Starting a Family Is Easier in Some States Than Others, New Ranking Finds
Choosing where to raise a family can involve much more than finding a suitable home or being close to relatives. For people planning to have a baby, the availability of quality medical care, the cost of childbirth, access to child care and the overall environment for young families can all make a major difference.
A new WalletHub analysis highlights how sharply those conditions vary across the United States. The study ranked all 50 states and Washington, D.C., using 31 measures connected to the cost of having a baby, health care, baby-friendly resources and family-friendly conditions.
The findings show that some states offer a much stronger combination of health services, affordability and support for parents, while others face challenges across several of those areas. Mississippi received the lowest overall ranking, followed by Alabama, Nevada, South Carolina and Georgia.
At the other end of the list, Massachusetts ranked first, with Minnesota, North Dakota, Rhode Island and New Hampshire rounding out the top five.
The rankings are not meant to suggest that families in lower-ranked states cannot receive good care or raise healthy children. Instead, they provide a broad comparison of statewide conditions that can affect parents before, during and after childbirth.
The WalletHub study considered four major areas: cost, health care, baby-friendliness and family-friendliness. The cost category included factors such as hospital charges for conventional and Caesarean deliveries, health insurance premiums, child care expenses, newborn screening costs, babysitter and nanny costs, and whether a state had expanded Medicaid.
Health care was another major part of the analysis. The researchers looked at measures related to the quality and availability of medical care, including outcomes affecting mothers and newborns. Baby-friendliness and family-friendliness added a wider perspective by considering resources and conditions that can influence life after the delivery room.
Mississippi placed last overall in the study, receiving a score of 27.99. It ranked 50th for health care and 51st for baby-friendliness, although it performed somewhat better in the cost category, where it ranked 24th.
Alabama ranked 50th overall with a score of 29.39. The state placed 49th for healthcare and last for baby-friendliness. Its relatively stronger performance in family-friendliness and costs was not enough to offset the weaker results in other categories.
Nevada ranked 49th overall. Its overall score was 33.31, with particularly weak results in baby-friendliness and family-friendliness. The state ranked 48th for baby-friendliness and 47th for family-friendliness, while its cost and health care rankings were closer to the middle of the national list.
South Carolina came in 48th overall, followed by Georgia at 47th. New Mexico ranked 46th, while Florida was 44th. The broader bottom portion of the ranking also included Arkansas, West Virginia, Oklahoma, Louisiana and several other states.
One important point from the study is that a state does not necessarily need to be inexpensive to rank highly. Massachusetts, for example, ranked 43rd for cost but still took the No. 1 position overall because of its strong performance in health care, baby-friendliness and family-friendliness.
Massachusetts received an overall score of 73.64. It ranked first for health care, second for baby-friendliness and first for family-friendliness. Those results helped outweigh its relatively high costs.
The state also has strong underlying health indicators. According to the Centers for Disease Control and Prevention, Massachusetts recorded an infant mortality rate of 3.49 deaths per 1,000 live births in 2024. That was well below the national rate of 5.52 per 1,000 live births for the same year.
The CDC’s national data also show how large the differences between states can be. In 2024, New Hampshire had the lowest infant mortality rate at 2.97 deaths per 1,000 live births, while Mississippi had the highest at 9.65. Alabama recorded a rate of 7.06, while Florida’s rate was 5.74.
These numbers do not by themselves explain why one state performs better or worse overall. Infant health can be affected by many factors, including prenatal care, maternal health, premature birth, birth conditions, socioeconomic circumstances and access to medical services.
North Dakota took the second spot in WalletHub’s overall ranking and stood out particularly for affordability. The state ranked fourth in the cost category and fourth for health care. WalletHub reported that North Dakota had the lowest average cost in the country for a conventional delivery without complications, at about $7,500.
Minnesota ranked third overall. It performed well across several categories, including health care, baby-friendliness and family-friendliness. Its overall score of 67.44 placed it only slightly behind North Dakota.
Rhode Island ranked fourth, while New Hampshire finished fifth. New Hampshire also had one of the strongest health-care performances in the ranking and ranked third for cost.
The contrast between the highest- and lowest-ranked states suggests that the experience of starting a family can depend heavily on location. A state may offer relatively inexpensive services but still struggle with access to care or family resources. Another state may have expensive housing and child care but provide stronger medical systems and parental support.
For expectant parents, that means a national ranking should be viewed as a starting point rather than a final answer. Families making decisions about where to live should also consider the specific hospital or birthing centre they plan to use, their health insurance network, nearby paediatricians, maternal health services, child care availability and local housing costs.
The broader health data reinforce why access to quality care matters. The CDC reported that 649 women died from maternal causes in the United States in 2024, producing a national maternal mortality rate of 17.9 deaths per 100,000 live births. Maternal health outcomes can vary substantially among different populations and communities, making access to appropriate prenatal, delivery and postpartum care an important consideration for families.
The WalletHub findings also show that being a good place to have a baby is not simply about what happens during pregnancy and delivery. Parents face expenses and practical challenges long after leaving the hospital. Child care, insurance, food security, paediatric services and household finances can all shape a family’s experience during the first few years of a child’s life.
That broader approach helps explain why Massachusetts ranked so highly despite not being one of the least expensive states. Its combination of medical care and family-orientated resources helped push it to the top of the list.
At the same time, the ranking should not be interpreted as a judgement on individual communities or hospitals. Conditions can vary considerably within the same state, and a family’s experience may depend on factors that a nationwide study cannot fully capture.
For parents-to-be, the most useful takeaway may be to look beyond the headline ranking. Comparing local hospitals, insurance coverage, prenatal services, delivery costs, paediatric care and childcare options can provide a much clearer picture of what life will actually look like for a particular family.
As childbirth and child-rearing costs remain important concerns for American households, the differences identified by the study offer another reminder that location can influence both the financial and practical challenges of starting a family.
Sources
WalletHub, “Best & Worst States to Have a Baby (2026).”
Centers for Disease Control and Prevention, National Center for Health Statistics, “Infant Mortality — Stats of the States.”
Centers for Disease Control and Prevention, National Center for Health Statistics. “Maternal Mortality Rates in the United States, 2024.”
Centers for Disease Control and Prevention, National Vital Statistics Reports, “Infant Mortality Rate: United States and Each State, 2024.”
