2024 Data Update — A Decade of Progress

Ten years after the original MISS assessment, the Birth Place Lab has released updated state rankings reflecting the current landscape of midwifery integration across the United States. The 2024 update captures significant policy changes, new licensure frameworks, expanded scope-of-practice legislation, and shifts in Medicaid coverage that have reshaped access to midwifery care since 2014–2015.

The Midwifery Integration Scoring System (MISS) rates key indicators of midwife integration in each U.S. state on a 50-item scale, with a maximum score of 100. A score of 100 would indicate that families in that state have full access to high-quality maternity care across all settings — homes, birth centers, and hospitals — without payer restrictions, and that all maternity care providers are regulated and practicing to their full scope. No state has yet achieved this standard.

The 2024 assessment reflects a decade of legislative activity, including new licensure in previously unregulated states, expanded Medicaid reimbursement, and updated scope-of-practice laws. The national average MISS score has risen from 35 in 2014–2015 to 51 in 2024 — meaningful progress, though significant gaps in access and equity remain. The highest-ranking state is now Maine (82); the lowest is Nebraska (23).