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If you look at the United States as a whole, the rate of infant mortality has been steadily declining since 1960. Back in 1960, if you had a thousand infants, 27 of them would die. The national average now is more like seven deaths per thousand.

But some Southern states are seeing a disturbing trend: Their rates are staying the same, or even getting worse. The most recent statistics show Mississippi with the biggest increase in the number of babies dying in their first year.

NPR's Kathy Lohr reports.

KATHY LOHR: Mississippi has historically had a higher infant-mortality rate than most of the country. But between 2004 and 2005, the number of babies dying in the state increased almost two points - to 11.4 deaths per 1,000 births.

Oleta Fitzgerald is the Southern regional director for the Children's Defense Fund.

Ms. OLETA FITZGERALD (Southern Regional Director, Children's Defense Fund): For a while, Mississippi was making great improvements, and the number of women having babies born dead or babies dying before their first birthday had decreased tremendously. We were very shocked to see that over the last four or five years, that those rates have started to climb and are spiking.

LOHR: Many are trying to figure out the reasons. Fitzgerald says it's simple.

Ms. FITZGERALD: This country is turning its face away from families that are poor. Nobody wants to take care of poor children, whether they are black or white or whatever color. So it is a moral issue, and it is something that we are going to have to deal with.

Ms. JANICE JOHNSON (Social Worker): What's a healthy diet?

Ms. JAMEKIA BROWN (Resident, Hollandale, Mississippi): A healthy diet is like - you got to eat baked. You got to get your starch. You got to get your vegetables, your fruit.

LOHR: In the Mississippi Delta, in tiny Hollandale, 22-year-old Jamekia Brown meets with social worker Janice Johnson. Brown is pregnant for the third time.

Ms. JOHNSON: …have you certified for weight (unintelligible). Are you getting your weight?

Ms. BROWN: Yes, they got me on that diary.

(Soundbite of laughter)

Ms. BROWN: It's a scheme.

Ms. JOHNSON: Skim milk, and it tastes good.

LOHR: Jameika was pregnant in 2004, but the child - a girl named Fre'Mya - was stillborn. Before that, when she was 17, Jameika had a baby boy - De'Terrence -who weighed four pounds, but had congenital problems and lived just one month. Jameika removes a few photos from a shoebox in her bedroom closet to show me.

(Soundbite of squeaking door, rustling sounds)

Ms. BROWN: And this is me with my first baby, De'Terrence. This is when they was going to tell me that they had to go to a second surgery, and they think that he wasn't going to make it. So they let me hold him while all the tubes and stuff was on him. This is for my - without the hat and with hat. She's dead.

LOHR: And those pictures?

Ms. BROWN: Yes. I never did get a weight. I didn't get no footprint or nothing for her.

LOHR: Despite health issues, including high blood pressure and thyroid problems, Jameika is pregnant again. And her social worker, Janice Johnson, is worried. Jameika is on Medicaid, but she can't see a specialist, even though her pregnancy is considered high-risk.

Ms. JOHNSON: Because we're so rural, we have to travel like 36 to 40 miles one way to a physician. You know, we don't have any type of transportation. So when they go in, they only see the nurse practitioner, and they see a physician on the eighth month. And most doctors now don't accept Medicaid. And with all the teen mothers and pregnant women that are on Medicaid, you know, it's hard.

LOHR: Johnson works for the federally funded Delta Health Partners, and she sees 55 patients in several rural counties. She makes home visits and provides support. Health department clinics are no longer open in every county, so she helps women get to doctor's appointments and get on Medicaid.

Women now need an original birth certificate, and they must apply in person. Many here say this new policy is preventing women and babies from getting the medical care they need.

Ms. FITZGERALD: So people have just, in many ways, dropped out.

LOHR: Again, Oleta Fitzgerald, with the Children's Defense Fund.

Ms. FITZGERALD: We see families that are operating as subcultures, and people who say I don't want welfare. I do not want to have to go to that office and ask those people anymore to help me. It is demoralizing. It is degrading.

LOHR: Another factor that contributes to the higher infant-mortality rate in Mississippi and the rest of the South is race. Black mothers are twice as likely to lose their babies as white mothers. This is true nationally, but in Mississippi, about half of all babies born are born to African-American women.

Even well educated, affluent black women are more likely to have problem pregnancies than their white counterparts. It's not clear why, but Dr. Alan Brann(ph), professor of pediatrics at Emory, says it's not just a medical problem. He says it's about reducing the number of very low birth weight babies - one of the biggest causes of infant mortality.

Dr. ALAN BRANN (Professor of pediatrics, Emory University): It is an indicator of the status of health of the community. It's the best canary we have in the mine to say this population that has high rates of very low birth-weight babies are not healthy people.

LOHR: Dr. Brann says it's too late to get high-risk women medical and prenatal care when they're pregnant. What's needed is to follow women between pregnancies to make sure they stay healthy and take care of any ongoing medical issues. A pilot project in Atlanta has been doing just that.

Dr. BRANN: Making available things that we know work - preconception care, primary care. Then it's…

LOHR: Basic health issues.

Dr. BRANN: It's not interesting. It's just simple, basic health issues that we have not afforded all of our citizens.

LOHR: The cost of providing ongoing medical care for these women is about $2,000 a year. The cost of treating babies born prematurely - some with huge problems - is tens or hundreds of thousands per child, and many never leave the hospital.

Ms. SANDY REYNOLDS (Resident, Mississippi): I never gave up on him till God actually let him take his last breath. And I still - I just - I never gave up on him.

LOHR: Sandy Reynolds' son, Jeremiah, weighed just one pound, 15 ounces when he was born. He lived 11 months in a neonatal intensive care unit in Jackson.

Ms. REYNOLDS: You would be amazed to him, because he laughed and he played, and this what made so hard to let him go. You're going to have to excuse me. God gave us 11 months, and I don't take back any time because we enjoyed every day that we went him. He was a happy baby, and, you know, we went down there and we dressed him up. We even dressed him up for Halloween. We had Christmas with him, and we never treated him like a sick baby.

LOHR: But Jeremiah's underdeveloped lungs were so susceptible to infection that he died the day after Christmas last year, without ever going home. Sandy Reynolds still grieves. This is the fourth child she's lost in 12 years.

Kathy Lohr, NPR News.

INSKEEP: You can see a list of the top 10 states for infant mortality and learn about the major causes of infant death by going to npr.org.

(Soundbite of music)

INSKEEP: This is NPR News.

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