Texas is among the lowest performing states for women’s health outcomes, according to a new report from a national women’s health nonprofit released Thursday morning.

The Commonwealth Fund’s 2024 State Scorecard on Women’s Health and Reproductive Care analyzed data on maternal mortality, insurance access and other factors in all 50 states and Washington D.C.

Texas ranked 50th overall in the study. Mississippi was the only state with worse health outcomes.

Texas has one of the strictest abortion laws in the country, banning the procedure in nearly all circumstances unless a doctor believes it’s necessary to save the life or protect the health of the pregnant patient.

Dr. David Radley helped collect and interpret data for the Commonwealth Fund study. He says states with the most restrictive abortion policies — like Texas, Oklahoma and Mississippi — also have the fewest obstetric and maternity care providers.

“There’s concern that abortion bans or limits will further reduce the number of providers offering maternity care owing to increased risk of legal action that providers face, especially when state laws are ambiguous,” Radley said.

A report from the March of Dimes found 46% of counties in the state are defined as maternity care deserts, meaning those counties have no maternity care centers or obstetricians. People seeking care have to travel an average of 30 miles to find a doctor in a maternity care desert, with some traveling up to 70 miles to find the nearest birthing hospital.

It’s not just providers that are hard to access in Texas. According to the report, the state also ranked last in the country for health care access and affordability. The study found 22% of Texas women between the ages of 15-44 don’t have health care coverage and 27% haven’t seen a doctor when they needed to because they couldn’t afford it.

Pregnant women are generally eligible for Medicaid in Texas, but Sara Collins, study author and vice president of the Commonwealth Fund, says that often doesn’t make up for years without insurance.

“It means that women enter their pregnancy having had less access to health care, particularly if they’re poor or low income, and in a poorer health situation than they would have been in had they had health insurance coverage,” Collins said.

Radley says those disparities in access to insurance and care are part of the reason Texas has one of the highest rates of maternal mortality in the country.

“We know from other research and reporting that inadequate access to health services before, during and after pregnancy, combined with disparities in socioeconomic status, underlying health and quality of care, have helped to drive the maternal mortality rate in the US higher than that of other high income countries,” Radley said.