For months, Dr. Daniel Edney had watched his state's infant mortality rate rise. "It just kept climbing," he remembers. "We'd get another death coming in, another death coming in."
As the public health officer in Mississippi, it's Edney's job to monitor the number of infant deaths in the state. When he saw the final figures for 2024, they were as bad as he feared.
Nearly 10 babies died for every 1,000 live births. For Black babies, it was even higher at 15.2. The numbers — the highest in more than a decade — led the state of Mississippi under Edney's leadership to declare a public health emergency on Aug. 21.
"If having babies dying at the rate that our babies are dying is not a public health emergency, I don't know what is," says Edney.
Mississippi's infant mortality rate is among the highest in the country, but advocates warn that the rate across the U.S. is also too high. Nationally, 5.6 babies die per 1,000 born.
"What that translates to is 20,000 deaths every year," says Dr. Michael Warren, chief medical and health officer for March of Dimes — a group that advocates for improvements in maternal health care. "That's the equivalent of a jumbo jet crashing once a week for an entire year and killing everyone on board."
Warren calls the U.S. "one of the most dangerous developed countries for giving birth."
Warren and other experts who study this issue worry that as people lose access to Medicaid over the next few years due to spending cuts by the Trump administration, infant mortality will get even worse — not just in Mississippi — but across the country.
Earlier care for the tiniest babies
At Forrest General Hospital in Hattiesburg, Miss., neonatologist Randy Henderson stands beside an incubator that holds a tiny baby boy — slightly bigger than an outstretched hand.
Born weighing 2 pounds 5 ounces, the baby is attached to tubes that feed him and regulate his breathing. "We've got a lot of growing to do," says Henderson, gazing at his patient.
Preterm birth is a significant factor in infant mortality. When babies are born early and small, their chances of survival decline.
Henderson works at one of only a few facilities in the state staffed with specialists to deliver and treat preterm babies. Some of his babies, he says, arrive weighing less than one pound.
The new public health emergency allows for such babies to be transported from smaller hospitals that aren't equipped to treat them to facilities like these. Ideally, mothers will deliver the babies here, where they can receive specialized care from birth.
When this new practice is fully operational, Edney says it will give public health officials the ability to track these vulnerable patients and give them necessary medical care as soon as possible.
"I can see in real time when she has delivered, where the baby is, when the baby is loaded," says Edney. "And when the baby makes it to the NICU."
Researchers and advocates say this kind of improved access to care for preemies is a necessary step forward toward addressing the infant mortality crisis — but stress that it doesn't address the root of the problem. Healthy babies start with the health of the mother. Untreated, chronic conditions like diabetes and high blood pressure can contribute to preterm birth.
" If you can get a mom healthy before she's pregnant, that is your best opportunity to prevent a preterm birth," says pediatrician Anita Henderson, who also works in Hattiesburg, Miss., and is married to Randy Henderson.
But many women in Mississippi and other places around the country aren't getting to the doctor regularly, either because it's hard to find health care where they live, or because they can't afford health insurance or get on Medicaid.
On the front lines of a crisis
Carlnishia Kimber Holmes, pregnant with her third child, eased onto the exam table during a recent appointment in Greenville, Miss.
"I'm gonna let you lay back and we're gonna listen to the baby's heartbeat," said her obstetrician Dr. Lakeisha Richardson. And in a few moments the room is filled with the faint whooshing sound of a small heart beating.
Kimber Holmes, 32, has hypertension and pre-eclampsia — a complication that can lead to serious organ damage or even death. Her baby is also growth restricted, weighing three pounds, 12 ounces at 35 weeks pregnant.
"It's very scary to me," she said.
Adding to the precariousness of her situation, she's had to drive two hours at least once a week to see a specialist in Jackson. That's in addition to her regular obstetric appointments.
Until recently she worked as an Early Head Start teacher, but she had to quit her job due to all her appointments. Now her family is down to one income.
Richardson is one of the rare obstetricians in the Mississippi Delta, and she says she sees situations like Kimber Holmes' every day. Many of her patients show up with conditions such as diabetes and high blood pressure, often untreated before pregnancy.
