Based on recently released Census Bureau data, women made up almost half of the workforce last year. Yet, even working full-time and year-round, they were paid only 79 cents for every dollar men made. The wage gap varies considerably between states. Women receive 86 cents for every dollar men make in New York, for example, while in Louisiana, women are paid just 66% of what men earn.

Income inequality is only one of the challenges women face. Across the nation, women are less likely to serve in leadership roles both in the private and public sectors. Health outcomes among female populations also vary considerably between states. Based on 24/7 Wall St.’s analysis, Mississippi is the worst state for women in the nation.

Click here to see the 10 worst states for women

In all of the worst rated states, women were less likely than their male peers to hold private sector management positions. In two of the worst states — South Dakota and Utah — women held fewer than one in three management jobs. According to Ariane Hegewisch, study director at the Institute for Women’s Policy Research, women are discriminated not just in base pay, but also lack career opportunities available to men. “A lot of [the wage gap] is also promotions, recruitments, and networking,” Hegewisch said. Perceptions of performance can also be affected by gender, meaning “the more the pay is related to performance and bonuses, the bigger the wage gap.”

Women in the worst rated states were also less likely to have leadership roles in government compared to women in the rest of the country. Only six of the 10 states had any female representation in Congress. Many of these states were among the nation’s worst for female representation in their own state legislatures as well. State Senates usually have between 30 and 50 Senators. Of the 10 states on this list, however, only Kansas had more than 10 female senators.

While the United States is among the most developed countries in the world, it was one of just a handful of nations where maternal mortality actually rose over the last decade, according to a recent study published in The Lancet, a respected medical journal. Pregnancy related mortality rates vary considerably between states.

To determine the worst states for women, 24/7 Wall St. developed on a methodology based on the Center for American Progress’ 2013 report, “The State of Women in America.”

We divided a range of variables into three major categories: economy, leadership, and health. Data in the economy category came from the U.S. Census Bureau and included male and female median earnings, the percent of children enrolled in state pre-kindergarten, state spending per child enrolled in pre-kindergarten, and education attainment rates. The leadership category included data on the percent of women in management occupations from the Census. It also includes the share of state and federal legislators who are women, and states that currently have female governors. The health section incorporated Census data on the percent of women who were uninsured as well as life expectancy. Infant and maternal mortality rates came from the Kaiser Family Foundation. Data on the expansion of Medicaid, as policies towards maternity leave, sick days, and time off from work came from the National Partnership for Women and Families.

State rankings on each of these measures were averaged to determine a score for each category. Possible scores ranged from 1 (best) to 50 (worst). The three category scores were averaged to create an indexed value that furnished our final ranking.

These are the 10 worst states for women.

10. Kansas
> Gender wage gap: 79 cents per dollar (25th best)
> Poverty rate, women: 15.2% (23rd lowest)
> Pct. in state legislature: 24.8% (25th highest)
> Infant mortality rate: 7.5 per 1,000 births (15th highest)

A typical man in Kansas earned $45,463 last year. The median earnings among women in the state, on the other hand, were just $35,869, or 79% of male earnings. The ratio was roughly in line with that of the nation. In addition to economic inequality, women in Kansas were far less likely than women in other states to hold leadership roles. Nearly 64% of management positions, for example, were held by men, one of the higher rates nationwide. Women, by contrast, held 36.2% of management occupations, one of the lower rates. Unlike the majority of the worst states for women, however, Kansas has a fair number of female state-level politicians. Of the 40 state senators, 12 are women, more than all but a handful of states.

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9. Alabama
> Gender wage gap: 79 cents per dollar (12th worst)
> Poverty rate, women: 20.5% (5th highest)
> Pct. in state legislature: 14.3% (4th lowest)
> Infant mortality rate: 9.2 per 1,000 births (2nd highest)

With just five women out of 35 in the Alabama State Senate, and just 15 women out of 105 members in Alabama’s House of Representatives, few states have less of a female presence in their legislature. Alabama also ranks poorly in several measures of health that impact women. The state had one of the highest infant mortality rates in the country, with 9.2 deaths per 1,000 live births. Alabama also had one of the lowest female life expectancies in the country, at 78.2 years as of 2010. The state also lacks any of the family-friendly workplace health policies identified by the National Partnership for Women and Families.

8. Indiana
> Gender wage gap: 74 cents per dollar (7th worst)
> Poverty rate, women: 17.5% (20th highest)
> Pct. in state legislature: 20.0% (16th lowest)
> Infant mortality rate: 7.4 per 1,000 births (16th highest)

While nationwide women earned roughly 80% of a man’s salary last year, women in Indiana earned less than three-quarters of a man’s wages, one of the worst pay gaps nationwide. Child rearing may be occupying what might otherwise be paid labor for women in Indiana, as the state offers little support for new mothers. State-funded preschool is not available for children under five years old. Also, less than 25% of women had completed at least a bachelor’s degree as of last year, one of the worst rates in the country and much lower than the nearly 30% of women nationwide.

7. South Dakota
> Gender wage gap: 75 cents per dollar (10th worst)
> Poverty rate, women: 15.5% (24th lowest)
> Pct. in state legislature: 22.9% (23rd highest)
> Infant mortality rate: 7.1 per 1,000 births (21st highest)

Median earnings for women in South Dakota were roughly 75% the earnings of their male counterparts in 2013, one of the lower rates in the country. The lower earnings may be due to the relatively small percentage of women in management occupations. As of 2013, slightly more than 31% of workers in managerial roles were women, well below the national rate of 39.2%. Working women in South Dakota cannot take paid time off to care for sick family members or tend to their own health or pregnancy. Moreover, South Dakota has not begun to implement the expansion of Medicaid benefits allowed under the Affordable Care Act. With women accounting for nearly 55% of all state residents living below the poverty line in 2012, expanding Medicaid benefits would likely improve the living conditions for women.

6. Montana
> Gender wage gap: 74 cents per dollar (6th worst)
> Poverty rate, women: 17.7% (18th highest)
> Pct. in state legislature: 27.3% (16th highest)
> Infant mortality rate: 6.6 per 1,000 births (tied-25th highest)

More than 27% of state political leaders are women in Montana, an exceptionally high rate, especially when compared with other states on this list. In the private sector, however, women were much less likely to fill leadership roles. Just 35.2% of management occupations were held by women. By contrast, women held nearly 40% of management positions across the nation. Women in Montana also have among the nation’sworst access to health services. Nearly 16% of women didn’t have health insurance last year, more than in all but a handful of other states.

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5. North Dakota
> Gender wage gap: 70 cents per dollar (5th worst)
> Poverty rate, women: 12.8% (10th lowest)
> Pct. in state legislature: 17.0% (19th lowest)
> Infant mortality rate: 6.6 per 1,000 births (tied-25th highest)

Women in North Dakota earned a median of just less than $35,000 in 2013, nearly $15,000 below a typical man’s earnings. The magnitude of the gender wage gap may be due to the relatively small proportion of women in management positions. Women held just 28.3% of such positions in 2013, the lowest rate in the country. For women who choose to have children, North Dakota does not require employers to offer paid maternity leave. Additionally, the state is one of 10 states that do not provide funding for state preschool. However, the state may be trying to remedy some of the hardships women and their families face. Under the Affordable Care Act, North Dakota is expanding Medicaid to individuals and families with incomes up to 138% of the federal poverty line.

4. Mississippi
> Gender wage gap: 77 cents per dollar (16th worst)
> Poverty rate, women: 26.6% (the highest)
> Pct. in state legislature: 17.2% (21st lowest)
> Infant mortality rate: 10.0 per 1,000 births (the highest)

A typical male in Mississippi earned less than $40,000 last year — less than male populations in any other state — and women in the state earned nearly $10,000 less than their male counterparts. Not only were incomes the lowest across the board, but women earned just 77% of what men made that year, one of the larger gender pay gaps. Mississippi residents, and women in particular, also had exceptionally poor rates of educational attainment. Less than 84% of women in the state had completed at least high school as of last year, versus 87.2% of women across the country. Like a handful of other states, only men represent Mississippi in the U.S. Congress. While women were relatively underrepresented in Mississippi politics, 42.5% of all management positions in the state were held by women, a higher proportion than in all but a few other states. Unfortunately, this did not seem to result in higher wages for women.

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3. Idaho
> Gender wage gap: 76 cents per dollar (13th worst)
> Poverty rate, women: 16.2% (7th lowest)
> Pct. in state legislature: 26.7% (17th highest)
> Infant mortality rate: 6.0 per 1,000 births (16th highest)

The state of Idaho does not offer funded pre-kindergarten programs for kids. While some parents in the state elect to pay for private preschool, some school districts choose to finance their own programs without state-level help. Additionally, few states had fewer women in management roles than Idaho, where only one-third of such jobs were filled by women. Idaho also lacks family-friendly paid leave and sick time laws. And the state decided not to expand Medicaid under the Affordable Care Act, which hurts women especially. According to a 2012 report from the Kaiser Family Foundation, “Because women are more likely than men to fall into one of the eligibility categories for Medicaid and are more likely than men to be poor, women comprise over two-thirds of beneficiaries.”

2. Wyoming
> Gender wage gap: 69 cents per dollar (2nd worst)
> Poverty rate, women: 12.1% (7th lowest)
> Pct. in state legislature: 15.6% (5th lowest)
> Infant mortality rate: 6.8 per 1,000 births (24th highest)

Wyoming had one of the country’s largest pay disparities between men and women. The median earnings for a woman working full-time, year-round was just $35,829, slightly lower than the U.S. median. By contrast, the comparable figure for men was close to $52,000, among the highest nationwide. One reason for the disparity may be the number of jobs directly, or even indirectly, tied to coal mining. Mining jobs are typically male dominated. While gender pay gaps are often thought to reflect career choices or social dynamics — such as women taking time off from their careers to raise a child — the Council of Economic Advisors reported in March that wage gaps “are seen even when men and women are working side-by-side performing similar tasks.” Outside of just pay, however, adult women in Wyoming were the most likely in America to be high school graduates, with 94% having earned their diploma as of last year.

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1. Utah
> Gender wage gap: 70 cents per dollar (4th worst)
> Poverty rate, women: 13.6% (13th lowest)
> Pct. in state legislature: 16.3% (6th lowest)
> Infant mortality rate: 5.0 per 1,000 births (2nd lowest)

Utah is the worst state for women. Less than 31% of management positions were held by women in Utah, the second lowest rate nationwide. Women were also less likely than women in the vast majority of states to hold leadership roles in government. Of the 75 seats in the state’s House of Representatives, just six were filled by women last year. And there were just five female state-level senators. In all, women made up just 16.3% of state legislators, less than in all but five other states. Perhaps the lack of women in traditionally high-paying management and high-level government occupations has exacerbated the gender pay gap. While a typical man in Utah earned more than $50,000 last year, most women made 70% — or $35,252 — of that figure, nearly the largest pay discrepancy in the country.

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