of birthing complications. However, between 2021 and 2022, these critical clinical care and quality measures did not improve, falling short of national public health goals. The rate of low-risk cesarean delivery — the percentage of first births that are singleton, head-first and term (37 or more completed weeks) that were cesarean deliveries — remained at 26.3% in both 2021 and 2022, failing to meet the Healthy People 2030 target of 23.6%. Additionally, adequate prenatal care — the percentage of live births in which the mother received appropriate prenatal care in the first four months of pregnancy — was 74.9% in 2022, below the Healthy People 2030 target of 80.5%.
While well-woman visits did not change significantly between 2019-2020 and 2021-2022, the prevalence in the most recent time period was significantly higher than it was in 2013-2014, indicating a long-term improvement. Well-woman visits provide women with an opportunity to engage in preventive care, such as vaccinations and screening tests, and enable discussions about healthier lifestyle strategies.
Asthma and Obesity Rose Among Women
Asthma and obesity were also challenges among women, both worsening between 2019-2020 and 2021-2022. Asthma prevalence increased 9%, from 11.7% to 12.7%, affecting approximately 743,800 more women than in 2019-2020. At the same time, obesity prevalence increased 8%, from 30.4% to 32.7%, impacting approximately 16 million women. There were disparities in both measures; asthma was 3.6 times higher among women who have difficulty with self-care (35.7%) than women without a disability (9.8%) and obesity was 4.0 times higher among Black (47.9%) than Asian (12.1%) women.
I always knew I wanted to work with children. I realized that providing the best outcomes for them starts with taking care of moms. That’s why I focus on postpartum care as a mental health nurse right now. – Yamilee, RN, a Diversity in Health Care scholar pursuing a DNP in midwifery, United Health Foundation Diversity in Health Care Scholar
Depression and Drug Deaths Worsened Among Women
Depression — the percentage of women ages 18-44 who reported being told by a health professional that they have a depressive disorder — increased 11% among women ages 18-44, from 26.1% to 29.1% between 2019-2020 and 2021-2022.
Drug deaths continued to rise among women, underscoring a longer-term trend. Drug deaths — the number of deaths due to drug injury per 100,000 females ages 20-44 — increased 38%, from 20.7 to 28.6 between 2017-2019 and 2020-2022. This increase reflects significant disparities by race/ethnicity and geography. In 2020-2022, drug deaths were 19.1 times higher among American Indian/Alaska Native (68.6) than Asian (3.6) women. Geographic disparities were also prominent, with drug death rates 10.2 times higher in West Virginia (91.2) than Hawaii (8.9).
Improvements in Smoking During Pregnancy, Household Smoke and Neonatal Abstinence Syndrome
Several measures that impact the health of children, including smoking during pregnancy, household smoke and neonatal abstinence syndrome, showed encouraging improvements.
Between 2021 and 2022, the percentage of women who reported smoking during pregnancy decreased 20%, from 4.6% to 3.7%. Additionally, neonatal abstinence syndrome — the prevalence of newborn hospitalizations for withdrawal symptoms due to prenatal exposure to illicit drugs — decreased 5% from 6.2 to 5.9 per 1,000 birth hospitalizations. Household smoke — the percentage of children ages 0-17 living in households where someone uses cigarettes, cigars or pipe tobacco — decreased 16% between 2020-2021 and 2022-2023, from 13.7% to 11.5%. According to the Centers for Disease Control and Prevention, exposure to smoke and opioids during pregnancy and childhood can lead to serious negative health outcomes for infants and children, including preterm birth, seizures and an increased risk of sudden infant death syndrome.
Despite these improvements, significant geographic disparities remain. In 2022, the prevalence of smoking during pregnancy was 21.9 times higher in West Virginia (15.3%) than California (0.7%). Neonatal abstinence syndrome was 24.7 times higher among American Indian/Alaska Native (17.3 hospitalizations per 1,000 birth hospitalizations) compared with Asian/Pacific Islander (0.7) infants, as well as 22.6 times higher in West Virginia (38.4) than Nebraska (1.7) in 2021. Household smoke prevalence was 4.7 times higher in West Virginia (24.9%) than Utah (5.3%) in 2022-2023.
Teen Suicide Declined, but Rates of Child Mortality and Mental Health Conditions Rose
In 2020-2022, the teen suicide rate decreased from its peak in 2017-2019, which was the highest rate since America’s Health Rankings began tracking the measure. The rate dropped by 6%, from 11.2 to 10.5 deaths per 100,000 adolescents ages 15-19 — an improvement resulting in 380 fewer teen suicides in 2020-2022 than in 2017-2019.