Some patients travel more than an hour to see her, and others, like Kimber Holmes have to drive further to see specialists. More than half the counties in Mississippi are considered maternity care deserts, where prenatal care is difficult or impossible to find.
As part of the state's new effort, public health officials in Mississippi are working to make prenatal care available through telehealth and local public health departments, as well as expanding home visiting and safe sleep programs.
"It's such a great need here," says Richardson, who grew up in this area and felt called to return after she completed her medical training. "I know this is where God wanted me to be," she says. " I think that everyone who wants to be a mom deserves motherhood."
Saving lives and money
Even if they live near care, many Mississippi women can't afford it. Lack of insurance is the biggest obstacle preventing Richardson's patients from receiving care, she says.
That's why so many researchers and advocates argue that Medicaid access is critical for tackling the crisis.
Gov. Tate Reeves has consistently resisted Medicaid expansion under the Affordable Care Act, which would allow for more low-income women of reproductive age to become insured through Medicaid before they become pregnant. Reeves' office did not respond to a request for comment on this story.
Even though women are eligible for Medicaid during pregnancy and for a year after giving birth, Richardson says, people are not always clear on the law. Even more frustratingly, lack of insurance prevents people from getting an appointment in order to confirm they're pregnant. A new law attempts to fix this problem by giving women presumptive eligibility if they say they're pregnant.
But Richardson often doesn't see patients in time to mitigate the risk of losing a baby as much as possible. She says it's not unusual for her to see someone for the first time when they are close to giving birth.
"Out of 10 deliveries, maybe one or two will be no prenatal care or late prenatal care," she estimates. "You end up being behind the eight ball the whole pregnancy."
In addition to saving lives, Anita Henderson points out, treating more women before they become pregnant would save money.
" Investing in moms now will prevent long-term complications and prevent those million dollar NICU babies," she says.
And this isn't just a Mississippi problem.
" What you're seeing in Mississippi is potentially going to happen in many more states," says Sara Rosenbaum, health policy professor at George Washington University. Rosenbaum says infant mortality could rise as people lose Medicaid in coming years, "even under states that have tried to stabilize people's coverage."
Under the recently passed federal budget, millions of people are predicted to lose access to Medicaid, including those who gained it as part of federal expansion under the Affordable Care Act. One estimate puts the number of women of reproductive age who could lose the access they got through federal expansions as close to six million.
Rosenbaum stresses that this is a vulnerable population.
" The Affordable Care Act expansion to all low income adults was particularly important if you looked at reproductive health," she says, "because it can assure that low income women can address problems before pregnancy."
Unequal burden of grief
Kimber Holmes made it to nearly 37 weeks, when she delivered a healthy baby girl. Since the baby was growth restricted, she was still small — four pounds five ounces. She stayed in the NICU for a few days before she got to come home.
Some moms aren't so fortunate. Despite all the analysis of the causes of infant mortality in Mississippi, some losses are inexplicable.
Thirty-four-year-old Brittany Lampkin lost a baby a few years ago. She was nearly 35 weeks along when she delivered. Her daughter's heart stopped beating 15 minutes later.
"She was an active baby, five pounds, three ounces, came out kicking, screaming strong," says Lampkin, "and then was just gone."
Lampkin says even now, both she and the baby's father are still grieving.
"I went through the stage of blaming myself," she says. Only recently, after "a lot" of therapy, has she been able to talk about the loss without becoming crippled with grief. She blames the loss for interfering with her existing relationships with her older children. "I just couldn't stop sleeping," she says of the immediate aftermath of her daughter's death.
The baby's death certificate lists the cause of death as "unknown," and reads "the manner of death is natural." Lampkin says she went through a phase of blaming herself. "How is it natural if I did everything that I was supposed to have done?" she asks.
Lampkin says she still has so many questions, not only about why she lost her daughter but about why Black women are suffering disproportionately.
"What happened? How are we regressing in medicine?" she says. "You know, it's really scary."
Edited by Jane Greenhalgh & Carmel Wroth
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