The study assesses all fifty states, plus the District of Colombia, on 32 metrics across three areas – health outcomes, health care quality and prevention, and coverage, access, and affordability.
Kentucky performed well in several areas. Kentucky women ages 18-44 rarely went without care because of cost, and only 6% of Kentucky women ages 19-64 lacked health insurance coverage.
However, Kentucky ranks in the bottom half on women’s health overall, with one of the worst rates of death from breast and cervical cancer - both of which are considered largely treatable with early detection and immediate care.
The state also had exceptionally high rates of death from any cause, which was mostly attributed to the state's opioid deaths. Kentucky’s all-cause mortality rate per 100,000 women ages 15-44 was 176.3 – nearly 60% more than the national average, and well over double the rate of the best performing state.
Dr. Sara Collins, Senior Scholar and Vice President of the Commonwealth Fund, said there are clear distinctions between states that perform well for women and states that perform poorly.
"Higher performing states have invested in health insurance coverage for nearly all their residents," said Collins, "They've made reproductive healthcare legal and accessible, and they've achieved lower maternity mortality rates with more maternal health care workers, more prenatal and postpartum checkups, and higher rates of postpartum depression screening."
Kentucky adopted the ACA’s Medicaid expansion a decade ago, but Commonwealth Fund Senior Scientist Dr. David Radley said access to health care isn’t just about access to health insurance.
"It's also about being able to get to a service provider when care is needed," said Radley. "It's estimated that over 5 million women [nationwide] already live in a county that's considered a maternity care desert, meaning there's no hospital or birth center offering obstetric care and there are no obstetric providers."
According to a 2022 report by The March of Dimes, nearly half of Kentucky’s 120 counties are defined as “maternity care deserts”, with over 30 percent of women lacking access to a birthing hospital within a 30 minute drive.
"We looked at the adequacy of the maternity care workforce in each state and found that states with the most restrictive abortion policies also tended to have the fewest maternity care providers," said Radley.
Following the Dobbs decision, a trigger law banned nearly all abortions in Kentucky, impacting reproductive care beyond abortion alone.
"Abortion bans or limits may inadvertently reduce the number of providers offering maternity care, owing to increased risk of legal action that practices face," concluded the study.
Dr. Joseph Betancourt, President of the Commonwealth Fund, said the report is not about politics, but policy.
"If you track across our scorecards, we engage in this work through the evidence lens, agnostic to politics but looking at policy and trends," said Betancourt. "There's no doubt that there's a series of state-held policy choices here that have a clear impact not only on women's health but on health more generally. Shining a light on these [policies] in our capacity to identify high performers from low performers provides a blueprint for improving health more generally for any state."
A bipartisan law tackling the high mortality rate of Kentucky mothers went into effect this week. The legislation expands health care access for new and expecting mothers, with pregnancy now considered a qualifying life event for health insurance coverage. It also establishes a psychiatric hotline called the Kentucky Lifeline for Moms.