Executive BriefIntroductionNational HighlightsKey FindingsEconomic Resources and EducationPreventive Clinical CareHealth BehaviorsPhysical HealthBehavioral HealthMortalityState SummariesAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingUS SummaryAppendixWomen’s MeasuresChildren’s MeasuresData Source DescriptionsThe Team
According to America’s Health Rankings® analysis of U.S. Census Bureau’s 2019 population estimates, women of reproductive age and children make up roughly 40% of the U.S. population. Maintaining and promoting the health of these two increasingly diverse populations has far-reaching effects across the United States. Fostering long healthy lives across generations requires that individuals and society work in tandem to promote healthy behaviors as well as systems that support the health and well-being of everyone.
To better understand the health of our nation’s women and children, America’s Health Rankings continues to collaborate with an advisory group of leading experts to develop the Health of Women and Children Report. The 2021 report provides a comprehensive look at the health of children and women of reproductive age across the nation and on a state-by-state basis in the time leading up to, and the early part of, the COVID-19 pandemic.
While the Health of Women and Children Report uses the most recent data available for each measure, most measures in the report leverage data from 2019, before the COVID-19 pandemic. However, data from the 2020 National Survey of Children’s Health capture insights from the early stages of the pandemic. The full impact of the pandemic across numerous health measures will likely surface as more data collected in 2020 and 2021 are released.
America’s Health Rankings has not included overall state rankings in this year’s Health of Women and Children Report out of the shared understanding that the country is still facing challenges due to COVID-19. The report, however, still provides rankings for individual measures so leaders can continue to benchmark their state's progress on key health indicators. Community leaders and advocates may leverage this year’s report as they focus on opportunities to build healthier communities that address issues caused by or exacerbated by the pandemic.
This 5th edition of the Health of Women and Children Report finds that despite encouraging progress in some areas, the nation faces stagnation and concerning trends. Entering the pandemic, women and children faced a variety of health challenges ranging from behavioral and physical health to educational achievement. Across many measures, the report found persistent and widespread disparities that affect American women and children based on the state where they live, their race and ethnicity, educational attainment and income level.
Impact of COVID-19
The COVID-19 pandemic presents unique challenges for women and children. As schools and businesses closed, households with children were left juggling work, child care and virtual schooling while also navigating the risks of daily activities such as grocery shopping and preventive health care visits. Women disproportionately left the labor force, making up more than half of the total workforce loss despite comprising less than half of the U.S. workforce. According to an analysis of Current Population Survey data by Pew Research, 2.4 million women and 1.8 million men left the workforce between February 2020 and February 2021.
Data from the U.S. Census Bureau’s COVID-19 Household Pulse survey show that adults with children who were unable to attend daycare or another child care arrangement due to the coronavirus pandemic most commonly reported supervising one or more children while working, cutting work hours to care for children or taking unpaid leave to care for children. The closing of schools and daycares disproportionately affected women, who still perform the majority of housework and child care.
In addition, many children and women of reproductive age have been infected with the virus that causes COVID-19. According to the American Academy of Pediatrics, more than 5.5 million COVID-19 cases, representing 15.7% of all cases, have been reported as of September 16, 2021, among children. As of September 22, 2021, 13,670 women ages 18-49 have died from COVID-19. Surveillance data of women of reproductive age (15-44) found that pregnant women were more likely than nonpregnant women to experience symptomatic COVID-19, intensive care unit admission, invasive ventilation, extracorporeal membrane oxygenation and death.
The pandemic has highlighted racial injustices as certain racial and ethnic groups have been disproportionately affected by COVID-19. Hispanic women had higher rates of COVID-19 infection during pregnancy and non-Hispanic Black women experienced a disproportionately higher number of deaths due to COVID-19, reflecting some of the longstanding disparities that persist in many of the measures included in the Health of Women and Children Report as well as the America’s Health Rankings 2021 Health Disparities Report.
The purpose of America’s Health Rankings is to inform and drive action to build healthier communities by offering credible and comprehensive data for improving health and the elements that determine health at the state and national levels. Using 35 data sources, including Center for Disease Control and Prevention’s Pregnancy Risk Assessment Monitoring System, the U.S. Census Bureau’s American Community Survey and the Maternal and Child Health Bureau’s National Survey of Children’s Health, the Health of Women and Children Report produces:
- 118 measures for tracking current and emerging health issues at the state and national levels, including four demographic measures.
- Five categories that comprise the America’s Health Rankings model: social and economic factors, physical environment, clinical care, behaviors and health outcomes.
- Six years of data for measures that were included in the first Health of Women and Children Report, released in 2016.
In summary, the Health of Women and Children Report aims to improve population health of women and children by:
Presenting a holistic view of health. This report goes beyond measures of clinical care and considers social, economic and physical environment measures to reflect the growing understanding of the impact of social determinants on health.
- Providing a benchmark for states. Each year the report presents trends, strengths, challenges and highlights for every state. Community leaders, public health workers and policymakers can monitor health trends over time and compare their state with neighboring states and the nation.
- Stimulating action. The report is intended to drive change and improve health by promoting data-driven discussions among individuals, community leaders, the media, policymakers and public health workers. States can incorporate the report into their annual review of programs, and many organizations use the report as a reference when assigning goals for health-improvement plans.
- Highlighting disparities. The report shows differences in health between states and among population groups at the state and national level, with groupings based on age, race and ethnicity, educational attainment and income. Health disparities must be addressed in order to achieve health equity.
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.”