People, regardless of gender, often face an uphill battle to stay healthy in the United States, which came in 50th out of 221 nations for life expectancy in the latest edition of the CIA's World Factbook.
But it can be a particular challenge for women. More than 300 U.S. counties saw a decline in women's life expectancy from 1987 to 2007, while just six counties showed a similar decline for men. Here's our list of 10 states where women are especially hit hard by poverty, obesity and high rates of smoking, and often struggle for access to family planning, prenatal care, mammograms and Pap tests.
Mississippi
The National Women's Law Center (NWLC) ranked the Magnolia State 51st of all U.S. states and D.C. in its 2010 Report Card on women's health.
Mississippi got failing grades for high rates of obesity, smoking, inactivity and chronic illness. One in four women 18 to 44 years old in the state had no health insurance in 2009-2010, compared to 1 in 20 women in Massachusetts, the top-ranked state.
About 71 percent of women 50 and older in Mississippi were up-to-date on breast cancer screening, compared to 88 percent of women in Massachusetts.
Arkansas
Arkansas has high rates of obesity, smoking, sedentary living, heart disease and diabetes. Life expectancy for women has declined in more than one out of five Arkansas counties.
But the state does have a number of public health programs, including the Arkansas Tobacco Quitline (1-800-QUIT-NOW), which offers free personalized phone counseling, free unlimited Web coaching and free medications.
Family planning services, Pap tests and STD testing, regardless of ability to pay, are available to both men and women through the Arkansas Department of Health. You can find the closest clinic on their website.
Idaho
The Gem State ranked last in the percentage of women over 49 who had a mammogram in the past two years (68 percent). Idaho also has the lowest number of practicing physicians per person in the country (17 for every 10,000 people, compared to 40 per 10,000 in Massachusetts).
"In some of these states, one of the issues is just purely numbers of providers, because you're looking at pretty rural states," notes Elizabeth Nash, state issues manager at the Guttmacher Institute.
Idaho does have state programs, like Women's Health Check, which offers free breast and cervical cancer screening to uninsured, low-income women.
Kentucky
While Kentucky rarely ranks in last place for most measures of women's health, there are a number of factors that drag down the health of women living in the Bluegrass State.
In almost every county in the state's Eastern Mountain Coal Fields region, women's life expectancy declined between 1987 and 2007. And the percentage of women without health insurance was 20.8 percent in 2010, ranking 40 among the states. (Massachusetts was in first place, with 5.2 percent.)
It's not all bad news though; Kentucky has low rates of chlamydia (4 percent in 2010, compared with 7.4 percent in the rest of the United States).
Louisiana
The National Women's Law Center ranked the Bayou State second worst, after Mississippi, on its 2010 women's health report card. A quarter of women in the state lack health insurance, and rates of sedentary living, obesity, unhealthy eating and smoking are high.
In 2010, the chlamydia rate was 12.3 percent, up from 8 percent in 2007. On the plus side, Louisiana has slightly-higher-than-average rates for Pap tests; 83 percent of women had one in the last three years. There are 9.7 infant deaths for every 1,000 live births in Louisiana, compared to 4.9 per 1,000 in Utah and Washington state, which have the nation's lowest infant mortality rates.
Tennessee
Women's life expectancy declined from 1987 to 2007 in 36 of Tennessee's 95 counties.
While 75 percent of non-Hispanic white women get first-trimester prenatal care, that's true for just 54.3 percent of black women and 43.4 percent of Hispanic women. Obesity rates among women jumped from 27.1 percent in 2007 to 34.5 percent in 2010 — the second-highest in the nation.
Tennessee women also have the nation's highest stroke death rate, and the third-highest breast cancer death rate.
Oklahoma
Only one place in the United States showed a state-level decline in women's life expectancy between 1987 and 2007: Oklahoma.
Jeannie McDaniel, a Democrat who has served in the House of Representatives since 2004, has said that many Oklahomans see legislation intended to improve public health, from health education to smoking cessation, as infringing upon the "sanctity of the family."
"I am very cognizant that women are suffering especially in Oklahoma, but common sense legislation … that could really improve the lot of women doesn't even get out of committee here," McDaniel said in 2011.
Texas
Texas ranked dead last in the percentage of women receiving first-trimester prenatal care in 2006 (just 62 percent, versus 89 percent in Massachusetts), and the percentage of women with health insurance (31 percent had no coverage in 2008-2009, compared to 5 percent of women in Massachusetts and 20 percent in the United States, overall).
Women in the Lone Star State had the third-highest rate of chlamydia infections (12 percent in 2010, up from 9 percent in 2007). Nationwide, the chlamydia rate was 7 percent in 2010, compared to 3 percent in West Virginia, the state with the lowest infection rate.
West Virginia
In 2010, 36.8 percent of women living in West Virginia got no leisure-time physical activity at all, up from 31.3 percent in 2007. Obesity rates increased to 32.6 percent during the same time, while the percentage of women who ate at least five servings of fruit and veggies daily fell from 22.9 percent to 18.8 percent.
Since 2003, the state has received Centers for Disease Control and Prevention funding for obesity prevention programs. In 2005, West Virginia established an Office of Healthy Lifestyles, which has launched some innovative anti-obesity programs. For example, they've teamed up with cities and towns to promote physical activity and healthy eating while revitalizing business districts.
Wyoming
In 2010, the Equality State's female workers made about 64 cents per dollar made by men in the same job — the largest wage gap in the United States.
The breast cancer and cervical cancer screening rates are low. Some women have to travel up to 100 miles to get a mammogram, some communities require a doctor's order to get a mammogram, and mobile screening units are scarce. And 96 percent of women live in counties with no abortion provider, the highest in the United States.
Our data
To compile this list, Health.com used data from several sources, including the Kaiser Family Foundation, the National Women's Law Institute and the Guttmacher Institute.
We looked at more than a dozen indicators, including the percentage of women getting first trimester prenatal care, the percentage of women who were up-to-date on cervical and breast cancer screening, maternal mortality rates, and the percentage of women living in poverty.
States that were in the top 10 on these indicators were most likely to be included in our list; states are not listed in any particular order.
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