In the U.S., pregnancy and birth outcomes are notoriously poor compared to other developed countries. Numerous factors might contribute to these tragic results, including an insufficient number of maternity care providers and a lack of postpartum support for families. It’s not surprising that many experts believe more access to high-quality prenatal and maternal care could be effective in bringing these heartbreaking numbers down.
Where do Americans have the best chance at this type of care? The latest ValuePenguin study analyzes six metrics in two categories (access and quality) to rank the states where residents have the best access to high-quality prenatal and maternal care. States in the Northeast — specifically in New England — rank at the top.
- Key findings
- Looking for the best access to prenatal and maternal care? Head to the Northeast (specifically New England)
- New Hampshire offers best access to high-quality care
- Texas offers worst access to high-quality care
- Full rankings
- State of infant, maternal mortality rates in U.S.
- Taking care of your health during pregnancy
- New England states offer the best access to prenatal and maternal care. New Hampshire, Rhode Island, Vermont, Massachusetts and Connecticut take the top spots. The other New England state — Maine — lands further back in 17th.
- New Hampshire finished with the highest overall score. The state has the highest percentage of women of childbearing age with a primary care provider. Meanwhile, its OB-GYNs and hospital maternity departments rate second-highest based on quality of care.
- Texas — one of the nation’s most populous states — finished with the lowest overall score. Although Texas has middle-of-the-road quality of care, far fewer women have access to it. The state is last in the percentage of women of childbearing age who have health insurance and who have a primary care provider.
- The infant mortality rate in the U.S. is 5.6 per 1,000 live births, according to 2019 data from the Centers for Disease Control and Prevention (CDC). The maternal mortality rate in the U.S. is 18 per 100,000 live births, according to 2020 data compiled by Surgo Ventures.
Looking for the best access to prenatal and maternal care? Head to the Northeast (specifically New England)
The Northeast — New England in particular — holds a dominant place at the top for access to quality prenatal and maternal care. According to the March of Dimes, three New England states — New Hampshire, Connecticut and Rhode Island — don’t have any women living in counties with little to no access to maternity care.
Vermont has fewer than 900 women living in counties with such conditions, while Massachusetts has about 2,000. But Maine, which is 17th on the ValuePenguin list, stands apart from the other New England states, with nearly 8,300 women who live in counties without full access to maternity care.
Maine also has a serious racial disparity in access to prenatal care. According to state Sen. Anne Carney, D-Cape Elizabeth, less than 75% of Black women in the state in 2019 had access to prenatal care during their first trimester of pregnancy.
On the other side of the equation, you’ll find a mix of Western and Southern states round out the places with the worst access to high-quality care in the U.S. In Nevada (No. 49 on the ValuePenguin list), nearly 60% of counties don’t have an obstetric provider. Meanwhile, almost 54% of the counties in Florida (No. 44 on the ValuePenguin list) don’t have hospitals or birth centers that offer maternity care.
New Hampshire offers best access to high-quality care
New Hampshire earned the highest spot on the ValuePenguin list of states with the best access to high-quality prenatal and maternity care. The state boasts several impressive statistics in this area, including:
- 94.4% of women have health insurance coverage (the U.S. average is 87.7%)
- 86.1% of women have a primary care provider — the most of any state (the U.S. average is 71.1%)
- 78.8% of births in the state have adequate prenatal care (the U.S. average is 85.0%, though New Hampshire still finishes 12th in this category)
- 66.0 maternal care providers per 100,000 women (the U.S. average is 48.5)
In addition to this wide access, health care providers in the state also receive high quality scores from the U.S. Department of Health and Human Services (HHS) and the CDC. In fact, New Hampshire holds the second-highest score in the U.S. in both the MIPS and the mPINC grading systems. When considering these factors together, New Hampshire has the highest overall score.
The Merit-based Incentive Payment System (MIPS) is a score created by the HHS to incentivize higher levels of care from Medicare Part B practitioners. Health care providers can be offered bonuses based on the scores they earn. The MIPS rankings within this study include only those who specialize in obstetrics or gynecology.
Maternity Practices in Infant Nutrition and Care (mPINC) is a score created by the CDC to measure the care and support mothers receive from hospital maternity departments in caring for their newborns. Some of the details that the 2020 survey measures include immediate postpartum care, feeding education and support, discharge support, institutional management and more.
