Health Outcomes

Most childhood deaths are preventable. In 2021-2023, the leading causes of death

among children ages 1-19 in the United States were accidents (unintentional injuries), homicide, suicide, cancer and congenital abnormalities.¹ The leading mechanisms of injury deaths

(intentional and unintentional) in 2021-2023 were firearms, followed by motor vehicle traffic accidents and poisoning.²

Changes over time. Nationally, the child mortality rate increased 14% between 2018-2020 and 2021-2023, from 25.9 to 29.6 deaths per 100,000 children ages 1-19. This rate exceeds the Healthy People 2030 target of 18.4 deaths among children and adolescents ages 1-19 per 100,000 population

.³ About 69,000 children died in the U.S. during 2021-2023, an increase of nearly 8,700 deaths from 2018-2020. 

Between 2018-2020 and 2021-2023, the child mortality rate significantly increased:

During the same period, the child mortality rate increased in 28 states. The largest increases were: 38% in Wyoming (30.1 to 41.5 deaths per 100,000 children ages 1-19), 30% in North Carolina (27.3 to 35.5) and 28% in Louisiana (38.1 to 48.9).

Differences. The child mortality rate varied significantly by race/ethnicity, age, geography and gender in 2021-2023. The rate was:

Losing an infant is devastating for parents, families and communities. In 2023, the leading causes

of infant death in the U.S. were congenital abnormalities, low birth weight, sudden infant death syndrome (SIDS), unintentional injuries and maternal complications.⁴ The U.S. has a consistently and considerably higher infant mortality rate

than other developed countries.⁵

Changes over time. Nationally, the infant mortality rate increased 4% between 2020-2021 and 2022-2023, from 5.4 to 5.6 infant deaths (before age 1) per 1,000 live births — the first increase in the history of the Health of Women and Children Report. This rate exceeds the Healthy People 2030 target of 5.0 infant deaths per 1,000 live births

.⁶ Reducing the rate of infant deaths is a Healthy People 2030 Leading Health Indicator

.⁷ Nearly 41,000 infants died in the U.S. during 2022-2023, an increase of more than 1,200 deaths compared with 2020-2021. 

Between 2020-2021 and 2022-2023, the infant mortality rate significantly increased: 

During the same period, the infant mortality rate significantly changed in 40 states. Among the 26 states where it rose, the largest increases were: 39% in Delaware (4.9 to 6.8 deaths per 1,000 live births), 24% in Iowa (4.2 to 5.2) and 15% in Oregon (4.0 to 4.6). The rate also decreased in 14 states, led by: 24% in New Hampshire (4.2 to 3.2); and 8% in Colorado (4.9 to 4.5), Kansas (6.0 to 5.5), Massachusetts (3.6 to 3.3) and West Virginia (7.1 to 6.5).

Differences. The infant mortality rate significantly varied by mother’s race/ethnicity, geography, mother’s age and infant gender. The rate was: 

Related Measure: Neonatal Mortality
Nationally, the neonatal mortality rate increased 3% between 2020-2021 and 2022-2023, from 3.5 to 3.6 deaths during the first 28 days of life (0-27 days) per 1,000 live births. Approximately 26,300 neonatal deaths occurred in 2022-2023, about 600 more deaths than in 2020-2021. In 2022-2023, the rate was:

The majority of maternal deaths resulting from pregnancy-related complications are preventable

.⁸ Despite this, the U.S. consistently has the highest rate

of maternal mortality among high-income countries.⁹

Changes over time. Nationally, the maternal mortality rate increased 36% between 2014-2018 and 2019-2023, from 17.3 to 23.5 deaths related to or aggravated by pregnancy (excluding accidental or incidental causes) occurring within 42 days of the end of a pregnancy per 100,000 live births. This rate exceeds the Healthy People 2030 target of 15.7 maternal deaths per 100,000 live births

.¹⁰ Reducing maternal deaths is a Healthy People 2030 Leading Health Indicator

.⁷ In 2019-2023, nearly 4,310 women died of pregnancy-related causes, an increase of more than 920 maternal deaths from 2014-2018. 

