Factors Driving Mississippi's Maternity Crisis

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Recent data from the 2025 WalletHub survey labels Mississippi the most dangerous state to have a baby. Each year, our state faces the highest maternal mortality rate in the nation. The Mississippi Maternal Mortality Review Committee recently reported over 70 pregnancy-related deaths, a staggering 83% of which were considered preventable. The primary causes—hypertensive disorders, infections, and cardiovascular disease—are often exacerbated by obesity, systemic discrimination, mental health challenges, and substance use. Data shows that 32% of these tragedies occurred in the Central Region, and 44% involved cesarean deliveries. Notably, nearly half of these mothers accessed prenatal care in their first trimester, yet Black mothers continue to face the highest risks of any ethnic group.

Infant mortality rates are equally devastating. With 9.7 deaths per 1,000 births, Mississippi loses over 300 babies annually before their first birthday. This crisis disproportionately impacts Black families, where the infant mortality rate recently surged by 24% to 15.2, even as rates for white infants declined. These deaths are frequently linked to low birth weight, preterm labor, and maternal health conditions like hypertension and diabetes. Over the last 12 years, preventable circumstances have claimed the lives of more than 3,500 infants in Mississippi.

The Underlying Factors

This crisis is fueled by a severe lack of maternity facilities and providers. In 53 of Mississippi’s 82 counties, there are no practicing OB-GYNs or hospitals offering labor and delivery services. For many rural families, this means driving 40 minutes or more for basic checkups, leading to dangerous delays in care. This shortage is expected to intensify as more rural units shutter. Currently, 70% of Mississippi’s 80 rural hospitals do not deliver babies, forcing large populations to seek care in distant urban hubs.

Provider scarcity is critical; only 373 obstetricians practice statewide. Mississippi has just one OB-GYN residency program at the University of Mississippi Medical Center, graduating only six doctors annually, few of whom remain in the state. Furthermore, high rates of obesity and chronic illness complicate outcomes, yet time-constrained physicians rarely offer evidence-based lifestyle interventions or referrals to community health programs, often relying instead on medical inductions and surgeries.

A Path Forward

State leadership has focused primarily on the new Obstetrics System of Care, which directs high-risk patients to specialized hospitals. While necessary, this does not address the root causes or the 53 maternity care deserts where access is non-existent. Mississippi for Moms advocates for the integration of certified nurse-midwives and freestanding birth centers to bridge these gaps. We believe saving lives requires supporting mothers before, during, and after pregnancy through early care, home visits, and community health workers.

Legislative action is essential. Currently, the Mississippi State Legislature has failed to pass laws that would incentivize midwife-led care. Specifically, we are calling for the abolition of the Collaborative Practice Agreement. This anti-competitive mandate requires nurse-midwives to pay "extortion fees" to physicians just to practice. Senator Hob Bryan, Chair of the Public Health and Welfare Committee, has repeatedly blocked progress on this issue to protect physician economic interests. We call on Senator Bryan and the Legislature to allow a vote during the 2027 session to exempt certified nurse-midwives from this unfair agreement. It is time to prioritize the health of Mississippi’s families over outdated mandates.

In Mississippi, it's rare to find a Certified Nurse Midwife (CNM) in Mississippi who is actually practicing midwifery care. This is due to a state law that requires the CNM to attain a collaboration agreement with a physician, who can charge her any amount of monthly fees he/she desires.   

Essentially, state legislators are providing protection to physicians who enjoy a direct financial and competitive benefit codified into Mississippi state law, known as a “shake down,” “extortion,” and “pay to play”. 

The law does not require meaningful cooperation between the physician and the CNM. Also, the physician is not required to interact with the CNM's patients at all. Further, there is no evidence these agreements improve care coordination, quality of care, health outcomes, patient safety, or consultations between providers. However, it ensures that physicians receive profits off the labor of nurse midwives while claiming it protects the patients' safety.

But the real reason for the law is that the Mississippi State Medical Association (MSMA),  a private lobbying organization representing the professional interests of physicians, is determined to maintain the status quo of physicians running our healthcare system, even though they are associated with the ongoing maternity care crisis in the State.  

The law applies exclusively to CNMs, who are licensed and insured advanced practice nurses regulated by the Mississippi Board of Nursing. In contrast, the state has refused to establish any professional standards, credentials, and regulations for midwives who are not nurses and who deliver babies in the home.  Further, it does not require that this unregulated group of professionals, most of whom have no college degree, attain a collaboration practice agreement with physicians in order to work. This is primarily because they are not viewed as competition for physicians, but CNMs are. 

Over the last several years, I have worked with legislators to pass legislation that would exclude CNMs from this law, and all bills died in the public health committee because of physicians' adverse influence.  MSMA writes big checks to state legislators, and their physician members dress up in their white coats and travel to the state capitol to influence legislators.

If you care about this issue, please contact Representative Sam Creekmore, Chairman of Public Health and Human Services and tell him to allow members to vote on House Bill (HB) 1576. Then call Senator Hob Bryant, Chairman of Public Health and Welfare, and tell him to allow members to vote on Senate Bill (SB) 2553: 

screekmore@house.ms.gov   (662) 534-9280 (W) 

hbryan@senate.ms.gov          (601) 359-2395  or   (662) 256-9601 (W)