Health Insurance
Southern States Offer Worst Access to High-Quality Prenatal, Maternal Care
It’s no secret that childbirth is expensive. In fact, the average cost of childbirth is $13,024 for a vaginal delivery without insurance. But birth itself isn’t where those costs begin or end: Prenatal and maternal care are vital for healthy babies and mothers.
While cost is certainly an issue, access and quality for these types of care are even more important. But your options might be limited depending on where you are.
According to the latest ValuePenguin study, Southern states are among those offering the worst prenatal and maternal care, while those in New England are among those offering the best.
Here’s what else we found.
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Key findings
- Six of the 10 states offering the worst access to prenatal and maternal care are in the South. These states are Alabama, Texas, Florida, Georgia, Arkansas and Tennessee.
- Alabama ranks lowest, with few maternal care providers and poor quality of care. Specifically, Alabama has the lowest number of maternal care providers per 100,000 residents at 27.5 — 40.2% less than the national average of 46.0. Texas, which ranked worst in our 2022 study, moves to second-lowest.
- Three New England states offer the best access to prenatal and maternal care. New Hampshire, Maine and Connecticut occupy the top spots. In our 2022 study, New Hampshire was first, Connecticut fifth and Maine 17th. Two other New England states, Massachusetts and Vermont, rank fifth and sixth in our updated study, behind Delaware.
- New Hampshire again finishes with the highest overall score. The state has the highest percentage of women ages 18 to 44 with a primary care provider (90.9%). Additionally, it has the second-highest average maternity practice score behind Delaware. The latter considers care practices and policies that impact newborn feeding, feeding education, staff skills and discharge support.
- Mississippi has the highest infant mortality rate. Here, the infant mortality rate is 9.4 per 1,000 live births as of 2021. Meanwhile, North Dakota has the lowest infant mortality rate at 2.8. Across the U.S., the rate is 5.4 per 1,000 live births. Meanwhile, the maternal mortality rate is 32.9 per 100,000 live births — up 89.1% from 17.4 in 2018.
South dominates list of states offering worst access to prenatal, maternal care
Look no further than the South for most of the states with the worst prenatal and maternal care. In fact, more than half of the 10 states offering the worst access to care are in the South: Alabama, Texas, Florida, Georgia, Arkansas and Tennessee.
Of these, Alabama ranks lowest. Specifically, Alabama has 27.5 maternal care providers per 100,000 residents — 40.2% less than the national average of 46.0 and the lowest of the states. Additionally, Alabama ranks poorly for the quality of care received, with the lowest average Merit-based Incentive Payment System (MIPS) score among the state’s OB-GYNs and tying for the second-lowest average maternity practice score.
Our quality score combines measures of the quality of care provided by OB-GYNs and the maternity care practices of participating hospitals. Specifically, we looked at:
- The average MIPS score among OB-GYN specialists in the state. This can incentivize higher levels of care from Medicare Part B practitioners, offering bonuses based on scores earned.
- The average Maternity Practices in Infant Nutrition and Care (mPINC) score among hospitals in each state. This score measures the feeding care and support mothers receive from hospitals.
These sub-scores were then averaged to create the final score featured later in our study.
10 states offering the worst access to prenatal and maternal care
Rank | State | % of women 18 to 44 with insurance coverage (Access) | % of women 18 to 44 with 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 score among OB-GYN specialists (Quality) | Average Maternity Practices in Infant Nutrition and Care score among hospitals (Quality) |
|---|---|---|---|---|---|---|---|
| 1 | Alabama | 89.1% | 79.2% | 27.5 | 73.9% | 67.7 | 73 |
| 2 | Texas | 77.3% | 67.3% | 38.1 | 69.7% | 92.1 | 80 |
| 3 | Nevada | 85.3% | 70.2% | 34.8 | 73.3% | 84.8 | 79 |
| 4 | Arizona | 85.8% | 72.6% | 40.6 | 71.7% | 91.1 | 77 |
| 5 | Nebraska | 90.1% | 83.7% | 40.6 | 79.9% | 81.8 | 74 |
| 6 | Florida | 83.9% | 61.7% | 40.6 | 64.4% | 95.6 | 83 |
| 7 | Georgia | 82.7% | 75.6% | 45.5 | 74.8% | 91.7 | 78 |
| 8 | Arkansas | 90.7% | 78.9% | 29.8 | 73.3% | 92.0 | 76 |
| 9 | Tennessee | 91.0% | 81.2% | 38.8 | 74.3% | 94.2 | 72 |
| 10 | Wyoming | 90.5% | 77.1% | 47.0 | 74.8% | 91.2 | 75 |
Source: ValuePenguin analysis of various sources. Note: Rhode Island was excluded due to a lack of new quality score data.