Between 2014-2018 and 2019-2023, the maternal mortality rate significantly increased in 11 states. The largest increases were: 159% in Mississippi (15.3 to 39.7 deaths per 100,000 live births), 139% in Nevada (9.5 to 22.7) and 95% in Virginia (17.1 to 33.4).

Differences. The maternal mortality rate varied significantly by race/ethnicity, geography, age, educational attainment and metropolitan status in 2019-2023. The rate was:

In 2023, the leading causes of death

for women ages 20-44 in the U.S. were unintentional injuries (led by poisoning and motor vehicle accidents

), cancer, heart disease, suicide and chronic liver disease/cirrhosis.^11,12 Women in the United States have a higher rate

of preventable deaths than women living in other high-income countries.¹³

Changes over time. Nationally, the mortality rate among women decreased 8% between 2022 and 2023, from 120.0 to 109.9 deaths per 100,000 women ages 20-44. Approximately 60,700 women ages 20-44 died in 2023, 5,300 fewer deaths than in 2022. Between 2022 and 2023, unintentional injuries decreased, and COVID-19 dropped out of the 10 leading causes of death among women for this age group.

Between 2022 and 2023, the mortality rate among women significantly decreased 10% among white (124.8 to 112.9 deaths per 100,000 women ages 20-44), 7% among Hispanic (81.0 to 75.1) and 6% among Black (192.3 to 179.9) women. 

During this time, the mortality rate among women significantly decreased in 17 states, led by: 20% in Connecticut (103.1 to 82.8 deaths per 100,000 women ages 20-44), 19% in Arkansas (167.2 to 136.0), and 15% in both Indiana (147.3 to 125.9) and Missouri (154.1 to 131.7).

Differences. In 2023, the mortality rate among women was 9.4 times higher among American Indian/Alaska Native (343.2 deaths per 100,000 women ages 20-44) compared with Asian (36.4) women.

Related Measure: Drug Deaths Among Women
For the first time in the history of the Health of Women and Children Report, the drug death rate plateaued. In 2021-2023, the number of deaths due to drug injury (unintentional, suicide, homicide or undetermined) per 100,000 women ages 20-44 remained at 28.6, the same as the period before. Racial/ethnic differences persisted; the drug death rate was 20.8 times higher among American Indian/Alaska Native (76.8) compared with Asian (3.7) women in 2021-2023. Provisional data from the CDC WONDER

indicate that the drug death rate among women ages 20-44 continued to decrease between 2021-2023 and 2022-2024.¹⁴

Women in the U.S. experience a significantly higher prevalence

of diagnosed depression than men.¹⁵ Depression is a common mood disorder

that can cause symptoms

such as hopelessness, loss of interest and fatigue, all of which impact daily life and functioning.^16,17 Depression is a risk factor

for attempting suicide.¹⁸

Changes over time. Nationally, the percentage of women ages 18-44 who reported being told by a health professional that they had a depressive disorder — including depression, major depression, minor depression or dysthymia — increased 11%, from 27.4% to 30.3% between 2020-2021 and 2022-2023. The prevalence has increased 22% (from 24.8%) since 2017-2018. In 2022-2023, more than 17.3 million women ages 18-44 in the U.S. had depression. 

Between 2020-2021 and 2022-2023, the prevalence of depression significantly increased:

During this time, the prevalence of depression also significantly increased in 11 states. The largest increases were: 30% in Hawaii (15.9% to 20.7%) and 22% in both Tennessee (34.8% to 42.4%) and California (19.6% to 23.9%). 

Differences. The prevalence of depression varied significantly by disability status, race/ethnicity, geography, sexual orientation, educational attainment, veteran status, age, household income and metropolitan status in 2022-2023. The prevalence was:

Related Measures: Postpartum Depression and Anxiety
In 2023, 11.9% of women with a recent live birth (more than 318,000 women) reported experiencing depression symptoms. The prevalence of postpartum depression was highest in Mississippi (17.1%), Kansas (16.3%) and Alaska (15.9%). It was lowest in Louisiana (7.2%), New Jersey (8.3%) and Vermont (8.4%). 

During the same year, 20.3% of women with a recent live birth (more than 544,000 women) reported experiencing anxiety symptoms. The prevalence of postpartum anxiety was highest in Mississippi (31.6%), Arkansas (29.1%) and Alabama (26.9%). It was lowest in Louisiana (12.8%), Florida (14.2%) and New Jersey (15.4%).

