Texas’ superlatives are nothing to brag about, according to the fifth edition of “Texas on the Brink,” an annual review that ranks the state on dozens of factors ranging from health insurance to voter turnout.

Despite having the highest birth rate, Texas has the worst rate of women with health insurance, and the worst rate of pregnant women receiving prenatal care in the first trimester, according to the report commissioned by the Legislative Study Group, a liberal-leaning research caucus in the Texas House.

While Texas has the second-highest public school enrollment, the state ranks last in the percentage of people 25 and older with a high school diploma. And though Texas has the highest percent of its population without health insurance, the state is 49th in per capita spending on Medicaid, and dead last in per capita spending on mental health, according to the report.

Here’s a look at how Texas compares to other states: 

At the bottom:

• Tax expenditures per capita (47th)

• Percent of population 25 and older with a high school diploma (50th)

• Percent of poor people covered by Medicaid (49th)

• Percent of population with employer-based health insurance (48th)

• Per capita spending on mental health (50th)

• Per capita spending on Medicaid (49th)

• Percent of non-elderly women with health insurance (50th)

• Percent of women receiving prenatal care in first trimester (50th)

• Average credit score (49th)

• Workers’ compensation coverage (50th)

Near the top:

• Number of executions (1st)

• Public school enrollment (2nd)

• Percent of uninsured children (1st)

• Percent of children living in poverty (4th)

• Percent of population uninsured (1st)

• Percent of population living below poverty (4th)

• Percent of population with food insecurity (2nd)

• Overall birth rate (2nd)

• Amount of carbon dioxide emissions (1st)

• Amount of toxic chemicals released into water (1st)

• Amount of hazardous waste generated (1st)