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SAN FRANCISCO — California could do much more to improve health care for women and girls, according to a report issued Tuesday by a women’s group. 

The study released by the Women’s Foundation, a San Francisco fund for women in the western United States, gave the state a “D” grade on the health status of women and girls in the state. 

“Despite a plethora of policies that have been put in place, the health care coverage for women and girls is mostly inadequate in the state of California,” said Patricia Chang, president and CEO of the Women’s Foundation. 

“For the richest state in the country, we’re not living up to our potential.” 

The report commends the state’s policies for family and medical leave and coverage for low-income children, but says women may not know they are covered and what exactly they are covered for, or how to apply. That’s a concern because women often take the responsibility of caring for their families, Chang said. 

But Ken August, a spokesman for the California Department of Health Services, said the report leaves out too much information to be accurate. 

“The report points out some challenges and some areas where work is needed, but it ignores so much else,” he said. 

He pointed out that California is strong in some areas, such as reproductive health, where it has an extensive family planning and reproductive health services program. He also said that any evaluation of health status should consider mortality rates.  

The mortality rate among women in the state decreased by 11 percent from 1990 to 1998. 

Still, one out of five women are not insured in California, which has the highest rate of uninsured people in the nation. 

“It’s common enough to be scary, that there are so many people who are put in a position of not being able to get or stay healthy,” said Ann Conradsen, who along with her 9-year-old son was without health care coverage for about five years. 

She left a job that provided health insurance and moved to Sacramento, where she now works three part-time jobs. 

Without health insurance, “it makes it really hard to be a good parent,” said Conradsen, who has back problems that have left her in crutches and has been paying for medical bills out of her pocket. 

Environmental risks are one of the factors that the report lists as a threat to women’s health, with California named the seventh largest hazardous waste-generating state in the country. 

One of the state’s most prominent industries is also pinpointed as a risk factor:  

Women who become pregnant while working in semiconductor plants are 40 to 100 percent more likely to miscarry than other women, according to a 1999 study. 

Women who work in low-paying jobs traditionally held by females face many environmental hazards in the workplace, and those women are the least likely to have access to health care, according to the report. Nearly half of the women of childbearing age in the state are at risk for hunger. 

The foundation makes recommendations to the governor and legislature, Cal-OSHA, employers and environmental enforcement agencies.  

It calls for a a study of the feasibility of universal coverage, expansion of the Healthy Families program, increased health coverage for unemployed and working adults, and a reduction in environmental and safety hazards in the workplace. 

“We hope this report encourages women and girls to organize, speak out and push for change,” said Diane Littlefield, executive director of Women’s Health Leadership, one of the report’s sponsors.  

Others were the Los Angeles Women’s Foundation, California Black Women’s Health Project, Latino Issues Forum, and Asian and Pacific Islander American Health Forum.