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Executive SummaryIntroductionExplore the Health of Women, Children and InfantsFindingsThe Health of Women and Children between StatesThe Health of Women and Children within StatesHealthy Communities for ChildrenClinical Preventive Services for ChildrenRacial Disparities in Measures of MortalityVariations in SmokingMeasures of Women's HealthBehaviors | Measures of Women’s HealthCommunity & Environment | Measures of Women’s HealthPolicy | Measures of Women’s HealthClinical Care | Measures of Women’s HealthOutcomes | Measures of Women’s HealthMeasures of Infants' HealthBehaviors | Measures of Infants’ HealthCommunity & Environment | Measures of Infants’ HealthPolicy | Measures of Infants’ HealthClinical Care | Measures of Infants’ HealthOutcomes | Measures of Infants’ HealthMeasures of Children's HealthBehaviors | Measures of Children’s HealthCommunity & Environment | Measures of Children’s HealthPolicy | Measures of Children’s HealthClinical Care | Measures of Children’s HealthOutcomes | Measures of Children’s HealthState SummariesAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingDistrict of ColumbiaUnited StatesAppendixData Sources and Measures of Women’s HealthData Sources and Measures of Infants’ HealthData Sources and Measures of Children’s HealthMethodologyModel DevelopmentAmerica’s Health Rankings® Health of Women and Children Steering GroupThe Team
This report finds that Massachusetts is the healthiest state for women, infants, and children overall (Figure 1 and Tables 1–2). Their position as the number one ranking state is based on an assessment of 60 measures of health. Vermont (2nd), New Hampshire (3rd), Connecticut (4th), and Minnesota (5th) round out the top five states. States in the top five are consistently strong in measures of children’s health, as well as the clinical care, behaviors, and policy categories.
Massachusetts ranks first due to its low mortality rates (maternal, infant, neonatal, and child), low teen birth rate, strong clinical care measures for women and children, low percentages of women and children without health insurance, and low prevalence of obesity among women. Massachusetts is challenged by a high prevalence of excessive drinking among women, high infant care costs, high rate of reported homeless family households, and high prevalence of alcohol consumption during pregnancy.
Mississippi ranks 50th overall. The state is preceded by Arkansas (49th), Louisiana (48th), Nevada (47th), and Oklahoma (46th). Mississippi’s challenges include ranking last in six measures of outcomes (infant mortality, neonatal mortality, low birthweight, preterm birth, child mortality, and unintended pregnancy), five community & environment measures (concentrated disadvantage, food insecurity, neighborhood amenities, and both protective home environment measures), two clinical care measures for children (developmental screening and adolescent immunizations), physical inactivity among women, mPINC (Maternity Practices in Infant and Nutrition Care) survey score, and percentage of infants exclusively breastfed for six months. Mississippi’s strengths include low infant care costs, low prevalence of excessive drinking among women, low rate of reported homeless family households, and low teen suicide rate. Common challenges among the bottom five states are high rates of preterm births, teen births, and obesity, weak community & environment and clinical measures for women and children, and weak policy measures for infants.

The differences between states are quite large. Looking at the scores used to produce the overall ranking (Figure 2), the top five states and the bottom three states stand out above or below the 6th (Utah) and 47th (Nevada) ranking states. This implies that it will be a challenge for other states to move into the top five and out of the bottom three. The largest difference in score between two adjacent states is between Mississippi (50th) and Arkansas (49th). This large difference suggests that Mississippi will likely continue to rank 50th in future editions of this report without large, state-wide interventions to improve the health of women, infants, and children.
Figure 2 Health of Women and Children, 2016 Scores

Table 3 Ratio Between the Healthiest State Value and the Unhealthiest State Value for Selected Measures

* Ratio = the higher value divided by the lower value

Some of the most dramatic differences between states exist at the individual measure level (Table 3). The prevalence of smoking during pregnancy is 17 times greater in West Virginia than in Connecticut; concentrated disadvantage prevalence is 12 times higher in Mississippi than in New Hampshire; the maternal mortality rate is 7 times higher in Georgia than in Massachusetts; the rate of teen suicide is 6 times greater in Alaska than in New Jersey; over twice as many infants die during their first year in Mississippi than in Massachusetts; and the child mortality rate is 2.5 times higher in Mississippi than in Rhode Island.

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