The infant mortality rate, a stat that tracks deaths of infants before their first birthdays, in many Southern states is higher than average for the U.S. — Mississippi’s health department even declared a state of emergency this year after the rate of infant deaths increased.
Lawmakers and medical experts say that health care spending cuts and restrictions on services could make things worse.
“These are states that historically have struggled both with infant mortality and maternal mortality,” Georgia Democratic Sen. Raphael Warnock told NOTUS. “Medicaid is part of a safety net that impacts overall health. When that safety net is broken, things like infant mortality are impacted as well as chronic disease.”
Democrats warn that a confluence of factors could lead to fewer people accessing care, potentially with dire consequences. The reconciliation bill that became law this summer cuts $1.1 trillion in Medicaid. Enhanced subsidies in the Affordable Care Act will expire in December, resulting in increased premiums in 2026 for millions if not extended — something Democrats have demanded in exchange for their votes to reopen the government — and potentially lowering the rate of people getting care. The congressional budget office has estimated that by 2034, the number of people left uninsured could increase to 11.8 million.
States in the South would be disproportionately affected if the enhanced ACA subsidies aren’t extended. According to analysis from the Urban Institute, Louisiana would see the steepest decline in subsidized marketplace enrollment in the country.
Many of these states — including Mississippi, Arkansas, Louisiana, Georgia and North Carolina — have traditionally had infant mortality rates on the higher end of the spectrum. Nationwide, the infant mortality was 5.61 infant deaths per 1,000 live births in 2023; in Mississippi, which has the worst rate of infant mortality, the rate was 8.94 deaths per 1,000 live births. That number climbed in 2024 to 9.7 deaths per 1,000 live births.
Dr. James Bauerband, a retired OBGYN based in Georgia, told NOTUS that the strain that Medicaid cuts have put on rural hospitals could cause the infant mortality rates in Southern states to increase.
“I understand you don’t want to have to insure people that could get insurance on their own and want to incentivize getting a job and getting good insurance,” Bauerband said. “But, there has to be the safety nets, and I think that making sure Medicaid is well-funded is something they really ought to do.”
Alison Gemmill, an assistant professor at the University of California, Los Angeles, recently did a study analyzing the impact that the Dobbs Supreme Court case decision had on infant mortality in states and found that there were “higher than expected” mortality rates “in states after adoption of abortion bans.”
She said the Trump administration’s termination of the Pregnancy Risk Assessment Monitoring System could lead to a lower understanding of infant mortality. The monitoring system collected insights from moms before and after giving birth, asking questions regarding alcohol use and stress during pregnancy, among others.
“Those are all things that we can’t capture in a birth certificate data source,” Gemmill said. “And that was a really important data for people like me to figure out what’s going on with pregnancy health in the nation, in a state over time. And they completely canceled that program.”
“So now it’s like we don’t even have the data to inform strategies on how to improve rates of pre-term birth infant mortality,” she added.
Democrats believe these reforms have lasting consequences.
“Not enough mamas get prenatal care, partly because of cost, and partly because of access,” Sen. Elizabeth Warren said. “Finding places that can treat them can be a real challenge. The Medicaid cuts will impact infant mortality, both for the people who are cut out of health care access, and also for people who depend on rural hospitals and community health centers that can’t survive the cuts and will close.”
Republicans have also raised concerns about infant mortality rates. Missouri Sen. Josh Hawley, a Republican whose state has more than 60 rural hospitals, told NOTUS that he wants to extend the funding for rural hospitals provided under the law from 2026 to 2030.
If changes take effect after that time, cuts to Medicaid could cause infant mortality rates to go up, he said.
“I want to make sure that that doesn’t happen,” he told NOTUS. “Under the president’s reconciliation bill, there’s increased funding for rural hospitals now for the next couple of years. … I want to see that extended.”
Some of the Republicans who voted against the reconciliation bill stopped short of saying its Medicaid cuts could affect infant mortality rates.
“We’ve had an infant mortality rate problem in this country for years,” Republican Sen. Susan Collins, who cited health care as her reason for voting against the reconciliation bill, told NOTUS. “This is not new, and it does warrant research to find out why we also have huge racial disparities in maternal mortality rates.”
North Carolina Sen. Thom Tillis, who also voted against the bill, called the country’s infant mortality rate “unacceptably high,” with root causes including poverty and substance abuse. However, he didn’t see the correlation between Medicaid cuts and infant mortality rates.
“I haven’t seen any data,” Tillis said. “Maybe some people would say that. But they’d have to be statistically, not politically, motivated to catch my attention. I just haven’t studied it.”
Alabama Sen. Katie Britt called on Democrats to support her legislation to help support women during the prenatal, postpartum and early childhood years of pregnancy. Britt told NOTUS that she will continue to work across the aisle to address it.
“That’s something we’ve got to get to the bottom of … find out what is the root cause,” Britt said.