A comprehensive study released July 18 by the Commonwealth Fund, a health care equity nonprofit and research group, ranks Missouri and Kansas among the worst states in the nation for a variety of women’s health metrics.

Missouri is the seventh-worst state in the nation for women’s health across many categories, including reproductive health care, mental health and mortality, the study found. Kansas is a little better, ranking the 20th worst for combined health outcomes.

The study also looked at factors including mental health, maternal mortality, syphilis rates and domestic violence. Here’s how Missouri and Kansas fared.

How does Missouri rank on women’s health care?

Missouri’s health and reproductive care outcomes are in the bottom fifth of states, ranking 43rd out of 50 states plus the District of Columbia. These factors include having the eighth-highest rates of death from breast cancer and cervical cancer, and the second-highest rates of poor mental health among adult women.

According to the study’s data, more than one in every four Missouri women between the ages of 18 and 64 reported “14 or more poor mental health days in the past month.” This persistently poor mental health can lead to other negative outcomes for Missouri women.

Missouri was also the 11th worst out of 50 states plus the District of Columbia for supporting women’s access to health care, the study found.

One in 10 Missouri women between the ages of 19 and 64 have no health insurance coverage, and nearly one in five in the 18–44 age range said they had skipped a necessary doctor’s visit in the past year because they couldn’t afford it.

Missouri also has the sixth-lowest rate of Pap smears for adult women, which can be used to detect cervical cancer and other health issues before they become debilitating.

While the study covers a wide variety of health issues, it places particular emphasis on reproductive and maternal health care. In this regard, it notes the effect of abortion bans in states like Missouri on broader women’s health issues.

“Many experts are concerned that abortion bans or limits may inadvertently reduce the number of providers offering maternity care, owing to increased risk of legal action that practices face,” the authors wrote.

Missouri’s near-total ban on abortion was implemented immediately after Roe v. Wade was overturned in 2022, but reports suggest thousands of residents have received abortions in other states.

The state has 74 maternity care providers per 100,000 women of childbearing age—defined in the study as ages 15–44. That’s lower than the national average of just under 79 providers.

The effects on pregnancy, childbirth and postpartum care are evident: Just under 29 women die during pregnancy for every 100,000 live births in the state, and 11% of babies are born prematurely.

Pregnant women in Missouri are also at a significantly higher risk of intimate partner violence than the national average, with 5.6% experiencing this abuse during pregnancy compared to 3.1% nationwide.

How does Kansas rank on women’s health care?

In Kansas, women fare a little better than Missouri for health outcomes—but are still worse than average on most metrics.

Women in Kansas have the 10th lowest health insurance rate in the country, with 12% of women ages 19–64 living without coverage. And 18% of women ages 18–44 have skipped an important doctor’s appointment in the past year because they haven’t been able to afford care.

Women in Kansas typically have low rates of syphilis infection and high rates of vaccination for the flu and pneumonia compared to the national average. The state also has slightly above the national average rate of abortion clinics available per 100,000 women. Kansas voters enshrined the right to abortion in the state’s constitution in 2022, and the clinics often serve women from neighboring surrounding states where abortion is more restricted.

However, maternal health care access in Kansas lags behind even Missouri in terms of available providers. The state has only around 67.6 providers per 100,000 women aged 15–44, compared to the national average of 78.9.

Overall, Kansas ranked the second-worst for women’s health care in the Great Plains region, which in this study included Missouri, Kansas, Iowa, Nebraska, Minnesota, North Dakota and South Dakota. The only state below it was Missouri.

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