NASHVILLE, Tenn. (WKRN) — How healthy a person is can depend on a variety of factors, such as whether that person smokes cigarettes or how many fruits and vegetables they eat.

Data shows certain health indicators tend to vary by state, with different areas presenting strengths and challenges in women and children’s health. Nationwide, a 2023 study by the United Health Foundation found that the mortality rate for those demographics is increasing.

And the outlook isn’t great for Tennessee either. After analyzing several different factors such as food insecurity, children in poverty and access to adequate health care, researchers put Tennessee in the bottom 10 states for women and children’s health.

The 2023 Health of Women and Children report is based on data from 34 sources including the U.S. Census Bureau’s American Community Survey, the March of Dimes, and the CDC’s Behavioral Risk Factor Surveillance System and Pregnancy Risk Assessment Monitoring System.

Each state is ranked by 83 different factors that are considered determinates of health. According to the United Health Foundation, the study is meant to provide a holistic view of health by also considering social, economic and physical environment measures.

The study focuses on women who are of a reproductive age, since officials said the health and well-being of women of reproductive age and children can “have a significant impact on the overall well-being of individuals, families and communities.”

Like many states, Tennessee, which fell in at 41 in the overall ranking, had both strengths and weaknesses. According to researchers, the latest data reflects a low prevalence of asthma among Tennessee children, as well as low rates of depression, anxiety and alcohol use among youth.

The state also ranks fairly high for children’s access to ADD and ADHD treatment, as well as cervical cancer screening for women. In addition, more women in Tennessee appear to be consuming enough fruit and vegetables daily and getting enough exercise.

And while the number of Tennessee women who report that they smoke cigarettes remains high, less women appear to be smoking during pregnancy. The report indicates an overall 32% decrease in women smoking during pregnancy between 2016 and 2021.

However, despite those strengths, Tennessee still has one of the highest overall mortality rates for women ages 20 to 44 in the nation. Injury deaths among Tennessee women have increased nearly 36% within the five-year period between 2016 and 2021.

In line with national trends, a large amount of Tennessee women are dying during or one year after pregnancy, with the state ranking at number 43 for the overall maternal mortality rate.

For women in Tennessee, there appears to be difficulty accessing adequate prenatal care and women’s health care providers, such as gynecologists and obstetricians, and many are living in what researchers consider a maternity care desert.

The state’s child mortality rate is also high, with a 24% increase in child injury deaths during that same five-year time period. The study ranked Tennessee as one of the worst states for childhood obesity and the state has a low rate of childhood immunizations.

Also contributing to the state’s overall low ranking is a high number of children living in poverty, low WIC coverage among eligible children ages 0 to 4, poor early childhood education and high rates of youth tobacco use, teen pregnancy and adverse childhood experiences.

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Nationwide, data shows “concerning trends” and disparities in mortality, as well as rising mental health challenges among women, with some gains in other health measures for both women and children, according to the report.

The national mortality rate for women ages 20 to 44 increased 40% between 2019 and 2021, and early childhood education enrollment fell 18% during that same time period.

However, more women reported consuming two or more fruits and vegetables daily in 2021, teen births fell almost 44% from 2011 to 2021, and electronic vape usage among high school students fell 45% between 2019 and 2021.

Minnesota was ranked as the best state for women and children’s health, while Mississippi was the worst. To view the full study, click here.