Texas ranks second-worst, moving up from last in our 2022 study. It ranks lowest for the percentage of women ages 18 to 44 with health insurance coverage, at 77.3%. (Nationally, that figure is 89.4%.) Additionally, it has the second-lowest percentage of women in this age range with a primary care provider, at 67.3% (versus 82.1% nationally).
Here’s how the rest of the Southern states in the bottom 10 compare:
- Florida has the lowest percentage of women ages 18 to 44 with a primary care provider (61.7%) and the second-lowest percentage of births with adequate prenatal care (64.4%, versus 74.9% across the U.S.). It also ties as the state with the third-lowest percentage of women ages 18 to 44 with insurance coverage (83.9%).
- Georgia has the second-lowest percentage of women ages 18 to 44 with insurance coverage (82.7%).
- Arkansas has the second-lowest rate of maternal care providers, at 29.8 per 100,000 women.
- Tennessee has the lowest average maternity practice score.
Why do these states rank low? According to ValuePenguin health insurance expert Divya Sangameshwar, a lack of access to prenatal and maternal care in these states plays a large role — especially in rural areas.
According to a study from the March of Dimes Perinatal Data Center, 34.3% of Alabama counties are described as maternal care deserts, meaning they have no obstetric hospitals or birth centers and no obstetric providers nearby. (Comparatively, that figure is 32.6% across the U.S.) This percentage rises to 46.5% in Texas. Georgia and Arkansas also have an above-average rate of maternal care deserts.
New England states occupy top 3 positions for best prenatal, maternal care
Meanwhile, you can look to the Northeast for the best prenatal and maternal care. New Hampshire, Maine and Connecticut — all New England states — occupy the top three spots.
In our 2022 study, New Hampshire also finished at the top. However, Connecticut and Maine moved up in the rankings. Previously, Connecticut ranked fifth and Maine 17th.
Two other New England states are also in the top 10: Massachusetts, at fifth, and Vermont, at sixth.
10 states offering the best access to prenatal and maternal care
Rank | State | % of women 18 to 44 with insurance coverage (Access) | % of women 18 to 44 with 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 score among OB-GYN specialists (Quality) | Average Maternity Practices in Infant Nutrition and Care score among hospitals (Quality) |
|---|---|---|---|---|---|---|---|
| 1 | New Hampshire | 92.0% | 90.9% | 64.9 | 82.3% | 90.6 | 91 |
| 2 | Maine | 95.3% | 90.2% | 54.9 | 83.9% | 97.9 | 85 |
| 3 | Connecticut | 93.7% | 83.7% | 62.5 | 83.1% | 98.1 | 87 |
| 4 | Delaware | 92.5% | 79.5% | 46.1 | 76.8% | 95.7 | 93 |
| 5 | Massachusetts | 97.9% | 87.3% | 58.6 | 78.8% | 90.3 | 88 |
| 6 | Vermont | 98.2% | 87.5% | 67.1 | 87.1% | 80.0 | 87 |
| 7 | Oregon | 92.7% | 74.6% | 68.9 | 77.8% | 95.8 | 87 |
| 8 | Wisconsin | 92.6% | 89.3% | 45.2 | 82.0% | 96.4 | 82 |
| 9 | Michigan | 95.6% | 85.5% | 55.2 | 77.8% | 97.1 | 80 |
| 10 | Ohio | 92.7% | 83.4% | 44.3 | 79.5% | 95.1 | 84 |
Source: ValuePenguin analysis of various sources. Note: Rhode Island was excluded due to a lack of new quality score data.
