Losing a baby late in pregnancy is more common in the South than in other regions of the United States, according to a new report given exclusively to NBC News.
The difference is dramatic: Compared with other parts of the country, the odds of having a high rate of late-stage pregnancy loss are nearly three times greater in Southern states.
The lack of Medicaid expansion in the South, along with the region’s large rural population and relatively low levels of adequate prenatal care, contributes to the high rates of fetal loss in the second half of pregnancy, according to the report by, a nonpartisan health care advocacy organization.
“We are losing lives,” said Venice Haynes, lead author of the report. “At what point are we going to stand up and say enough is enough?”
The new analysis found that the mean fetal mortality rate for 16 Southern states in 2023 was 6.05 fetal deaths at 20 weeks’ gestation or more per 1,000 live births and fetal deaths, compared with a mean fetal mortality rate of 5.25 for all other states. The analysis is based on provisional data from the .
Fetal deaths after 24 weeks’ gestation have been declining steadily since 1990, according to a CDC report last year. She South — including Mississippi, Georgia and Arkansas — had the highest rates.
The new report found that the South also has higher rates of postpartum depression and fewer perinatal health workers compared to other regions in the United States.
The new data is “a very significant finding,” said Dr. Amanda Williams, interim chief medical officer of the, which has found that the South also has the highest rates of preterm births in the country.
Williams said she isn’t optimistic about the outlook for mothers and babies in the South.
. Nationally Medicaid covers 41% of births, with in many Southern states. In addition, nearly every Southern state has a strict abortion ban, and research suggests such laws are and discouraging 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.”
‘Your body remembers’
of late stage pregnancy loss — or stillbirths — including infection or a fetus’ genetic condition. Often the cause is never known.
One reason for the high stillbirth rate in the South is that Black women experience fetal loss at the rate of other groups. Black women have higher rates of underlying diseases such as and, which can put a pregnancy at risk. More than half of the , according to a recent Pew Research report.
which can affect a pregnancy.
Kim Smith, a Black woman who lives in South Carolina, developed a severe type of preeclampsia called HELLP syndrome, and when she was five months pregnant she lost her daughter, Lauren Kelly. Some studies have shown a and preeclampsia, a condition in which a pregnant woman develops dangerously high blood pressure.
Smith, 42, was raised in Greenville, North Carolina, by a single mother.
“My mother’s a minister, my aunts are ministers, my uncles are bishops. We grew up in a very loving and faithful family,” she said.
But Smith’s family was poor and lived in a neighborhood with frequent shootings and high rates of drug abuse. Racial tensions were high: She remembers as a child hearing people making racist comments, and the Ku Klux Klan sometimes marched near her neighborhood.
“I recall as a child hearing gunshots and hearing police sirens and ambulance sirens on a regular basis,” she said.
Smith married and moved to Irmo, South Carolina. When she became pregnant with her daughter in 2011, she was an administrator at federally qualified health care centers in underprivileged neighborhoods with poor health outcomes. It was difficult work as she observed the impact of poverty and racism on the community.
“That level of stress is not unique to me. It was just kind of the culture,” she said.
While she worked hard and relied on her faith and her family’s love, she said, it wasn’t always easy.
“When you experience life, what do you do? You make the best of it, and you push through. And we give ourselves a badge for that. But at the end of the day, our bodies remember the stress,” she said. “Your body remembers what you experience.”
After she lost her baby, Smith changed jobs and took other steps to reduce stress in her life. She went on to have three sons — all healthy pregnancies — and is now a health tech entrepreneur.
‘No state’s doing well’
In many ways, the South is a perfect storm for bad outcomes for pregnant women, according to an analysis done for NBC News by the at the March of Dimes.
Compared with other parts of the country, the South has the highest percentage of uninsured women ages 19-54 and the highest percentage of women that age living in, where access to maternity care is limited or absent, according to the March of Dimes. The region also has the highest percentage of births in which the mothers received inadequate prenatal care. Even though the South stands out, the entire United States suffers from high rates of pregnancy and postpartum complications, said Natalie Davis, CEO of United States of Care.
The maternal mortality rate in the United States is higher than in other developed countries — more than four times the rates in the United Kingdom, Australia or Germany, according to the The group has also found that the United States has a low supply of midwives and OB-GYNs compared with most other developed countries — 16 per 1,000 live births compared with, for example, 35 in the Netherlands and 43 in France per 1,000 live births.
“Our message to every governor is that no state’s doing well at this,” she said. “Every state needs to focus on this.”
Stopping a ‘continual cycle’ in the South
There are high-tech and low-tech approaches to addressing pregnancy complications like stillbirth.
Researchers are developing to predict which pregnant women are likely to go into premature labor. Programs such as in Alabama and in Florida provide rides for expectant mothers to get to their prenatal appointments.
“They’re missing their appointments because bus connections are too long or there isn’t even a bus that goes to their neighborhood,” said Dr. Catherine Tom, president of Green Cars for Kids. Providing the rides so the women can get care “is so simple — it’s not rocket science.”
Another program,, connects low-income first-time mothers-to-be in 40 states with nurses. Sharon Sprinkle, the director of the program in several Southern states, said her teams have prevented many “near misses” by educating their clients about signs of early labor, preeclampsia and other pregnancy complications.
Too often, pregnant women report back that their concerns were “minimized or totally dismissed, when, in fact, if they were listened to, the outcome would have been better,” she said.
Nurses in the program teach clients to “unleash their power and be comfortable having conversations with physicians to say: ‘This is what’s going on. I need you to listen. And if you won’t listen, find somebody else in your office who will listen.’”
Sprinkle, a registered nurse who has worked in infant and maternity care in the South for decades, said she isn’t surprised by the new findings about stillbirths. Neither is Dr. Cornelia Graves, a maternal-fetal medicine specialist and professor at the University of Tennessee Health Science Center.
Graves said poor pregnancy outcomes in the South will continue because of of underlying diseases such as diabetes, obesity and.
“We know that women who are unhealthy give birth to unhealthy babies who then become unhealthy children who then become unhealthy mothers,” she said. “It is a continual cycle.”
