• Posted March 7, 2025

Stillbirth Rates Are Highest in the South

Women in the U.S. South are three times more likely to lose a baby in late pregnancy than mothers in other regions, a new study reports.

The study, exclusively reported March 6 by NBC News, attributes the high rates of pregnancy loss in part to lack of Medicaid expansion in the South. 

"We are losing lives," lead author Venice Haynes, senior director of research and community engagement at United States of Care, the nonpartisan health care advocacy organization that did the study, said.

"At what point are we going to stand up and say enough is enough?"

The group also cited a large rural population and comparatively low levels of adequate prenatal care as contributors.

Using data from the U.S. Centers for Disease Control and Prevention (CDC), researchers found 6.05 fetal deaths at 20 weeks' or more of pregnancy for every 1,000 live births and fetal deaths. That compared with a rate of 5.25 for the rest of the U.S.

Since 1990, fetal deaths after 24 weeks of pregnancy have steadily declined, the CDC reported last year. Mississippi, Georgia and Arkansas were among the southern states with the highest rates.

The new research noted that the South also has higher rates of postpartum depression and fewer health workers devoted to the weeks immediately before and after birth.

Dr. Amanda Williams, interim chief medical officer of the March of Dimes, told NBC News she's not optimistic about the outlook for mothers and babies in the South.

Congress is weighing drastic cuts to Medicaid, which insures low-income Americans. It covers 4 in 10 births, with especially high rates in many Southern states.

What's more, strict abortion bans in the region have led many obstetricians to leave and are dissuading some young doctors from working there.

"We anticipate it will get worse," Williams said. "This is an area of the country that needs more investment, more support, more providers, not less."

Stillbirth is when a fetus dies in utero after 20 weeks of pregnancy. Often, it's unclear why a pregnancy is lost in late stages, though infection or a genetic condition in the fetus are among the causes.

Among the underlying factors for the South's high rate of stillbirth: More than half of the Black population lives in the region, and Black women have higher rates of high blood pressure, stress and diabetes. All can put a pregnancy at risk. 

An analysis done for NBC News by the March of Dimes found that the South has the highest percentage of uninsured women between 19 and 54 years of age. The region also has the highest percentage of women living in areas with little to no access to prenatal care.

Natalie Davis, CEO of United States of Care, said that even though the South stands out, rates of pregnancy and post-birth complications across the U.S. are higher than in other developed nations.

For example, the maternal death rate in the U.S. is more than four times that of the U.K., Australia or Germany, according to the Commonwealth Fund.

The U.S. also has fewer midwives and OB-GYNs than most other developed countries -- 16 per 1,000 live births compared with 43 in France and 35 in the Netherlands.

"Our message to every governor is that no state's doing well at this," Davis told NBC News. "Every state needs to focus on this."

Some promising efforts are already underway.

Researchers are developing AI tools to predict which women are at risk of premature labor, and programs in Alabama and Florida ferry expectant moms to their prenatal appointments.

A program in 40 states connects low-income, first-time moms-to-be with nurses who educate them about signs of early labor and dangerous pregnancy complications like preeclampsia.

Dr. Cornelia Graves, a maternal-fetal medicine specialist in Nashville, Tenn., said the new findings were not surprising. Poor pregnancy outcomes in the South will persist because of high rates of underlying diseases, she said.

"We know that women who are unhealthy give birth to unhealthy babies who then become unhealthy children who then become unhealthy mothers," Graves said. "It is a continual cycle."

More information

The U.S. Centers for Disease Control and Prevention has more about late-term pregnancy loss, or stillbirth.

SOURCE: NBC News, March 6, 2025