The Granite State also has the second-lowest infant mortality rate in the U.S. — 3.2 infant deaths per 1,000 births. Further, the state offers more than a dozen programs, in cooperation with primary health care providers, to support preventive and primary services for women and children.
How the rest of the top 5 shake out
Following New Hampshire, four other New England states round out the top five — Rhode Island, Vermont, Massachusetts and Connecticut. All four states stand out in one or more meaningful ways where prenatal or maternal care is concerned.
- Rhode Island has the highest percentage of births with adequate prenatal care in the U.S. (88.6%).
- Connecticut ranks fourth in the same metric (84.4%).
- Massachusetts has the highest percentage of women ages 18 to 44 who have health insurance coverage.
- Vermont holds the second spot in both of those metrics and has the second-highest number of maternal care providers per 100,000 women.
Top 5 states by metric
|Percentage of women 18 to 44 with insurance coverage||Massachusetts (96.7%)||Vermont (96.3%)||Rhode Island (95.2%)||Maine (94.9%)||Minnesota (94.9%)|
|Percentage of women 18 to 44 with a primary care provider||New Hampshire (86.1%)||Vermont (85.4%)||Maine (84.3%)||Massachusetts (84.2%)||Rhode Island (83.0%)|
|Maternal care providers per 100,000 women 15 and older||Alaska (102.0)||Vermont (71.0)||Oregon (70.2)||Rhode Island (69.9)||New Mexico (68.8)|
|Percentage of births with adequate prenatal care||Rhode Island (88.6%)||Vermont (86.9%)||Maine (84.8%)||Connecticut (84.4%)||Iowa (84.1%)|
|Average Merit-based Incentive Payment System scores of OB-GYN specialists||North Dakota (68.7)||New Hampshire (67.4)||Arizona (67.1)||Montana (66.9)||Minnesota (66.9)|
|Statewide Maternity Practices in Infant Nutrition and Care scores for hospitals||Rhode Island (96)||New Hampshire (90)||Oregon (87)||California (87)||Connecticut (87)|
Source: ValuePenguin analysis of various sources
Texas offers worst access to high-quality care
Texas has the second-largest population in the U.S. Yet the Lone Star State also earned the lowest overall score in the ValuePenguin analysis.
In addition to having the lowest percentage of women 18 to 44 with health care coverage and the lowest percentage of women with a primary care provider, Texas also has a high teen birth rate (22.4 births per 1,000 women ages 15 to 19) and a high infant mortality rate (5.5 per 1,000 live births). Finally, the state has the fifth-highest cesarean — C-section — delivery rate in the country.
How the rest of the bottom 5 shake out
Nevada, Wyoming, Georgia and Tennessee are the other four states that landed in the bottom five in this study. Each state has some notable statistics in terms of prenatal or maternal care quality and access.
- Nevada, which ranks second to last on the ValuePenguin list, has only 37.5 maternal health care providers per 100,000 women. (Only four states in the U.S. have fewer.)
- Wyoming has the fourth-lowest MIPS score and one of the lowest percentages of women with a primary care provider (62.3%) in the U.S.
- Georgia has a significant percentage of women (19.9%) without insurance coverage. And 36.1% of women in the state don’t have a primary care provider.
- Tennessee is another state with a high percentage of women who don’t have health insurance coverage (18.2%). The state also has the lowest mPINC score in the U.S.
Bottom 5 states by metric
|Percentage of women 18 to 44 with insurance coverage||Texas (73.6%)||Oklahoma (76.3%)||Florida (79.9%)||Georgia (80.1%)||Tennessee (81.8%)|
|Percentage of women 18 to 44 with a primary care provider||Texas (57.0%)||Nevada (58.1%)||Florida (61.9%)||Wyoming (62.3%)||Georgia (63.9%)|
|Maternal care providers per 100,000 women 15 and older||Arkansas (30.4)||Alabama (31.0)||Mississippi (32.3)||Oklahoma (36.2)||Nevada (37.5)|
|Percentage of births with adequate prenatal care||Hawaii (60.3%)||New Mexico (65.8%)||Alaska (66.0%)||Colorado (67.1%)||Florida (67.7%)|
|Average Merit-based Incentive Payment System scores of OB-GYN specialists||Maine (62.0)||Idaho (62.9)||Rhode Island (63.7)||Wyoming (63.8)||New Mexico (63.9)|
|Statewide Maternity Practices in Infant Nutrition and Care scores for hospitals||Tennessee (70)||Nevada (72)||Kentucky (73)||Nebraska (73)||Wyoming (75)|
Source: ValuePenguin analysis of various sources
States with the best — and worst — access to high-quality prenatal and maternal care
% of women 18 to 44 with insurance coverage [Access]
% of women 18 to 44 with a primary care provider [Access]
Maternal care providers per 100,000 women 15 and older [Access]
% of births with adequate prenatal care [Access]
Average Merit-based Incentive Payment System scores of OB-GYN specialists [Quality]
Statewide Maternity Practices in Infant Nutrition and Care scores for hospitals [Quality]
Source: ValuePenguin analysis of various sources
State of infant, maternal mortality rates in U.S.
