Indiana and Ohio are tied for last place in the Great Lakes region for women’s health care quality, access and affordability, according to what the authors describe as a “deeply concerning” report.
The Commonwealth Fund’s first comprehensive look at women’s health care also placed Indiana and Ohio in the bottom half nationwide: They tied for 29th of 51 spots. The District of Columbia was included in the study, which examined the most recent data available in 32 categories.
The New York-based nonprofit research firm included five states in the Great Lakes region: Indiana, Ohio, Michigan, Illinois and Wisconsin. The report was released July 18.
Patti Hays, who is CEO of the AWS Foundation, vice president of the local health department’s board and a registered nurse, agreed to share some personal views on the Commonwealth Fund’s report. She said the results point to issues that “demand attention.”
“In a county where we boast of being a national leader in areas of cardiac care, cancer services or advanced technology, there is no excuse for our incidence of infant mortality and lack of needed women’s health care services,” Hays said in a statement. “Too many women lack trust that the system acts in their best interest. Access to quality, trusted and socially aligned primary care is vital to community health.”
Indiana performed especially poorly in abortion clinics per 100,000 women (46th of 51); women ages 18 to 64 who report poor mental health (42nd); and infant mortality per 1,000 live births (41st).
States with abortion restrictions often have fewer maternity care providers, which affects access, the authors said. The data used in the report is from 2021 and 2022. It’s possible that Indiana has fewer maternity care providers now following the state legislature’s adoption of abortion restrictions in 2022.
Ohio’s lowest rankings were on infant mortality (44th); women who report poor mental health (44th); and self-pay in-hospital births (40th).
Authors’ view
Sara Collins, the study’s lead author and the fund’s senior scholar, said comparing health care systems “is an important way of telling us what is and isn’t working in American health care.”
“The scorecard’s findings are deeply concerning and underscore the urgent need for federal and state policies to expand women’s access to affordable, timely reproductive care and other essential health services … ,” she said in a statement.
Collins, who is also the fund’s vice president for health care coverage and access, said women deserve access regardless of who they are, what they earn and where they live.
Dr. Joseph Betancourt, The Commonwealth Fund’s president, said results vary considerably by location.
“While some states are championing women’s continued access to vital health and reproductive services, many others are failing to ensure women can get and afford the health care they need,” he said in a statement. “And this failure is having a disproportionate impact on women of color and women with low incomes.”
One of study’s top line findings was: “Gaps in women’s health and care could widen further, especially for women of color and those with low incomes who live in states that have restricted access to reproductive health care.”
Study coauthor Dr. Laurie Zephyrin echoed concerns about how state laws affect women’s health care.
“Instead of limiting care, federal and state policymakers should work to ensure that women have access to the full continuum of care throughout their lives,” she said in a statement.
Two officials elected to represent northeast Indiana residents were asked to react to the study’s conclusions.
Sen. Liz Brown, R-Fort Wayne, rejected the authors’ characterization of the legislature’s performance. She said state laws passed in recent years help women and their families.
“Of course Indiana ranks low on abortion access according to this pro-abortion entity. When we convened in summer 2022 to make Indiana a mother and baby-friendly state, we didn’t only limit access to most abortions, we also spent $87 million on new spending and tax cuts to aid mothers, families and healthy pregnancies,” she said in a statement. “We’ve continued funding positive policies for these populations, and we’ll continue doing so in future sessions because advancing the dignity of human life is the right thing to do.”
House Democratic Leader Phil GiaQuinta, D-Fort Wayne, said the report’s findings are “disturbing.”
“Indiana has been under one-party Republican legislative control for nearly 20 years and, unfortunately, our state policies are a reflection of the radicalization of party politics we are seeing nationwide,” he said in a statement. “In 2022, the Republican-led legislature dealt a devastating blow with a near total abortion ban that rolled women’s rights back 50 years. The findings in this report are disturbing but come as no surprise to Hoosier Democrats who have been echoing these concerns for years.”
GiaQuinta disagreed with Brown’s description of the state’s support for mothers.
“There was a lot of talk from the Republican supermajority about taking steps to support new mothers and babies in light of the abortion ban,” he said. “Unsurprisingly, promises to support maternal and infant health fell to the wayside, while Indiana’s maternal health statistics continue to plummet, and more women suffer as a result of these restrictions.”
Additional findings
Indiana ranked 41st in the percentage of women ages 18 to 64 who reported being in poor or fair health and 42nd for women in the same age bracket who reported having 14 or more poor mental health days in the past month. Ohio’s rankings in those categories were 34th and 44th, respectively.
On the positive side, the Hoosier State ranked relatively high in women ages 18 to 44 who had a routine checkup in the past two years (13th of 51) and women with up-to-date breast cancer screening (17th).
And the number of women ages 15 to 44 with syphilis was relatively low at 43 per 100,000 compared to the U.S. median of 78 per 100,000. As a result, Indiana ranked 14th in that category nationwide. Ohio ranked 24th with 57 per 100,000 testing positive for syphilis in the same age demographic.
The Allen County Department of Health compiles public health data, including syphilis infection rates.
Dr. Tom Gutwein, the county’s health commissioner, said the local health department focuses on its mandate, which doesn’t include tracking problems or gaps in clinical care for women.
“Our work in Allen County to promote and protect public health, however, does include efforts to improve maternal and child health, which is key to lowering the infant mortality rate,” he said in a statement.
Gutwein highlighted the department’s support of local programs providing maternal and child health care, including more than $300,000 in grants this year.
“Access to care and supportive services are essential to ensuring women and children in Allen County are healthy and kept healthy,” he said.
Hays also highlighted racial differences found in the report.
“Disparity in health outcomes for non-white women and babies in our state and Allen County demands attention,” Hays said. “The added funds to public health that were provided in the 2022 (state) budget was a good start. Public health providers rather than politicians need to be directing their attention to women’s health and the issues that are directly driving these outcomes.”
Statewide view
Hays noted that the report’s findings are for the entire state of Indiana and aren’t broken down by city or county. Rural counties in the state might have more limited access to primary care doctors and OB/GYNs than Allen County, pulling down the state’s numbers.
Although Allen County trails the nation in the number of primary care doctors – one for every 1,350 residents locally compared to one for every 1,330 Americans – the Indiana rate is worse. Statewide, there is one doctor for every 1,520 Hoosiers.
Hays pointed to a pipeline for future Fort Wayne providers, including the Family Practice Residency Program, a partnership between Lutheran Health Network’s three local hospitals and the Fort Wayne Medical Society to train primary care physicians. Parkview Health recently launched residency program in other practice fields. And Indiana University Fort Wayne operates a four-year medical school program.
It isn’t unusual for physicians to settle in the communities where they have residencies.
GiaQuinta isn’t satisfied by taking a narrow – though positive – view. He plans to continue pushing back against statewide abortion restrictions, which the Commonwealth Fund found affects access to and quality of health care for women.
“Indiana is amongst the bottom performing states for access to maternal health care,” he said. “In 2023, 36% of the counties in the state were maternal health care deserts. The near-total abortion ban further complicated this lack of access, making it difficult to attract doctors and other health care professionals to a state that threatens to criminalize them for providing life-saving health care.”
It’s not only a health care issue, it’s an economic development issue, according to GiaQuinta.
“As Democrats have said from the very beginning: abortion is health care. Period,” he said. “Cutting off access to abortion not only directly affects the health of women in our state, but our ability to retain and attract future Hoosiers – people who want to live in a state free of governmental overreach where politicians enter the exam room.”
