Birth Safety in America Depends Heavily on Location

Across the United States, the odds of a safe delivery vary widely from state to state, according to a new study from The Birth Injury Lawyers Group analyzing birth outcomes in all 50 states. The study built a composite Birth Danger Index from three measures: how often mothers die during or shortly after childbirth, how often babies arrive before 37 weeks, and how easily expectant mothers can reach obstetric care. The resulting scores run from 86.2 in Mississippi to 9 in Massachusetts. With about 10,000 babies born in the country every day, or 3,628,934 in total in 2024, that 77-point spread affects a large number of families.

Maternal mortality: a fourfold divide

The first measure shows the starkest contrast. From 2019 to 2023, Tennessee recorded 42.1 maternal deaths per 100,000 live births, more than four times California’s rate of 10.1 and well above the national average of 17.9. Louisiana, Mississippi, Arkansas, Alabama, Virginia, South Carolina, Indiana, Kentucky, and Arizona complete the ten highest rates. Minnesota, Massachusetts, Utah, and Connecticut join California among the lowest. According to the study, a mother’s true risk depends on more than her state. Women aged 40 and older had 62.3 deaths per 100,000 live births, compared with 16.5 for women aged 25 to 39 and 13.7 for women under 25. Black mothers had a rate of 44.8, nearly three times the rate for White mothers. Births to women over 40 have climbed every year since 2018, so more pregnancies each year begin in a higher risk group.

Preterm birth: Mississippi at twice New Hampshire’s odds

The second measure follows a similar regional pattern. Mississippi had the nation’s highest preterm birth rate in 2024 at 15%, about 1.71 preterm births per 1,000 residents, compared with a national average of 10.4%. Louisiana (13.99%), Alabama, Arkansas, and West Virginia came next, followed by South Dakota, Texas, Nebraska, Kentucky, and Georgia. New Hampshire had the lowest rate at 7.93%, ahead of Vermont (8.19%), Oregon, Rhode Island, and Massachusetts. After accounting for population, a Mississippi mother is more than twice as likely as a New Hampshire mother to deliver early. In raw totals, that was 5,021 preterm births against 933. The study notes that preterm birth is the leading cause of infant death and long term disability nationwide, and is closely tied to gaps in prenatal care that let conditions like preeclampsia and gestational diabetes go unnoticed.

Maternity care access: 1,100 counties with no delivery care

The third measure helps explain the first two. More than 35% of U.S. counties, over 1,100 in all, are maternity care deserts with no birthing facility or obstetrician. These counties affect more than 2.3 million women and roughly 150,000 births each year. North Dakota has the highest share, with 39 of 53 counties (73.6%) lacking care. Oklahoma, Nebraska, South Dakota, and Arkansas each have about half or more of their counties in the same position. Texas has the largest count, with 126 desert counties, and nearly one in four reproductive-age women there is uninsured, the highest rate in the country. Arkansas has the fewest obstetric clinicians at 98.1 per 10,000 births and the lowest rate of midwife-attended births at 0.4%. Mothers in desert counties travel an average of 38 minutes for care, versus 14.4 minutes in fully served counties, and one in 25 obstetric units closed between 2021 and 2022. Massachusetts, meanwhile, has full access in every county.

The Birth Danger Index: where it all comes together

Combining the three measures, Mississippi ranks as the most dangerous state, with a 15% preterm rate, 39.68 maternal deaths per 100,000 live births, and maternity care deserts in 48.8% of its counties. Louisiana, Arkansas, Alabama, and Tennessee complete the bottom five, each scoring above 60. Seventeen states are classified as Dangerous, mostly across the South and the rural Great Plains. At the other end, Massachusetts (9) and California (9.3) lead a group of 17 Safe states that also includes Connecticut, New Hampshire, Vermont, Rhode Island, Maine, Minnesota, Wisconsin, and Washington. The study finds the three measures usually move together, with some notable exceptions. North Dakota ranks 12th most dangerous despite a preterm rate of just 9.4%, mainly because of its maternity care deserts. Arizona has few deserts (6.7%) but a high maternal mortality rate (30.44).

The data also points to a mismatch between where babies are born and where care is available. Utah leads the nation in birth rate per capita, but Oklahoma and Louisiana combine top ten birth rates with some of the weakest maternal health systems in the country. Raising a child to 18 is estimated to cost $320,000 to $500,000, so families in those states face financial pressure on top of higher medical risk. Taken together, the findings suggest that birth safety in America depends less on individual choices than on the strength of local healthcare infrastructure.