By state, New Hampshire ranks first largely due to the state having the highest percentage of women ages 18 to 44 with a primary care provider (90.9%). Additionally, it has the second-highest average hospital maternity practice score (remember, this includes practices and policies that impact newborn feeding, feeding education, staff skills and discharge support), just behind Delaware. New Hampshire also ranks fifth for the rate of maternal care providers, at 64.9 per 100,000 women (versus 46.0 nationally).
Here’s how the other top-ranking New England states stack up:
- Maine has the second-highest percentage of women ages 18 to 44 with a primary care provider (90.2%) and the third-highest percentage of births with adequate prenatal care (83.9%).
- Connecticut has the fifth-highest percentage of births with adequate prenatal care (83.1%), has the fifth-highest average MIPS score among OB-GYNs (98.1) and ties for the fifth-highest average maternity practice score (87).
- Massachusetts has the second-highest percentage of women ages 18 to 44 with insurance coverage (97.9%), ties for the third-highest average maternity practice score (88) and has the fifth-highest percentage of women ages 18 to 44 with a primary care provider (87.3%).
- Vermont has the highest percentage of women ages 18 to 44 with insurance coverage (98.2%), the highest percentage of births with adequate prenatal care (87.1%), the third-highest rate of maternal care providers per 100,000 women (67.1) and the fourth-highest percentage of women ages 18 to 44 with a primary care provider (87.5%). It ties for the fifth-highest average maternity practice score (87).
Note: Rhode Island was excluded due to a lack of new quality score data. The last available maternity practice data in Rhode Island was from 2018, while the number of OB-GYNs with a MIPS score was very low. However, it’s worth noting that Rhode Island would have the second-highest percentage of births with adequate prenatal care in the U.S. if included, at 86.5%.
Unlike the states with the worst access to prenatal and maternal care, those that rank highest have a lower percentage of maternal care deserts. In fact, 100.0% of New Hampshire counties are defined as full access, according to data from the March of Dimes Perinatal Data Center. That compares to just 54.8% of U.S. counties. All counties in Maine, Connecticut and Massachusetts are also considered full access. Meanwhile, just 7.1% of counties in Vermont are considered maternity care deserts.
Full rankings
Rank | State | % of women 18 to 44 with insurance coverage (Access) | % of women 18 to 44 with 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 score among OB-GYN specialists (Quality) | Average Maternity Practices in Infant Nutrition and Care score among hospitals (Quality) | Access score | Quality score | Final score |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | New Hampshire | 92.0% | 90.9% | 64.9 | 82.3% | 90.6 | 91 | 74.9 | 82.3 | 78.6 |
| 2 | Maine | 95.3% | 90.2% | 54.9 | 83.9% | 97.9 | 85 | 76.6 | 79.8 | 78.2 |
| 3 | Connecticut | 93.7% | 83.7% | 62.5 | 83.1% | 98.1 | 87 | 70.8 | 84.9 | 77.8 |
| 4 | Delaware | 92.5% | 79.5% | 46.1 | 76.8% | 95.7 | 93 | 53.9 | 95.3 | 74.6 |
| 5 | Massachusetts | 97.9% | 87.3% | 58.6 | 78.8% | 90.3 | 88 | 73.2 | 74.7 | 73.9 |
| 6 | Vermont | 98.2% | 87.5% | 67.1 | 87.1% | 80.0 | 87 | 85.1 | 55.6 | 70.3 |
| 7 | Oregon | 92.7% | 74.6% | 68.9 | 77.8% | 95.8 | 87 | 58.4 | 81.2 | 69.8 |
| 8 | Wisconsin | 92.6% | 89.3% | 45.2 | 82.0% | 96.4 | 82 | 67.4 | 70.3 | 68.8 |
| 9 | Michigan | 95.6% | 85.5% | 55.2 | 77.8% | 97.1 | 80 | 66.7 | 66.6 | 66.7 |
| 10 | Ohio | 92.7% | 83.4% | 44.3 | 79.5% | 95.1 | 84 | 59.6 | 72.9 | 66.3 |
| 11 | Colorado | 89.0% | 80.4% | 62.6 | 71.8% | 97.1 | 86 | 50.6 | 80.9 | 65.8 |
| 12 | New York | 93.1% | 81.6% | 54.3 | 75.7% | 93.8 | 85 | 57.9 | 73.2 | 65.6 |
Source: ValuePenguin analysis of various sources. Note: Rhode Island was excluded due to a lack of new quality score data.
