Oklahoma is among the poorest-performing states overall for women’s health care access, quality and outcomes, according to a national study from the Commonwealth Fund. The experts behind it are concerned about growing disparities in care after Roe v. Wade was overturned.

The state ranked 48th overall in this study, tying with Nevada, and only surpassing Texas and Mississippi. The study evaluated states on 32 indicators related to health outcomes, coverage, access and affordability, and health care quality and prevention.

Its worst performance fell in its rates of uninsured women, women ages 18-44 who went without care because of cost and a lack of maternity care providers.

Oklahoma ranked second to last nationally in its number of providers who practice obstetrics and gynecology, with 55 medical providers per 100,000 women ages 15-44 in 2022. The U.S. average is 78.9 per 100,000 women, and the best ranking state from the study is 159.7 per 100,000 women.

A survey from last year found strict abortion laws, like those found in Oklahoma, were a deterrent for medical students applying for state residency programs.

Joseph Betancourt, the Commonwealth Fund’s president, said in a press release, the scorecard is a reminder that where you live matters to your health and health care.

“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. And this failure is having a disproportionate impact on women of color and women with low incomes,” Betancourt said.

Oklahoma performed better in categories like women 65 and older with a pneumonia vaccine and its rate of low-risk cesarean births.