Losing a baby late in pregnancy is significantly more common in the South than in other regions of the United States, according to a new report shared exclusively with NBC News.
The disparity is striking: Southern states have nearly three times the likelihood of experiencing high rates of late-stage pregnancy loss compared to other parts of the country.
A report from the nonpartisan healthcare advocacy group United States of Care points to key factors contributing to this trend. These include the lack of Medicaid expansion, a large rural population, and inadequate access to prenatal care.
The report found that in 2023, the average fetal mortality rate for 16 Southern states was 6.05 fetal deaths per 1,000 live births and fetal deaths at 20 weeks’ gestation or later. In contrast, the average rate for all other states was 5.25. The data is based on provisional figures from the Centers for Disease Control and Prevention (CDC).
While fetal mortality after 24 weeks has steadily declined since 1990, the South continues to record the highest rates, particularly in states like Mississippi, Georgia, and Arkansas.
In addition to late pregnancy loss, the region also has higher postpartum depression rates and fewer perinatal healthcare providers than other areas in the country.
“This is a very significant finding,” said Dr. Amanda Williams, interim chief medical officer at the March of Dimes. The organization has also identified the South as having the highest preterm birth rates in the U.S.
Williams is concerned about the future, given ongoing discussions in Congress about potential Medicaid cuts. Medicaid currently covers 41% of births nationwide, with an even higher reliance in many Southern states. Furthermore, most states in the South have strict abortion bans, which research suggests are leading to fewer obstetricians practicing in the region and discouraging young doctors from working there.
“We anticipate it will get worse,” Williams warned. “This part of the country needs more investment, more support, and more healthcare providers—not fewer.”
There are many reasons for late pregnancy loss, including infections and genetic conditions. In some cases, the cause remains unknown. However, one of the most alarming findings in the report is the racial disparity in stillbirth rates.
Black women experience fetal loss at more than twice the rate of other racial groups. Contributing factors include higher rates of hypertension, diabetes, and chronic stress, which can all increase pregnancy risks. Additionally, over half of the Black population in the U.S. lives in the South, according to Pew Research data.
Kim Smith, a Black woman from South Carolina, knows this reality firsthand. She developed a severe form of preeclampsia called HELLP syndrome and lost her daughter, Lauren Kelly, when she was five months pregnant.
Smith grew up in a poor neighborhood in Greenville, North Carolina, where she frequently heard gunshots and sirens. She later moved to Irmo, South Carolina, and worked in underprivileged communities as a healthcare administrator.
“The stress level isn’t unique to me,” Smith said. “It’s just part of the culture.”
Though she leaned on her faith and family, the impact of chronic stress took a toll. “We push through and give ourselves a badge of honor for it. But at the end of the day, our bodies remember the stress,” she said.
After her loss, Smith made lifestyle changes to reduce stress and eventually had three healthy sons. Today, she is a health tech entrepreneur.
The South has the highest percentage of uninsured women aged 19 to 54 and the most maternity care deserts—areas with little to no access to prenatal care. These issues, combined with high rates of inadequate prenatal care, create an environment where maternal and infant health suffers.
But the problem isn’t limited to the South. The entire U.S. has high maternal mortality rates compared to other developed nations. According to the Commonwealth Fund, the U.S. maternal death rate is more than four times higher than in the U.K., Australia, or Germany. Additionally, the U.S. has a lower number of midwives and OB-GYNs, with only 16 providers per 1,000 live births compared to 35 in the Netherlands and 43 in France.
“No state is doing well at this,” said Natalie Davis, CEO of United States of Care. “Every state needs to focus on maternal health.”
Addressing pregnancy complications like stillbirth requires both high-tech and low-tech approaches.
Researchers are developing artificial intelligence tools to predict which women are at risk for premature labor. At the same time, simple solutions—such as providing transportation to medical appointments—can make a big difference. Programs like Kid One in Alabama and Green Cars for Kids in Florida offer free rides to pregnant
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