Mississippi has declared a public health emergency after new data showed the state’s infant mortality rate climbed to its highest level in more than a decade, intensifying scrutiny of widening racial disparities and the fragility of maternal-and-child health services. The Mississippi Department of Health reports 9.7 infant deaths per 1,000 live births in 2024—nearly double the most recent U.S. average of 5.6 per 1,000. Since 2014, more than 3,500 Mississippi infants have died before turning one. “Every single infant loss represents a family devastated, a community impacted, and a future cut short,” State Health Officer Dr. Dan Edney said. “We cannot and will not accept these numbers as our reality.”
The declaration is unusual for an infant mortality crisis and is designed to accelerate a statewide response. “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.” The move also places Mississippi’s experience within a national context: even cities with robust health systems continue to see stark racial gaps. Boston’s latest data show 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 rate falling below the national average. Public health leaders say such patterns reflect structural inequities that shape pregnancy and early childhood long before delivery.
Mississippi’s leading causes of infant death include congenital malformations, prematurity, low birthweight, and Sudden Infant Death Syndrome. The burden is not evenly shared: Black infants in the state are more than twice as likely as White infants to die before their first birthday, and recent state figures indicate the gap has widened. Clinicians caution that many drivers lie outside the hospital. “Healthy babies come from healthy moms,” said Dr. Rebekah Gee, former Louisiana health secretary and now CEO of Nest Health. “If women can’t get continuous healthcare before, during, and after pregnancy, it is no surprise their babies are dying at higher rates.” Neonatologist Dr. Stephen Patrick of Emory University added that what happens in neonatal intensive care often mirrors challenges long in the making—poverty, limited access to care, unstable housing, and transportation barriers.
Officials say the emergency order allows agencies to move faster to close gaps in care. The immediate plan includes expanding prenatal services in counties with no obstetric providers, creating a regionalized obstetric system to improve emergency transfers, and strengthening home-visiting and community health worker programs that support families during pregnancy and the first year of life. “Improving maternal health is the best way to reduce infant mortality,” Dr. Edney said. Dr. Morgan McDonald, National Director for Population Health at the Milbank Memorial Fund, called the declaration a needed signal: “It should draw our attention to a problem that is tragic and preventable,” she said, praising the focus on concrete solutions that honor families affected by loss.
The response, however, collides with uncertainty around federal data and prevention programs. Mississippi has relied on the CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS) to track behaviors before, during, and after pregnancy and to monitor infant outcomes. PRAMS has been targeted for elimination, and program staff were laid off in June. Cuts to CDC Safe Motherhood initiatives could also weaken maternal mortality surveillance, hospital quality collaboratives, and infant safe-sleep education. “Without robust data, we are flying blind,” Dr. Patrick said. A former CDC Division of Reproductive Health staffer affected by recent reductions called it “willful ignorance” to cut maternal and child health programs during parallel crises in maternal and infant mortality. Polling suggests most Americans favor keeping these systems: the Emory-Rollins National Child Policy Poll found 65% view PRAMS as important, and only 16% supported ending federal funding for the long-running “Safe to Sleep” campaign.
Coverage policy will shape outcomes as much as clinical strategy. Medicaid finances nearly six in ten births in Mississippi, compared with roughly four in ten nationally. The state extended postpartum Medicaid coverage from two months to a full year in 2023, but it has not expanded Medicaid under the Affordable Care Act, leaving many low-income women uninsured before or between pregnancies. Pending federal policy changes could further reshape coverage. Provisions in a reconciliation package—described by supporters as the “Big Beautiful Bill”—would add work requirements and more frequent eligibility checks for many Medicaid enrollees. KFF analysts estimate such changes could raise Mississippi’s uninsured rate by 1 to 2 percentage points, potentially leaving 20,000 to 40,000 more residents without coverage. Public health experts warn that this could destabilize rural hospitals dependent on Medicaid reimbursement, further restricting access to prenatal and delivery services in regions already described as obstetric deserts.
Evidence from other states points to what sustained coverage can deliver. After Medicaid expansion, Arkansas reported a 29% reduction in Black infant mortality over five years; Louisiana documented earlier prenatal care and fewer preterm births following its 2016 expansion; and Colorado saw declines in infant mortality, particularly in rural areas, as more women gained continuous coverage before, during, and after pregnancy. Nationally, one analysis found a 50% greater reduction in infant mortality in expansion states than in non-expansion states, with the steepest gains among Black infants. Forty states and the District of Columbia have expanded Medicaid; Mississippi remains one of ten holdouts.
For more than a century, the United States has treated infant mortality as a barometer of societal well-being. W.E.B. Du Bois argued that high infant death rates among Black families reflected inequities in living conditions rather than innate differences. Mississippi’s emergency, alongside Boston’s persistent gaps, suggests those inequities remain entrenched. State leaders say the declaration is intended to galvanize coordinated action across hospitals, agencies, and community partners—backed by data, stable funding, and policies that ensure continuous coverage for women of childbearing age.
For readers asking what happened, why it matters, and what’s next: Mississippi elevated infant mortality to an emergency because the rate has surged well above the national average, and racial disparities are widening. It matters because infant mortality encapsulates maternal health, economic stability, and access to care; without reliable data systems and steady coverage, targeted interventions are harder to deliver and sustain. What comes next will be measured by the speed and reach of prenatal expansion, the effectiveness of a regional obstetric network, the resilience of home-visiting and community support, and whether federal and state policies reinforce or erode the coverage and hospital capacity on which healthy pregnancies—and healthy babies—depend.
