For yet another year, Mississippi’s health system performance has been deemed the worst in the country.

The comprehensive annual report from the Commonwealth Fund, a private health care research foundation, ranked Mississippi as one of the worst states for a number of health categories, including reproductive and women’s health and racial health equity, based on the most recent available data from 2021.

The fund has consistently found stark health disparities in Mississippi and ranked the state near the bottom or last for a number of measures used to evaluate health system performance.

The results hardly come as a shock to Dr. Daniel Edney, Mississippi’s state health officer. As the leader of the state health department, he’s intimately familiar with the health care challenges Mississippians are up against.

“If we had 60 states, we’d be 60th in health,” he said. “Someone has to be 50th, but it doesn’t have to be us.”

Within Mississippi’s healthcare system ranking, some of the worst categories are the state’s preterm birth rate, infant mortality rate, breast and cervical cancer deaths, and premature deaths.

The latter is a category that worsened since last year’s report, and the fund connects the rise, which has lowered the nation’s average life expectancy, to the COVID-19 pandemic. People of color experienced the steepest declines. Mississippi’s avoidable death rate surged more than 35 percent between 2019 and 2021.

The scorecard for the first time included measures to evaluate state reproductive care and women’s health performance, and the results showed that throughout the country, women struggled to receive adequate health care. Those difficulties were especially pronounced in Mississippi. The only state with worse outcomes was New Mexico.

Mortality rates for women of reproductive age generally increased across all states, including Mississippi, especially among American Indian/Alaska Native and Black women. Mississippi’s maternal mortality rate between 2019 and 2021 was the highest, with 50.3 deaths per 100,000 live births.

The report said that many of the deaths could be attributed to inequitable access to comprehensive health care and racial and ethnic disparities in quality of care, even at the same hospitals. Growing “maternity care deserts” and lack of insurance coverage contributes to the problem.

Furthermore, Mississippi ranked at the bottom when considering health care access and affordability.

Edney has long stressed that maternal and infant mortality is one of the biggest health care challenges the state is facing.

“It’s critically important that we… take the fact that we have the lowest life expectancy, the highest infant death rate, and one of the highest maternal death rates in the country very seriously and stop accepting it as our lot in life,” Edney said. “We must be willing to do whatever it takes to get us off the bottom in health.”

According to experts at the Commonwealth Fund, postpartum care is critical to improving reproductive health outcomes. Mississippi extended postpartum Medicaid coverage to one year this legislative session.

But experts say it’ll take more than just one policy change to turn the state’s health care crisis around.

The state health department, in conjunction with the Mississippi Division of Medicaid, has recently created a program that sends nurses to the homes of mothers experiencing high-risk pregnancies. While the Healthy Moms, Healthy Babies program currently serves about 700 people across the state, Edney said it’s not nearly enough.

However, Edney previously told Mississippi Today he didn’t get the state funding this year to hire more nurses for the program.

The report also showed that 22.4 percent of women in Mississippi did not receive prenatal care in the first trimester. An investigation by Mississippi Today found that the state Division of Medicaid, the largest funder of births in the state, does not track when expecting mothers go to their first prenatal appointment.

Many of the states with some of the worst health outcomes were those without Medicaid expansion, including Mississippi. Republican state leaders have remained steadfast in their opposition to the policy change.

And now, as the Magnolia State starts to feel the compounded effects of the reversal of abortion rights, a crumbling health care system and the unwinding of pandemic-era policies that extended insurance coverage, the situation may be poised to worsen.