It’s important to consider both infant and maternal mortality rates in the U.S. when examining the subject of access to high-quality prenatal and maternal care.
- Infant mortality rate: The overall infant mortality rate in the U.S. is 5.6 per 1,000 live births. This rate is based on 2019 CDC data. When you do a state-by-state comparison, infant mortality rates range from 8.7 (Mississippi) to 2.8 (Vermont) per 1,000 live births.
- Maternal mortality rate: The overall maternal mortality rate in the U.S. is 18 per 100,000 live births. The rate comes from 2020 data compiled by nonprofit Surgo Ventures. Once again, nationwide maternal mortality rates can differ widely from one state to another — from 39 (Louisiana) to 7 (California) per 100,000 live births.
In addition to state-by-state variances, there are huge gaps between mortality rates when you consider race. Infant mortality rates for non-Hispanic Black infants in the U.S. are more than twice as high as the infant mortality rates for non-Hispanic white infants, based on 2018 CDC data (the latest available).
Maternal mortality figures also vary widely by race. The U.S. maternal mortality rate in 2020 for non-Hispanic Black women was 55.3 per 100,000 live births. That figure is 2.9 times higher than the national maternal mortality rate for non-Hispanic white women.
"Better access to quality care could improve pregnancy and birth outcomes, but the U.S. has a shortage of qualified maternity care providers," says Robin Townsend, ValuePenguin health insurance research analyst. "For each live birth in other developed countries, there are two to six times more maternity care providers (including midwives and OB-GYNs) than there are in the U.S."
Access to care is a financial issue, too.
"Further insurance reforms are needed to make prenatal and maternal care more affordable in the U.S.," Townsend says.
Taking care of your health during pregnancy
Access to health care is essential during pregnancy. Having a health insurance policy in place can help you make sure you’re able to afford the health care you and your child need.
The average cost of childbirth without insurance coverage is $13,024 for a vaginal delivery. Meanwhile, uninsured women who have a C-section pay an average of $22,646.
"Without insurance, women have less access to resources they need to keep themselves and their babies healthy during pregnancy, which can lead to premature birth, low birth weight, and maternal and child mortality," Townsend says.
Even if you’re already pregnant, you can get health insurance, Townsend notes. Under the Affordable Care Act (ACA), health insurance companies can’t refuse coverage because of preexisting conditions. Private, short-term medical plans, however, don’t have to follow ACA rules.
"Pregnant women may be able to get low-cost or free prenatal care from community health centers or other family planning clinics," Townsend says. "Income-based programs like Medicaid and the Children’s Health Insurance Program (CHIP) are also available, and enrollment is open year-round for those who qualify."
ValuePenguin analysts created scores for access to medical care ("Access Score") and quality of medical care ("Quality Score") relevant to pregnant and delivering women across the 50 U.S. states. These two scores were then averaged (equal weight) to create a final score.
The Access Score consisted of the following equally weighted measures:
- Percentage of women ages 18 to 44 with health insurance
- Percentage of women ages 18 to 44 with a personal doctor or health care provider
- Maternal care providers (obstetricians, gynecologists and midwives) per 100,000 women 15 and older in the state
- Percentage of live births that had adequate or better prenatal care
The Quality Score consisted of the following equally weighted measures:
- Average Merit-based Incentive Payment System (MIPS) scores for OB-GYN specialists
- Statewide Maternity Practices in Infant Nutrition and Care (mPINC) scores for hospitals
Analysts used data from the:
- U.S. Census Bureau/U.S. Bureau of Labor Statistics (BLS) Current Population Survey (March 2021)
- Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS) (2018-19)
- Centers for Medicare & Medicaid Services (CMS) National Plan and Provider Enumeration System (NPPES) (September 2020)
- March of Dimes’ PeriStats (2020)
- CMS provider data
- CDC mPINC state reports (2020)