Women in Missouri, regardless of where they live, have added barriers when it comes to quality women’s health and reproductive care and outcomes compared with most other states. Commonwealth Fund 2024 State Scorecard on Women’s Health and Reproductive Care ranks Missouri 40 out of 51 for health outcomes, coverage, accessibility, affordability, and health care quality and delivery.

Specifically, the state ranks 43rd (out of 51) for health system performance, maternal and all-cause women’s mortality, as well as infant mortality, and physical and mental health status. It ranks 39th for insurance coverage, provider accessibility, and health care affordability, and 35th for low-risk cesarean birth rate, preventive care use, pre- and postpartum care, and mental health screening.

Just the Stats

The state performed the worst for women who are up-to-date on cervical cancer screening at 44th, and 48th among women ages 18 to 64 who report poor mental health. Additionally, Missouri ranks above the U.S. average when it comes to the following health care factors per the Commonwealth study:

Health Outcomes: (Missouri’s rate/U.S. average)

  • Maternal deaths while pregnant while with 42 days of termination of pregnancy per 100,000 live births (2020-2022: 28.9/26.3)
  • Infant mortality deaths per 1,000 live births (2021: 5.9/5.4)
  • Breast and cervical cancer deaths per 100,000 female population (2022: 23.3/20.9)
  • All-cause mortality rate per 100,000 women ages 15-44 (2022: 141.8/110.3)
  • Rate of women ages 15-44 with syphilis per 100,000 live births (2022: 116.0/78.0) 
  • Rate of infants born with congenital syphilis per 100,000 live births (2022: 118.1/102.5)
  • Percent of women ages 18-64 who reported having 14 or more poor mental health days in the past month (2022: 26%/21%)
  • Percent of women with a recent live birth who experienced intimate partner violence before and/or during pregnancy (2021: 5.6%/3.1%)

Coverage, Access, and Affordability

  • Percentage of women with a recent live birth without health insurance coverage a month before pregnancy (2021: 20%/12%)
  • Percentage of women ages 18-44 who reported a time in the past 12 months when they needed to see a doctor but could not because of cost (2022: 19%/17%)

Health Care Quality and Prevention

  • Percentage of women ages 18-44 who reported not visiting a doctor for a routine checkup in the past two years (2022: 15%/13%)
  • Percent of live births where prenatal care did not begin during the first to third month of pregnancy, among birth records that specified a time period for when prenatal care began (2022: 24%/23%)
  • Percentage of women with a recent live birth who did not report receiving a maternal postpartum checkup visit (2021: 11%/9%)

Preterm births and Black infant mortality

In a separate March of Dimes report, Missouri is branded with a D- for a preterm birth rate of 11.3%, with a U.S. average of 10.3%. Factors that contribute to Missouri’s preterm birth rate include carrying multiples, previous preterm birth, diabetes, hypertension, smoking, and unhealthy weight. 

It’s also important to note that Missouri has a high rate, 15.6%, of birthing people who receive care in the fifth month of pregnancy or later – or have less than 50% of the appropriate number of prenatal visits for the unborn child’s gestational age. 

Additional stats from the report include the following:

 

Key findings from Missouri’s 2018-2020 Pregnancy-Associated Mortality Review (PAMR) continue to underscore the state of maternal and infant health in Missouri. According to one finding, birthing people covered through Medicaid have a 10 times greater pregnancy-associated not related (PANR) mortality rate than birthing people with private insurance. Additionally, 84% of pregnancy-related deaths in the state (there were 210 deaths between 2018 and 2020) were determined to be preventable. This is 9% higher than the previous multi-year report. Other findings gleaned from the report include:

  • The pregnancy-related mortality ratio (PRMR) was 32 deaths per 100,000 live births, up from 25.2 deaths in the last multi-year report.  
  • The PRMR for Black women was three times the ratio of white women. 
  • The greatest proportion (49%) of pregnancy-related deaths occurred between 43 days and one year after pregnancy.  
  • Mental health conditions, including substance use disorder (SUD), were the leading underlying cause of pregnancy-related deaths, followed by cardiovascular disease and then homicides.  
  • All pregnancy-related deaths due to mental health conditions, including SUD, were determined to be preventable.  
  • The number of suicide deaths doubled when comparing 2017-2019 with 2018-2020.
  • This corresponded with an increase in the number of firearm deaths.  
  • Women residing in metropolitan counties were almost twice as likely to die a pregnancy-related death than those residing in rural counties.
  • Women residing in rural counties had the highest ratio of pregnancy-associated, not related deaths (PANR), at 68 deaths per 100,000 live births.

As a result of the report, the following recommendations are among those made by the PAMR board.

Health Care Providers:

  • Perform a full assessment for depression and anxiety utilizing a standardized, validated tool at least once prenatally and at least once during the comprehensive postpartum visit, adding additional screenings as indicated. 
  • Perform universal screening for SUD utilizing a standardized, validated tool on every patient at least once prenatally and at least once during the comprehensive postpartum visit, adding additional screenings as indicated. 
  • Make referrals to mental health professionals, social workers, community health workers, and SUD treatment programs as appropriate. 
  • Obtain further education regarding screening, referral, and treatment of:  
    • Mental health conditions during and after pregnancy.  
    • SUD during and after pregnancy.  
    • Cardiovascular disorders associated with pregnancy (i.e. peripartum cardiomyopathy, hypertensive disorders of pregnancy, etc.).

Health Care Facilities:

  • Use social workers and community health workers, during pregnancy and postpartum, to increase continuity of care for referrals, follow-up care, communication, and social determinants of health. 
  • Standardize practices and procedures across the health care system through utilization of quality improvement practices such as Alliance for Innovation on Maternal Health (AIM) patient safety bundles.

Community-based organizations:

  • Collaborate with health care facilities and providers to reduce stigma surrounding maternal mental health and SUD, and provide assistance to resources for these conditions. 
  • Collaborate with health care facilities and providers to educate their community on domestic violence (DV) and intimate partner violence (IPV), and provide resources and assistance for women affected by DV or IPV. 
  • Empower pregnant and postpartum women to use doula services, home visiting and/or community health workers, which has been shown to increase health care utilization.
  • Provide outreach to educate women on preconception health and early and consistent prenatal care to optimize a woman’s health.