When it comes to infant mortality, Mississippi ranks highest
Looking at infant mortality, Mississippi has the highest rate of any state, with 9.4 infant deaths per 1,000 live births as of 2021. Comparatively, the infant mortality rate in the U.S. is 5.4 per 1,000 live births.
Mississippi’s 2021 rate was a five-year high. According to Mississippi Today, Mississippi saw a 900% increase between 2016 and 2021 in babies born with syphilis — a disease that can commonly lead to death or other complications. Before 2023, Mississippi was one of just six states that didn’t require syphilis screenings during pregnancy.
Meanwhile, North Dakota has the lowest infant mortality rate at 2.8 per 1,000 live births.
Regarding maternal mortality, the rate in the U.S. is 32.9 per 100,000 live births. That’s up 89.1% from 17.4 in 2018. That could be due to women increasingly having children at older ages, as well as an increasing number of women becoming pregnant with conditions like hypertension, obesity, diabetes and more.
Expecting? Expert tips on finding prenatal, maternal care
Preparing for a child can be wonderful, but it also comes with a lot of anxiety for many pregnant women.
"Living in a maternity care desert can be a daunting prospect to a pregnant person, and for many, moving to an area with a nearby OB-GYN clinic and birthing center for prenatal care and childbirth isn’t feasible," Sangameshwar says. "However, there are options they can explore."
She recommends the following:
- Reach out to your insurer to explore prenatal care providers near you. This includes family medicine practitioners, midwives and doulas. You can also look for a Federally Qualified Health Center (FQHC) near you, which can help with transportation to a facility for more specialized OB-GYN care or for childbirth, or consider telehealth.
- Explore the best health insurance for pregnant women early. "Being uninsured and pregnant can cause financial devastation," Sangameshwar says. "If you’re planning to start a family, reviewing your health insurance coverage should be an important step. While all Affordable Care Act-compliant health insurance plans and Medicaid should cover prenatal care, labor and delivery services and after-birth care, it’s worth looking into plans with a lower deductible and those that offer these services with no copay."
- Consider supplemental maternity coverage, but look into it before you get pregnant. "This type of insurance pays you directly and will cover some of the expenses your health insurance provider won’t cover," she says. "There are two main kinds of extra insurance you can buy for pregnancy: Short-term disability and hospital indemnity. A short-term disability or maternity leave plan is designed to replace a mother's income during maternity leave and if her doctor orders bed rest. A hospital indemnity plan pays you a fixed amount during a hospital stay. Usually, the amount is a daily limit, like $100 or $500. These plans have monthly rates, just like other health insurance policies."
Methodology
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 49 U.S. states. Rhode Island was excluded due to a lack of new quality score data. 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) score among OB-GYN specialists
- Average Statewide Maternity Practices in Infant Nutrition and Care (mPINC) score among hospitals
Analysts used data from the:
- U.S. Census Bureau/U.S. Bureau of Labor Statistics (BLS) Current Population Survey (March 2023)
- Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS) (2021)
- Centers for Medicare & Medicaid Services (CMS) National Plan and Provider Enumeration System (NPPES) (September 2022)
- March of Dimes’ PeriStats (2022)
- CMS provider data
- CDC mPINC state reports (2021)
- KFF