If you were thinking about starting a family and had the entire country to pick from, where would you choose to live?

Most of us don’t make the decision that way. But according to a new report from the Birth Injury Lawyers Group, which analyzed data from all 50 states, there are some clear choices based on health and cost metrics. According to its 2024 rankings, there are significant variations between states on the road to determining the best and worst states for raising children.

For instance, Arkansas’ maternal deaths, which are relatively rare, are still nine times higher than Vermont’s, at 43.5 per 100,000 births compared to 4.7 in Vermont. And Mississippi loses three times more babies at 9.39 infant deaths per 1,000 births compared to North Dakota’s 2.77.

The rankings were determined by weighting scores for each state for infant mortality, the fertility rate, the annual per-child cost for child care, maternal mortality, percentage of preterm births and babies born with low birthweight (less than 5 lbs. 8 oz.), average out-of-pocket spending per childbirth, child care cost percentage in single-parent media income — and separately, in double-parent median income.

The report said that Mississippi has the lowest annual per-child child care cost at $5,439, while Massachusetts at $16,781 is the highest.

Per the group’s analysis, North Dakota’s the best place to raise a child, followed by Utah and South Dakota. The worst three states are Mississippi, South Carolina and Tennessee.

Broken down and explained, the best states and their scores are:

  1. North Dakota (health score 9, cost score 9) total 85. Per the report, “With a low infant death rate (2.77 per 1,000 births) and a maternal mortality rate of 24.2 per 100,000 live births, it provides a safe and healthy environment for childbirth. The annual cost of child care per child is $8,624, and the state has a low percentage of preterm births at 9.56%.”
  2. Utah (health score 8.45, cost score 8.15) total 78. The report said that “Utah boasts a low infant death rate (4.58 per 1,000 births) and a maternal mortality rate of 16.1 per 100,000 live births. The annual cost of child care per child is $8,268, making it accessible to many parents.”
  3. South Dakota (health score 7.7, cost score 7.88) total 73. “The state has a low infant death rate (6.07 per 1,000 births) and a maternal mortality rate of 28.5 per 100,000 live births. The annual cost of child care per child is $6,677, and the percentage of preterm births is 10.53%,” the report said.
  4. Iowa (health score 8.22, cost score 7.28) total 71. “Iowa also boasts a low infant death rate (3.99 per 1,000 births) and a maternal mortality rate of 20.2 per 100,000 live births. The annual cost of child care per child is $9,322, and the percentage of preterm births is 10.03%,” the authors wrote.
  5. Idaho (health score 8.07, cost score 6.81) total 68. Per the report, “The state’s infant mortality rate of 5.13 per 1,000 births and a maternal mortality rate of 18.3 per 100,000 live births indicate a good health care environment. Idaho’s fertility rate of 60.7 per 1,000 and its balance of health care quality and affordability make it a desirable state for families.”
  6. Kansas (health score 7.66, cost score 6.98) total 67. As noted, “The infant mortality rate is 5.30 per 1,000 births, and the maternal mortality rate is 22.0 per 100,000 live births. The state’s fertility rate is 61.0 per 1,000, and it offers reasonable child care and childbirth costs.”
  7. Wyoming (health score 7.29, cost score 7.14) total 67. The report said, “Wyoming maintains a low infant death rate (5.45 per 1000 births) and a maternal mortality rate of 15.7 per 100,000 live births. The annual cost of child care per child is $8,236.”
  8. Delaware (health score 7.26, cost score 7.15) total 67. Per the report, “The state has an infant mortality rate of 4.77 per 1,000 births and an encouraging maternal mortality rate of 19.0 per 100,000 live births. Delaware’s fertility rate is 56.5 per 1,000, and it offers manageable child care and childbirth costs.”
  9. Missouri (health score 6.71, cost score 7.26) total 66. Noted the report, “The infant mortality rate is 5.85 per 1,000 births, and the maternal mortality rate is 25.7 per 100,000 live births. Missouri’s fertility rate is 58.4 per 1000. The state’s balance of health care services and cost of living makes it a favorable option for families, despite a higher maternal mortality rate.”
  10. New Hampshire (health score 7.7, cost score 6.7) total 66. Per the rankings, “The infant mortality rate is 3.96 per 1,000 births, and the maternal mortality rate is 14.5 per 100,000 live births, one of the lowest in the nation. New Hampshire’s fertility rate of 49.9 per 1000 and its focus on high-quality health care, despite higher costs, make it a commendable choice for families.”
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The worst states to raise a child, per the ranking:

  1. Mississippi (health score 4, cost score 4.71) total 40.
  2. South Carolina (health score 5.56, cost score 4.08) total 42.
  3. Tennessee (health score 5.79, cost score 4.05) total 42.
  4. West Virginia (health score 5.82, cost score 4.06) total 42.
  5. Alabama (health score 5, cost score 4.53) total 42.
  6. Arkansas (health score 4.98, cost score 4.66) total 43.
  7. Louisiana (health score 5.38, cost score 4.56) total 44.
  8. North Carolina (health score 6.33, cost score 4.61) total 48.
  9. Georgia (health score 5.62, cost score 5.14) total 48.
  10. Massachusetts (health score 7.69, cost score 4) total 49.