A new report reveals just how dangerous it can be to give birth in certain parts of the United States.
This study, published by the Birth Injury Lawyers, ranks all 50 states using data from the CDC, National Vital Statistics System, and other federal sources. States were scored based on infant and maternal mortality, birth-related costs, access to care, and early childcare expenses.
The results show a stark divide, where geography can mean the difference between a safe delivery and a preventable tragedy.
North Dakota came in first, earning the highest score overall. The state has the nation’s lowest infant mortality rate (2.77 deaths per 1,000 births) and relatively low maternal deaths. Childbirth and childcare costs also remained more manageable than in much of the country.
But at the bottom of the list sits Mississippi, where systemic issues continue to put mothers and infants at risk. According to the data, the state records 9.39 infant deaths per 1,000 births, more than triple North Dakota’s rate, and a maternal mortality rate of 48.1 per 100,000. Mississippi also has among the highest rates of premature and low-weight births in the nation.
Dr. Michelle Owens, who chairs Mississippi’s Maternal Mortality Review Committee, says the burden of care is falling on hospitals that are already stretched thin.
“A substantial portion of this care is being shouldered by smaller hospitals with limited resources, many of whom are facing possible closure,” Owens said in a 2023 review of the state’s maternal health system.
In areas with limited access, the consequences are severe. “The farther a woman is from a delivery center, the more likely she is to give birth in a facility unequipped for emergencies—or to deliver in transit,” said maternal health researcher Dr. Katy Kozhimannil, speaking in a separate interview on rural care. “That delay can be fatal in a hemorrhage or preeclampsia situation.”
These closures aren’t hypothetical. In recent years, Mississippi has seen a sharp decline in the number of hospitals with labor and delivery units, especially in rural counties. Many expecting mothers now face hours-long drives for basic prenatal care.
The situation isn’t unique to Mississippi. South Carolina and Tennessee, which ranked 49th and 48th, respectively, also report high maternal and infant mortality rates. In Tennessee, maternal deaths sit at 41.7 per 100,000 live births, and annual childcare costs approach $9,000 per child. Researchers warn these numbers don’t exist in a vacuum; they’re the result of years of underinvestment and fragmented healthcare coverage.
The overturning of Roe v. Wade in 2022 cast an even harsher spotlight on these disparities. Many of the lowest-ranking states also have the strictest abortion laws and fewest protections for maternal health.
In Mississippi, abortion is banned in nearly all cases, and Medicaid does not cover postpartum care beyond 60 days unless extended through waivers. Meanwhile, access to OB-GYNs is vanishing from many rural areas.
By contrast, top-ranking states like Utah, South Dakota, and Massachusetts demonstrate how access, affordability, and birth-related infrastructure intersect. Each of these states offers extended postpartum coverage, more rural maternity access, and lower-than-average maternal mortality rates.
The report doesn’t make policy recommendations, but the data paints a clear picture. Childbirth in the U.S. is not inherently dangerous, but in certain states, it’s increasingly unsafe.
