America’s Health Rankins (United Health Foundation) has released their 2021 Health of Women and Children Report. The 5th edition of this 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.


The report indicates that in the year before the pandemic, despite encouraging progress in some areas, the nation faces stagnation or concerning negative trends in several measures, such as maternal morality and anxiety. The report states that “Across many measures, the report found persistent and widespread disparities that affect American women and children based on their geography, race/ethnicity, educational attainment and income level.”


Some of the more concerning statistics:


Maternal Morbidity and Mortality Reveal Continued Challenges and Disparities in Maternal Health. Between 2018 and 2019, maternal mortality increased 16% nationally, from 17.4 to 20.1 maternal deaths per 100,000 live births. Three states had the greatest increases in maternal mortality rates: Florida (70% increase, from 15.8 to 26.8), Georgia (up 23% from 27.7 to 34.0) and Indiana (up 16% from 24.5 to 28.4).


Drug deaths among women increased across the nation. Deaths due to drug injury increased among women across the nation. In 2017-2019, there were 20.7 deaths per 100,000 females ages 20- 44 — 33,000 women — representing a 24% increase since 2014-2016. This increase was widespread across states and racial/ethnic groups. Drug deaths among women rose in 23 states and the District of Columbia, led by the District of Columbia (170% increase, from 4.3 to 11.6), Delaware (74% from 26.1 to 45.3) and Vermont (73% from 17.0 to 29.4). Black (55% from 9.8 to 15.2), Hispanic (34% from 5.9 to 7.9) and white (21% from 23.8 to 28.9) women all faced significant increases during this time period. Drug deaths among women were highest in West Virginia (67.4), Ohio (46.9) and Delaware (45.3) and lowest in Hawaii (7.6), California (8.5) and Texas (8.6).


Significant increase in both teen suicide and childhood anxiety. The teen suicide rate reached 11.2 deaths per 100,000 adolescents ages 15-19 in 2017-2019 — equivalent to 7,105 adolescents. Teen suicide has increased 26% since 2014- 2016, from 8.9 to 11.2 deaths per 100,000 adolescents. The rate of teen suicide rose across racial and ethnic groups in this time, increasing among Black (38% from 5.6 to 7.7), Hispanic (27% from 6.4 to 8.1) and white (14% from 11.7 to 13.3) adolescents. Large disparities continue to persist by race/ethnicity: the rate is 4.7 times higher among American Indian/Alaska Native adolescents (36.1) than Black adolescents (7.7). Disparities also exist by geography. The teen suicide rate is 8.3 times higher in Alaska (44.9) than in Massachusetts and New Jersey (5.4).


Childhood anxiety in the period leading up to, and the early stages of, the pandemic, anxiety was widespread and rising among children. In 2019-2020, 9.1% of children ages 3-17 — nearly 5.6 million children — had anxiety problems, a 21% increase from 7.5% in 2017-2018. Children in different states faced varying levels of challenges, with the prevalence of childhood anxiety 4 times higher in Maine (15.9%) than in Hawaii (4.0%).


Approximately 1 in 3 fourth grade students were at a proficient reading level for their age. The report found that approximately 1 in 3 fourth grade public school students were at a proficient reading level for their age.  The report points out that this characteristic is an important marker in educational development, saying that educational attainment is a strong predictor of health.


In 2019, just 34.3% of fourth grade students scored proficient or above on reading assessments. Reading proficiency varied by state and was nearly twice as high in Massachusetts (45.4%) than in New Mexico (23.7%), a 21.7 percentage point gap. Disparities were also prevalent across race/ethnicity. Reading proficiency was 3.1 times higher among Asian/ Pacific Islander children (54.5%) compared with Black children (17.6%). It was also higher among white (44.4%) children and below the national average among Hispanic (22.6%) and American Indian/Alaska Native (19.8%) children.


The report includes 118 measures of health obtained from 35 data sources including the U.S.

Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System and WONDER Online Database, the Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau’s (MCHB) National Survey of Children’s Health, the U.S. Department of Education’s National Assessment of Educational Progress, and the U.S. Census Bureau’s American Community Survey.