Despite this overall significant improvement, geographic disparities persist. The states with the lowest teen suicide rates were New York (5.1 deaths per 100,000 adolescents ages 15-19), New Jersey (5.3) and Connecticut (5.8). In contrast, the states with the highest rates were Montana (36.3), South Dakota (33.7) and Alaska (30.2).
In 2020-2022, the teen suicide rate was 7.1 times higher in Montana (36.3) than New York (5.1). Disparities also exist along racial/ethnic lines, with the teen suicide rate 4.7 times higher among American Indian/Alaska Native (37.2) than Hispanic (7.9) adolescents.
Between 2020-2021 and 2022-2023, diagnosed mental health conditions — the percentage of children ages 3-17 told by a health care provider they currently have attention deficit/hyperactivity disorder (ADHD), depression or anxiety problems, or told by a doctor or educator they have behavior or conduct problems — increased 12%, rising from 17.7% to 19.9%. In 2022-2023, the prevalence was 3.8 times higher among American Indian/Alaska Native (24.9%) than Hawaiian/Pacific Islander (6.6%) children.
While this increase could indicate an improvement in diagnosis of mental health challenges rather than a surge in the underlying conditions themselves, the newly added mental health treatment measure — the percentage of children ages 12-17 who received needed mental health treatment or counseling — has not significantly changed in recent years. In 2022-2023, 82.5% of children who needed mental health treatment received it. The U.S. Surgeon General has issued several advisories calling for efforts to increase the number of mental health providers for adolescents and to build a more robust and diverse mental health workforce.
Between 2017-2019 and 2020-2022, child mortality increased 14%, from 25.4 to 29.0 deaths per 100,000 children ages 1-19. The national rate remains above the Healthy People 2030 target of 18.4. Some states had even higher rates; for example, child mortality was 3.1 times higher in Mississippi (49.4) than Massachusetts (15.8) in 2020-2022. Contributing to the overall increase in child mortality was a 37% increase in firearm deaths — the number of deaths due to firearm injury of any intent (unintentional, suicide, homicide or undetermined) — from 4.3 to 5.9 per 100,000 children ages 1-19, approximately 3,500 more deaths than in 2017-2019. Injury deaths also rose 20% during this period, from 15.5 to 18.6 deaths per 100,000 children ages 1-19, leading to approximately 43,000 deaths.
By continuing to use data to identify gaps, advocate for policy changes and push for innovations that make care more efficient and accessible, I believe we can close the mental health care gap. – Dr. Sy Saeed, Founding Executive Director, North Carolina Statewide Telepsychiatry Program, and Professor and Chair Emeritus, Department of Psychiatry and Behavioral Medicine, Brody School of Medicine at East Carolina University
Improvements in Children’s Physical Health and Increase in Pediatricians
In contrast to the rising prevalence of obesity among women, the prevalence of overweight or obesity among youth decreased 6%, from 33.2% to 31.1% of children ages 10-17 between 2020-2021 and 2022-2023. This decrease translates to approximately 428,000 fewer children than in 2020-2021.
Between 2022 and 2023, the number of pediatricians rose 4%, from 109.3 to 113.2 per 100,000 children ages 0-21. This follows a positive trend in which the number of pediatricians increased at the national level by 13%, from 100.1 to 113.2, between 2019 and 2023. Despite this growth, the nation still experiences a shortage of pediatric specialists, according to the Children’s Hospital Association. Additionally, the uneven distribution of pediatricians and family physicians leaves many rural and underserved communities with insufficient care options.
Key Socioeconomic Drivers of Health Improved Following Pandemic Declines
Enrollment in early childhood education increased 16%, from 40.2 % to 46.7% between 2021 and 2022, trending closer toward the pre-pandemic rate of 48.9% in 2019. The Community Preventive Services Task Force recognizes high-quality early childhood education programs as an avenue to improving health, promoting health equity and narrowing the educational achievement gap.
In addition, unemployment among women decreased 31% between 2021 and 2022, from 5.2% to 3.6%, returning to 2019 levels. Research indicates that unemployment can negatively impact the health of women and children by limiting access to health insurance, education, nutritious food and quality child care.
Call to Action
The 2024 Health of Women and Children Report spotlights the various factors that influence the health of women and children, underscoring the importance of the social drivers of health to the well-being of our communities. By taking a proactive and preventive approach to health, supporting the health care workforce and ensuring everyone has access to the resources and care they need to thrive, we can address health challenges before they worsen. We encourage policymakers, advocates, community leaders and individuals to use these findings to advance better health and well-being for all women and children nationwide.