Mississippi once again has the country’s highest rate of fetal death, according to data released by the Centers for Disease Control and Prevention last week.

The report examined the nearly 21,000 deaths of fetuses in utero that occurred after 20 weeks’ gestation – also called stillbirths – in the United States in 2020. The overall national rate was 5.7 such deaths per 1,000 live births, about the same as it was the year before.

But in Mississippi, the rate was nearly double that, at 10.6. That was an increase from 2019, when the state also led the country with a rate of 9.4.

The report didn’t include state-specific analysis of the causes of the stillbirths. Nationally, the most commonly reported cause was “unspecified.” Mississippi maternal health advocates say the state’s inadequate access to basic health care – exacerbated by one of the country’s highest rates of uninsurance and state leaders’ decision not to expand Medicaid – explain the data and other grim statistics.

As state leaders passed abortion restrictions in recent years, they claimed they were making Mississippi “the safest state in the nation for an unborn child.” But Mississippi has long claimed the country’s highest infant mortality rate and a maternal mortality rate about twice the national figure. With abortion now banned in all but rare circumstances, the CDC report highlights yet another of the risks facing pregnant Mississippians.

Black mothers and babies in Mississippi are far likelier to die than their white counterparts, and likelier to experience adverse outcomes like premature birth and low birthweight.

To Getty Israel, the CEO and founder of the Jackson clinic Sisters in Birth, these statistics all tell the same story: Mississippians are not healthy, and Black women in the state are particularly vulnerable to conditions that endanger their pregnancies. Most of the patients her clinic serves are Black women without insurance.

“There are so many Black women who don’t even have primary care,” she said. “The only time a poor woman, a low-income woman in our state is almost guaranteed to get access to insurance and a provider is when she’s pregnant. But she’s already unhealthy.”

About 60% of births in Mississippi are covered by Medicaid. House Speaker Philip Gunn, R-Clinton, killed a proposal to extend postpartum Medicaid coverage from 60 days to 12 months during the most recent legislative session.

But postpartum coverage wouldn’t solve many of Mississippi’s awful maternal and infant health outcomes, Israel pointed out. Women of reproductive age who qualify for Medicaid only when they are pregnant may have gone years without seeing a provider, increasing their risk of conditions like obesity and high blood pressure. Those conditions in turn increase their risk of premature birth, which often requires expensive and stressful hospital stays for newborns.

“You want to get these women healthy before they become pregnant,” Israel said. “At the end of the day, state of Mississippi taxpayers are paying for these premature births. We are paying for these million-dollar babies that are in the NICU that could have been avoided. And most premature births can be avoided.”

The CDC report on fetal deaths did not provide a breakdown of the rate by race for each state, but showed that Black mothers in the U.S. had a fetal mortality rate of 10.34 in 2020, compared to 4.73 for white mothers.

Because small numbers of fetal deaths in some states can make the yearly data unreliable, the report also compiled the rate of fetal death after 24 weeks’ gestation for 2018 through 2020. Mississippi topped that ranking as well, with a rate of 6.57. There were 722 such deaths during the three-year period.

Induced terminations are not included in the count.

Mississippi’s new state health officer Dr. Daniel P. Edney said maternal and infant health will be a priority.

“I refuse to believe that our mothers and babies are just fated to continue to die at the highest rate in the nation,” he said at a press conference on Thursday. “We’re talking about white mothers and Black mothers. We’re talking about white babies and Black babies… What’s absolutely egregious is the fact that our Black mothers are dying at three times the rate of the rest of the nation.”

The COVID-19 pandemic may have played a role in the uptick in fetal deaths in Mississippi. Then-state health officer Dr. Thomas Dobbs said in Sept. 2021 that the state had recorded 72 fetal deaths in unvaccinated pregnant women who were infected with COVID-19, a figure “twice the background rate of what would be expected.”

Just over half of Mississippians have been fully vaccinated against COVID-19, one of the lowest rates in the country.

Last year, health department researchers published a study on 15 women who died from complications of COVID-19 during their pregnancies from March 2020 through October 2021. Nine of the women were Black, three were Hispanic and three were white and non-Hispanic. Their deaths were associated with one miscarriage and two stillbirths, while twelve babies were delivered.