Note: Data were not available for California, Idaho, North Carolina or Ohio.

Related: Frequent Mental Distress Among Women
Nationally, the percentage of women ages 18-44 who reported their mental health was not good 14 or more days in the past 30 days increased 12%, from 21.0% to 23.6% between 2020-2021 and 2022-2023. The prevalence significantly increased among women with annual household incomes of $50,000-$74,999, those with incomes less than $25,000 and those with incomes of $25,000-$49,999; high school graduates and women with some post-high school education; Hispanic women and white women; women ages 18-24, 25-34 and 35-44; and women living in both metropolitan and nonmetropolitan areas. 

During this time, the prevalence of frequent mental distress significantly increased in six states. The largest increases were: 41% in Alaska (17.4% to 24.6%), 36% in Tennessee (24.3% to 33.0%) and 27% in Texas (18.1% to 23.0%).

Frequent mental distress significantly varied by disability status, race/ethnicity, sexual orientation, household income, geography, age, educational attainment, veteran status and metropolitan status in 2022-2023. 

While higher rates of diagnosis may reflect improved awareness and engagement with care, they could also indicate a growing burden

of mental health challenges for youth.¹⁹ Early diagnosis

and treatment of mental health conditions in children is vital to preventing problems at home, in school or forming friendships.²⁰

Changes over time. Nationally, the percentage of children ages 3-17 with a mental health condition increased 9%, from 18.8% to 20.5% between 2021-2022 and 2023-2024. This includes children who were told by a health care provider that they had ADHD, depression or anxiety problems; or were told by a doctor or educator that they had behavior or conduct problems. There were increases in the prevalence of ADHD (10%, from 10.1% to 11.1%) and anxiety (13%, from 9.9% to 11.2%). The prevalence of depression (4.2%) and behavioral problems (7.7%) did not significantly change. 

Between 2021-2022 and 2023-2024, the prevalence of mental health conditions significantly increased: 

During this period, mental health conditions increased 32% in Iowa (18.6% to 24.5%), and 28% in both Oregon (20.3% to 26.0%) and California (12.7% to 16.2%). 

Differences. Mental health conditions among children significantly varied by race/ethnicity, geography, caregiver educational attainment and gender in 2023-2024. The prevalence was:

Frequent physical distress measures the population experiencing persistent and likely severe physical health

problems, which can significantly impact health-related quality of life and overall wellness.²¹

Changes over time. Nationally, the percentage of women ages 18-44 who reported their physical health was not good 14 or more days in the past 30 days increased 37%, from 7.1% to 9.7% between 2020-2021 and 2022-2023. In 2022-2023, more than 5.4 million women reported frequent physical distress. Between 2020-2021 and 2022-2023, the prevalence significantly increased:

During the same period, the prevalence of frequent physical distress significantly increased in 18 states and the District of Columbia. The largest increases were: 81% in the District of Columbia (4.2% to 7.6%), 68% in New York (5.7% to 9.6%), 64% in Oregon (7.4% to 12.1%) and 62% in both Virginia (5.8% to 9.4%) and Vermont (6.5% to 10.5%). 

Differences. Frequent physical distress significantly varied by disability status, household income, race/ethnicity, educational attainment, geography, sexual orientation, veteran status, age and metropolitan status in 2022-2023. The prevalence was: 

Note: Data for Kentucky, Pennsylvania and all sexual orientation groups in Colorado are from 2022 only. Data for all racial and ethnic groups and all sexual orientation groups in Alabama, Arizona, California, Idaho, New Jersey and Wyoming are from 2023 only. The values for American Indian/Alaska Native (18.6%), other race (14.2%), multiracial (12.6%) and white (10.9%) women may not differ significantly based on overlapping 95% confidence intervals. The same is true for Asian (6.8%), Black (7.4%), Hispanic (9.4%), multiracial and other race women.

