Nearly Half of Mississippi Counties Are Maternity Care Deserts

Mississippi remains one of the worst states in the country for pregnant women, and a new report puts hard numbers to what families in the Delta and rural communities have long known: they are largely on their own.

The March of Dimes released its latest maternity care deserts report this week, finding that nearly half of Mississippi's counties have no obstetric clinician and no birthing facility. Those aren't just geographic gaps — they represent roughly 107,000 Mississippians and account for about 7,000 births every year with no local care available.

The national picture is bad: one in three counties across the U.S. qualifies as a maternity care desert. Mississippi is worse than the national average. "The U.S. is still one of the most dangerous developed countries in which to give birth," said Honour McDaniel Hill, director of Infant and Maternal Health Initiatives for the March of Dimes. "Two women die every day in this country from pregnancy-related causes."

Mississippi consistently ranks at or near the top of national maternal and infant mortality figures. For women in the Delta specifically, that isn't a statistic — it's a reality Dr. Lakeisha Richardson navigates every day.

Richardson grew up in Indianola and now practices in Greenville, one of just a handful of OB-GYNs working in the region. She returned after completing her residency and says others she knows who serve rural Mississippi think of it the same way — it's home. But she's clear-eyed about what it takes to keep physicians coming back.

"The biggest factor that doctors look at when they're choosing where to live is where they want to raise their families," Richardson said. "We all want to serve and come back and help others, but we also have to take into consideration our own children and their education and their culture and experiences."

Building a sustainable rural healthcare workforce, she argues, requires more than pipeline programs — though those matter too. Reserving spots at the University of Mississippi Medical Center for students who commit to rural service would help. So would investing in the infrastructure that makes communities livable.

For patients already in the system, the distances are brutal. Women in Richardson's practice regularly drive more than an hour each way for care. And they typically arrive at their first prenatal appointment in worse health than patients in areas with higher insurance rates. One in five of her patients carries a chronic condition — diabetes, hypertension — that has gone unmanaged for years because they had no coverage until pregnancy made them eligible for Medicaid.

Mississippi's Medicaid program draws one of the stingiest eligibility lines in the country. Outside of pregnancy, a family of three must earn less than $6,000 a year to qualify. Pregnancy temporarily relaxes those rules, opening eligibility up to about $54,000 for a family of three — but that coverage evaporates after delivery.

If Mississippi expanded Medicaid as 41 other states and D.C. have done, roughly 123,000 uninsured adults would gain access to coverage. The March of Dimes identifies expansion as one of the clearest paths to improving maternal outcomes. Mississippi lawmakers came closer than ever to passing it in 2024 before the proposal collapsed along partisan lines.

The insurance gap shows up everywhere. Ninety-five percent of Mississippi counties have uninsured rates above the national average. In states that haven't expanded Medicaid, one in three women on pregnancy Medicaid had no coverage at all before they conceived — meaning chronic conditions go untreated until a pregnancy forces them into the system, often too late.

Untreated hypertension and diabetes increase the risk of preeclampsia, stillbirth, and preterm birth — a category Mississippi already leads the nation in.

For women who can't reach care in time, the consequences are severe and sometimes fatal. Mississippi Today has reported on women dying before they could make it to a hospital. Nurse midwives could help close that gap, but Mississippi law requires them to pay supervising physicians to practice — a financial arrangement critics describe as exploitative and unworkable in a state with a shortage of providers. A federal lawsuit over the policy was filed earlier this year; legislation to fix it died in committee this spring.

Richardson carries the load of a system stretched past capacity. National data shows the average OB-GYN delivers about one baby every three days. Richardson routinely delivers multiple in a single day — sometimes five.

"It can be exhausting," she said.