Mississippi declares public health emergency over rising infant deaths

Mississippi health officials have declared a public health emergency after releasing data showing the state's infant mortality rate has risen to its highest level in more than a decade.

In Mississippi, 9.7 infants died for every 1,000 live births in 2024, nearly double the most recent national average of 5.6 deaths per 1,000, according to the state Department of Health. Since 2014, more than 3,500 Mississippi infants have died before their first birthday.

The decision to declare a public health emergency places Mississippi's struggle within a wider national story. Here's what to know.

Even in cities with strong healthcare systems, such as Boston, Black infants continue to die at far higher rates than their White peers.

In Boston, the city's most recent report showed Black infants dying at more than twice the rate of the overall population and triple the rate of White infants, despite the city's overall infant mortality rate falling below the national average. Public health experts say both examples underscore the limits of focusing only on individual behavior or clinical care when structural inequities are key drivers of infant deaths.

"Every single infant loss represents a family devastated, a community impacted, and a future cut short," said State Health Officer Dr. Dan Edney, who announced the Mississippi declaration. "We cannot and will not accept these numbers as our reality."

The leading causes of infant death in Mississippi include congenital malformations, premature birth, low birthweight, and Sudden Infant Death Syndrome.

Disparities remain stark — Black infants in Mississippi are more than twice as likely as White infants to die before their first birthday, and recent state data show those racial gaps have widened.

Despite growing concerns, declaring a public health emergency for infant mortality is unusual.

"This is a novel and necessary step," said Dr. Michael Warren, Chief Medical and Health Officer at March of Dimes. "It elevates infant mortality to the level of urgent crisis response, which it truly is."

State officials said the declaration allows them to move more quickly to address gaps in care.

Their plan includes expanding prenatal services in counties without obstetric providers, creating an obstetric system of care to regionalize services and improve emergency transfers, and strengthening home visiting and community health worker programs.

"Improving maternal health is the best way to reduce infant mortality," Dr. Edney said.

Dr. Morgan McDonald, National Director for Population Health at New York-based nonprofit Milbank Memorial Fund, said the declaration "should draw our attention to a problem that is tragic and preventable."

She added: "We applaud Dr. Edney and his public health team for raising the alarm in a way that honors the families who have suffered this tragedy and also focuses attention on concrete solutions."

Experts caution, however, that individual and clinical interventions alone cannot solve the problem.

"Healthy babies come from healthy moms," said Dr. Rebekah Gee, former Louisiana health secretary and now CEO of Nest Health, a New Orleans-based company which provides in-home whole-family care, with a focus on those covered by Medicaid. "If women can't get continuous healthcare before, during, and after pregnancy, it is no surprise their babies are dying at higher rates."

Dr. Stephen Patrick, a neonatologist and professor at Emory University, added that treating infant deaths as a series of isolated medical cases misses the broader reality. "So much of what we see in neonatal intensive care units reflects challenges that moms face long before delivery — poverty, access to healthcare, housing, even transportation," Patrick said.

Federal funding cuts are also complicating the state's response to the crisis.

The Pregnancy Risk Assessment Monitoring System (PRAMS), a Centers for Disease Control and Prevention program that collects state-specific data on maternal and infant health, has been targeted for elimination. CDC staffers who carried out the survey established nearly 40 years ago to improve maternal and infant health outcomes were fired in June.

Mississippi relied PRAMS to track maternal behaviors before, during, and after pregnancy, and to monitor infant outcomes. Many of CDC's Safe Motherhood initiatives are also in jeopardy of losing funding, which would affect maternal mortality surveillance, infant sleep safety programs, and hospital-based collaboratives designed to standardize care.

"Without robust data, we are flying blind," Patrick said.

Analysts also warn that such cuts could limit the state's ability to detect trends such as unsafe sleep practices or gaps in postpartum care.

"It's willful ignorance to cut vital maternal and child health programs when we have public health crises of both maternal mortality and infant mortality in this country," said a former CDC Division of Reproductive Health staffer who lost their job in a recent reduction in force. "For many people, it's downright dangerous to be pregnant in the U.S. in the 21st century. And that is shameful."

Polling suggests most Americans support maintaining these programs. According to the Emory-Rollins National Child Policy Poll, 65% of Americans say PRAMS is important for improving outcomes for mothers and infants, while fewer than one in ten believe it is not needed.

Similarly, only 16% supported ending federal funding for the long-running "Safe to Sleep" campaign, which educated parents about reducing risks of sleep-related infant deaths.

Medicaid plays an outsized role in Mississippi, financing almost 6 in 10 of births in the state, compared to about 4 in 10 nationally, according a KFF Health News analysis of government data.

In 2023, the state extended postpartum Medicaid coverage from two months to a full year. But Mississippi has not expanded Medicaid under the Affordable Care Act, leaving many low-income women uninsured before or between pregnancies.

Meanwhile, Congressional proposals could reshape Medicaid coverage, including the reconciliation bill already passed by Congress which would require many enrollees in the government health care program to prove they are either working, volunteering or in school to receive coverage.

Dr. McDonald noted that since Mississippi is not a Medicaid expansion state, it would be subject to most of the work requirement and frequent redetermination provisions of President Trump's so-called "Big Beautiful Bill."

KFF analysts estimate that bill's funding caps and work requirements could raise Mississippi's uninsured rate by 1 to 2%, potentially leaving 20,000 to 40,000 more residents without coverage.

Public health experts say such policies could destabilize rural hospitals that rely heavily on Medicaid reimbursement, in turn limiting access to prenatal and delivery services in regions already described as "OB deserts."

Other states that expanded Medicaid under the Affordable Care Act have seen measurable improvements in infant health.

Arkansas, for example, reported a 29% reduction in Black infant mortality in the five years following expansion. In Louisiana, which expanded Medicaid in 2016, researchers documented increases in early prenatal care and decreases in premature births. Colorado also saw declines in infant mortality, particularly in rural areas, as more women gained access to continuous coverage before, during, and after pregnancy.

Nationally, one analysis found a 50% greater reduction in infant mortality in expansion states compared to those that did not expand Medicaid, with the steepest gains among Black infants. Today, 40 states and the District of Columbia have expanded Medicaid, while Mississippi remains one of 10 holdouts.

The U.S. has long treated infant mortality as a measure of societal health. More than a century ago, sociologist W.E.B. Du Bois argued that high rates of infant deaths among Black families reflected inequities in living conditions rather than innate differences.

Mississippi's emergency declaration and Boston's persistent disparities suggest those inequities remain deeply entrenched. State officials said the declaration is intended to galvanize coordinated action across hospitals, state agencies, and community groups.

"It will take all of us working together to give every child the chance to live, thrive, and celebrate their first birthday," Dr. Edney said.