Self-reported health status is a subjective measure of health-related quality of life

that encompasses not only specific health conditions or outcomes, but also factors such as social support, ability and ease of functioning, and other socioeconomic, environmental and cultural components.²² Research shows that those with “poor” self-reported health status have a mortality risk

double that of those with ”excellent” self-reported health status.²³

Changes over time. Nationally, the percentage of women ages 18-44 who reported their health was very good or excellent decreased 13%, from 59.0% to 51.6% between 2020-2021 and 2022-2023. In 2022-2023, around 30 million women reported having very good or excellent health. Between 2020-2021 and 2022-2023, the prevalence significantly decreased:

During this time, the prevalence of high health status significantly decreased in 37 states. The largest decreases were: 20% in both Oregon (59.0% to 47.3%) and Rhode Island (61.4% to 48.9%), 19% in both Hawaii (65.1% to 52.5%) and Tennessee (61.0% to 49.3%), and 18% in Maryland (62.3% to 51.3%).

Differences. The prevalence of high health status varied significantly by disability status, educational attainment, household income, race/ethnicity, sexual orientation, geography and age in 2022-2023. The prevalence was: 

Severe maternal morbidity is a critical indicator

for identifying preventable, severe complications in maternal health care.²⁴ As a population-level metric, it helps uncover the underlying causes of maternal health disparities, guides improvement efforts and supports the prevention of maternal mortality.

Changes over time. Nationally, the severe maternal morbidity rate decreased 6% between 2021 and 2022, from 100.3 to 94.7 significant life-threatening maternal complications during delivery per 10,000 delivery hospitalizations. In 2022, approximately 32,000 women experienced severe maternal morbidity, about 2,000 fewer than in 2021. Between 2020 and 2021, severe maternal morbidity significantly decreased:

During this time, the severe maternal morbidity rate significantly decreased 24% in Arizona (105.6 to 80.5 complications per 10,000 delivery hospitalizations), 22% in Mississippi (94.2 to 73.7), 14% in Texas (92.5 to 79.8) and 10% in Florida (114.7 to 102.7).

Differences. The prevalence of severe maternal morbidity significantly varied by geography, race/ethnicity, age, metropolitan status and household income. The prevalence was:

Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome

occurring in newborns, most commonly caused by fetal exposure to maternal opioid use

.^25,26 Symptoms

of NAS can include tremors, high-pitched crying, seizures and low birth weight

, as well as long-term impacts

such as developmental delays, growth problems and hearing and vision problems.^27–29

Changes over time. Nationally, the rate of NAS decreased 10% between 2021 and 2022, from 5.9 to 5.3 birth hospitalizations with a diagnosis code of withdrawal symptoms due to prenatal exposure to illicit drugs per 1,000 birth hospitalizations. In 2022, there were approximately 18,000 NAS hospitalizations in the U.S., nearly 2,000 fewer hospitalizations than in 2021. Between 2021 and 2022, NAS hospitalization rates significantly decreased:

During this time, the rate significantly decreased in nine states. The largest decreases were: 26% in Maine (18.2 to 13.5 NAS hospitalizations per 1,000 birth hospitalizations), 25% in Kentucky (16.8 to 12.6), 21% in Massachusetts (7.8 to 6.2) and 20% in Pennsylvania (11.1 to 8.9). At the same time, the rate significantly increased in one state: 26% in Minnesota (5.0 to 6.3).

Differences. The prevalence of NAS hospitalizations significantly varied by geography, race/ethnicity, household income and metropolitan status in 2022. The rate was:

Childhood obesity is defined

as a body mass index (BMI) value at or above the 95th percentile based on age and sex, while overweight is defined as a BMI value at or above the 85th percentile but below the 95th percentile.³⁰ Overweight and obesity in childhood are associated

with physical, social and psychological health issues during adolescence and adulthood, including increased risk of substance misuse

, disordered eating behaviors

, chronic diseases

and poor self-esteem

.^31–35

Changes over time. Nationally, the percentage of children ages 6-17 who had overweight or obesity for their age based on reported height and weight decreased 7%, from 33.8% to 31.3% between 2021-2022 and 2023-2024. In 2023-2024, approximately 14.7 million children had overweight or obesity, 1.1 million fewer than in 2021-2022. The prevalence of overweight and obesity significantly decreased:

Differences. The prevalence of children who had overweight or obesity significantly varied by race/ethnicity, geography, caregiver educational attainment, special health care needs status and gender in 2023-2024. The prevalence was: