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.