MISSISSIPPI — Mississippi has the highest preterm birth rate in the United States, standing at 15%, compared to the national average of 10.4%. Preterm birth—defined by the World Health Organization as a delivery before 37 weeks of pregnancy, or three weeks early—is one of the leading causes of infant mortality and long-term health complications.

These statistics highlight a public health issue that disproportionately impacts marginalized communities and families in maternity care deserts, according to March of Dimes, a nonprofit focused on maternal and infant health.

For mothers like Alexis Downs, these numbers aren’t just data points—they represent the very real challenges of navigating Mississippi’s strained health care system.

“I feel like my hospital birth went exactly how it was supposed to,” Downs said about the birth of her first child, Huxley. “I feel like that’s a problem.”

Downs described the experience as rushed and disempowering, noting she felt like she wasn’t in control of her body and that she was at the mercy of the facility’s schedule.

“I think they (birthing teams) do intervene a lot. Which in some cases, they do have to, and I understand that, but in a lot of cases, I feel like it’s more so having control over what they think needs to happen,” she said.

Downs said decisions were made for her, sometimes without her knowledge. She recalled waking up to discover she had been given Pitocin, a medication used to induce contractions during labor.

“They said I wasn’t progressing fast enough, but no one even asked me,” she said.

The experience led Downs to look for alternatives, and when she got pregnant with her second child, Theo, she turned to a Certified Professional Midwife.

“With the home birth, it felt more like I had control over my body, over my labor, my delivery. It was so empowering,” Downs said.

As Downs advocated for at-home births, she clarified they aren’t for everyone, but the priority should be making it easier for mothers to choose what best fits their needs.

Barriers to maternal care

The main barriers to maternal care centers around proximity and cost. The Mississippi State Department of Health reports the state leads the nation in maternity care deserts, with more than 51% of its counties lacking an obstetric provider or birthing facility—nearly double the national average of 32.6%.

In total, there are 35 birthing-friendly hospitals and health system locations in Mississippi, with only seven facilities in the southeast corner. That means fewer than 1 in 4 women have access to a birthing clinic or hospital within 30 minutes, compared to 1 in 10 nationwide.

March of Dimes reports that, on average, mothers in rural areas travel over 15 miles to access care, which can be prohibitive for families without reliable transportation—concerns area mayors and hospital officials have voiced.

Cost is another significant barrier, especially for low-income or underinsured families. According to FAIR Health, a nonprofit that collects data on health insurance claims, the average out-of-network cost nationwide for giving birth vaginally is nearly $29,000 and increases to nearly $38,000 for a cesarean section. Mississippi falls slightly below at $25,000 and $35,000, respectively.

Annaly Whitt, Director of Health Services at the Mississippi Department of Health (MSDH), believes a deeper understanding of systemic barriers and more awareness of available resources for expecting mothers can help growing families and health care workers overcome those hurdles.

According to Whitt, improving maternal care starts with improving prenatal care.

Influence of accessible care and resources

The Reproductive Health Journal notes maternal health outcomes depend on the mother’s health during pregnancy, the timing of medical treatment and access to health care facilities.

In an action plan developed by MSDH’s Mississippi Maternal Health Symposium Workgroups, experts emphasized three areas of improvement targeting those issues: enhancing the understanding of maternal health in Mississippi; driving forward action and community-level involvement; and showcasing maternal health prevention strategies to highlight policy and systemic changes.

“Maternal health is a critical indicator which leads to identification of the overall health and well-being of a society,” the report reads. “Despite advancements in medical science, significant disparities in maternal health outcomes persist, especially in underserved and vulnerable populations of Mississippi.”

Black infants face significantly higher mortality rates than White infants in Mississippi. In 2022, the infant mortality rate for non-Hispanic Black infants was 12.1 per 1,000 live births, nearly double the 7.2 per 1,000 for non-Hispanic White infants.

Lafayette County was the only one to meet the March of Dimes’ Healthy People 2030 preterm birth rate goal of 9.4%, with a 9.1% average from 2020 to 2023. In southeast Mississippi, Forrest County ranked highest at 16%, likely due to the location of birth centers across the state.

This map shows Mississippi’s preterm birth rate by county, on average, from 2020-2023. (March of Dimes)

“Preterm birth is one of the three leading indicators for infant mortality,” Whitt said. “We need to ensure there are different levels of maternal and neonatal care across the state that are available and accessible to all women and children.”

Adequate prenatal care is instrumental in improving preterm birth rates and maternal outcomes, according to Mayo Clinic, which points out that preterm birth can cause respiratory issues, developmental delays and chronic illnesses.

Whitt advocates for Medicaid expansion, stating it would provide more resources for secondary prevention, helping babies and children who face health challenges like cleft lip or lip ties.

“Preterm birth isn’t just a health issue; it’s a systems issue,” Whitt explained. “When mothers can’t access prenatal care early and consistently, their risk factors for complications increase exponentially.”

Potential solutions

Notable solutions are growing in popularity to offset the challenges of accessing affordable care, including midwives and doulas.

Whitt pointed to the disparity in costs between hospital and midwifery care, noting midwifery-assisted births range from $3,000 to $9,000—a stark difference from the average $30,000 bill for out-of-network facilities.

“For many families, the cost is prohibitive,” Whitt said. “And with limited insurance coverage for midwifery services, families are often left with no choice but to pay out of pocket.”

Currently, Mississippi does not permit midwife-run birthing centers and restricts Certified Nurse Midwives (CNMs) to hospital or clinic settings. Only a few hospitals allow nurse midwives to deliver babies:University of Mississippi Medical Center (UMMC), Southwest Mississippi Regional Medical Center in McComb and Anderson Regional Health System.

As recent as last year, state lawmakers considered efforts to increase midwifery services, including the failed Senate Bill 2080, which would have created licensure and regulations for midwifery. Republican Senator Kevin Blackwell introduced the proposal so “parents have the freedom to choose the manner, place, and attendant for giving birth.”

“Regulating professional midwifery in community settings will increase access to birthing options for the families of Mississippi and preserve parental choice,” Sen. Blackwell outlined in SB 2080.

On the national level, the Momnibus Act, introduced by the Black Maternal Health Caucus in the U.S. House of Representatives, seeks to address maternal health disparities, particularly for Black women.

The legislation proposes measures to improve access to care, including funding for local programs, increased availability of doulas and midwives and better health care services. The Act aims to tackle the root causes of maternal health issues, including poverty and inadequate access to health care.