Indiana and Ohio are tied for last in the Great Lakes region for the quality, access and affordability of women's health care, according to the report, which the authors described as “deeply concerning.”
The Commonwealth Fund's first comprehensive study of women's health care also placed Indiana and Ohio in the bottom half of the nation, tied for 29th out of 51. The study included the District of Columbia, which looked at the most recent available data in 32 categories.
The New York-based nonprofit research firm surveyed five Great Lakes states: Indiana, Ohio, Michigan, Illinois and Wisconsin. The report was released on July 18.
Patty Hayes, CEO of the AWS Foundation, vice chair of the local health department's board of directors and a registered nurse, agreed to offer a personal opinion on the Commonwealth Fund report. She said the findings highlight an issue that “demands attention.”
“In a county that ranks among the best in the nation for cardiac care, cancer treatment and advanced technology, there is no excuse for high infant mortality rates and a lack of needed women's health services,” Hayes said in a statement. “Too many women don't believe the system is working in their interest. Access to quality, reliable and socially inclusive primary care is essential to the health of our community.”
Indiana performed particularly poorly in the number of abortion clinics per 100,000 women (46th out of 51 states), the number of women ages 18-64 reporting poor mental health (42nd), and infant mortality rate per 1,000 live births (41st).
States with abortion restrictions often have fewer obstetric care providers, which affects access, the authors say. The data used in the report is from 2021 and 2022. There may now be fewer obstetric care providers after the Indiana Legislature adopted abortion restrictions in 2022.
Ohio's lowest rankings were in infant mortality rate (44th), women reporting poor mental health (44th) and out-of-pocket inpatient childbirth (40th).
Author's opinion
Sara Collins, the study's lead author and a senior research fellow at the foundation, said comparing health systems “is an important way to learn what's working and what's not working in the U.S. health system.”
“The scorecard findings are of serious concern and underscore the urgent need for federal and state policies to ensure women have access to affordable and timely reproductive health care and other essential health services,” she said in a statement.
Collins, who also serves as the foundation's vice president of health coverage and access, said women have a right to health care no matter who they are, how much they make or where they live.
Joseph Betancourt, president of the Commonwealth Fund, said results vary widely from place to place.
“While some states support women's continued access to important medical and reproductive services, many others have failed to ensure women can obtain and afford the care they need,” he said in a statement, “and this failure disproportionately impacts women of color and low-income women.”
One of the study's key findings is that “disparities in women's health and healthcare are likely to be exacerbated, especially for women of color and low-income women living in states with limited access to reproductive healthcare.”
Study co-author Dr. Laurie Zephirin also expressed concern about how the state law will affect women's health care.
“Instead of restricting care, federal and state policymakers should work to ensure women have full access to health care throughout their lives,” she said in a statement.
Two elected officials who represent residents of northeastern Indiana were asked for their reaction to the study's conclusions.
Republican Sen. Liz Brown of Fort Wayne rejected the bill's authors' assessment of the Legislature's performance, saying recently enacted state laws help women and their families.
“Of course, Indiana ranks low for abortion access according to this pro-abortion group. When we came together in the summer of 2022 to make Indiana a mother- and baby-friendly state, we not only restricted access to most abortions, but also enacted $87 million in new spending and tax cuts to support mothers, families and healthy pregnancies,” she said in a statement. “We continue to fund positive policies for these people and will continue to do so in upcoming sessions because elevating the dignity of human life is the right thing to do.”
House Democratic Leader Phil Giaquinta, D-Fort Wayne, called the report's findings “alarming.”
“Indiana has had a one-party Republican legislative control for nearly two decades, and unfortunately, state policy reflects the extremism of partisan politics we've seen across the nation,” he said in a statement. “In 2022, the Republican-led Legislature dealt a devastating blow with a near-total abortion ban, rolling women's rights back 50 years. The report's findings are alarming, but they come as no surprise to Indiana Democrats, who have been voicing these concerns for years.”
Giaquinta disagreed with Brown's explanation of the state's support for the mother.
“The Republican supermajority vigorously debated passing measures to support new mothers and babies in light of the abortion ban,” he said. “Predictably, promises to support the health of mothers and babies were ignored, and Indiana's maternal health statistics continue to plummet, with even more women suffering as a result of these restrictions.”
Additional findings
Indiana ranked 41st in the percentage of women ages 18-64 who reported poor or fair health and 42nd in the percentage of women in that age group who reported having 14 or more days in the past month with poor mental health. Ohio ranked 34th and 44th, respectively, in those categories.
On the positive side, Indiana ranked relatively highly for women ages 18-44 who had a routine screening in the past two years (13th out of 51 states) and for women who had their most recent breast cancer screening (17th).
Additionally, Indiana's syphilis case rate among women ages 15 to 44 is relatively low at 43 cases per 100,000, compared to the national median of 78 cases per 100,000. As a result, Indiana ranks 14th in the nation in that category. Ohio ranks 24th in that age group with 57 cases per 100,000.
The Allen County Health Department compiles public health data, including syphilis infection rates.
Dr. Tom Gutwein, the county's health director, said the local health department is focused on its mission, which doesn't include tracking issues or gaps in clinical care for women.
“However, our efforts to promote and protect public health in Allen County also include working to improve maternal and child health, which is key to reducing infant mortality,” he said in a statement.
Gutwein highlighted the department's support for local programs providing maternal and child health care, including more than $300,000 in grant funding this year.
“Access to care and support services is essential to the well-being of Allen County women and children,” he said.
Hayes also highlighted the racial disparities found in the report.
“The disparities in the health outcomes of non-white women and infants in the state and Allen County are noteworthy,” Hayes said. “The additional funding for public health provided in the 2022 (state) budget was a good start. Public health providers, not politicians, need to focus their attention on women's health and the issues that are directly causing these outcomes.”
Statewide View
Hayes noted that the report's findings are for the whole of Indiana, not broken down by city or county. Rural counties across the state may have more limited access to primary care physicians and obstetricians-gynecologists than Allen County, lowering the statewide numbers.
While Allen County lags behind the nation in the number of primary care physicians (1 for every 1,350 local residents and 1 for every 1,330 Americans), Indiana's ratio is even worse: Statewide, there is 1 physician for every 1,520 Indiana residents.
Hayes pointed to a pipeline for future Fort Wayne health care providers, including the Family Practice Residency Program, a partnership between the three local hospitals in the Lutheran Health Network and the Fort Wayne Medical Association to train primary care physicians; Parkview Health recently launched a residency program in other areas of practice; and Indiana University Fort Wayne operates a four-year medical school program.
It is not uncommon for physicians to settle in an area where they have a residence.
Giaquinta isn't content with a narrow (but positive) view: She plans to continue to oppose statewide abortion restrictions that the Commonwealth Fund has concluded affect women's access to and quality of health care.
“Indiana is one of the worst-performing states when it comes to access to maternal and child health care,” he said, “In 2023, 36% of the state's counties were maternal and child health care deserts. Our near-total abortion ban further compounds this lack of access, making it difficult to attract doctors and other medical professionals to the state where they may be criminalized for providing life-saving care.”
Giaquinta said this isn't just a health care issue, but also an economic development issue.
“Democrats have said all along: abortion is health care. Period,” he said. “Cutting off access to abortion not only directly impacts the health of women in our state, but it also impacts our ability to retain and attract future Hoosiers – people who want to live in a state free of government overreach that puts politicians in doctor's offices.”
