According to 2024 CDC figures, 3,628,934 babies were born in the United States (that’s around 10,000 a day). Yet there’s a huge gap between the safest and most dangerous states for giving birth.
In this study, The Birth Injury Lawyers Group analyzed data pertaining to all U.S. states to measure the birth safety gap. Our findings have enabled us to deliver birth safety rankings for every state so that all potential U.S. parents can clearly see where maternity services are working well, and where they’re working less well.
Let’s first take a look at the states that feature the highest birth rates in the U.S.
Birth Rates Across The United States
The 3,628,934 babies born in the United States in 2024 represents a decline of 16% since 2007, with the general fertility rate down 22% over the same period. Yet that national average tells only a very broad story, with state birth rates wildly variable.
If we measure births on a per capita basis (as opposed to by raw numbers), Utah ranks first, driven by its comparatively young population and a family-oriented culture. It’s followed in the top ten rankings by a mix of Western, Midwestern, and Southern states, with the lowest birth rates concentrated in the Northeast (Vermont, Maine, and New Hampshire). Simply put: some regions have significantly more babies than others.
But birth patterns are far from purely a matter of culture or tradition. Two of the top 10 states, Oklahoma and Louisiana, also rank among the worst for maternal mortality, preterm birth outcomes and maternity care access. Some of the states with the highest birth rates are also among those least able to support safe childbirth.
It’s also worth pointing out that there’s no implicit link between high birth rates per capita and high total birth numbers. Although Texas ranks second in both birth rate and total birth rankings, Utah leads on birth rates despite its much smaller population. (In this case, its position does reflect genuine cultural and demographic trends.)
A broader regional pattern is also clearly apparent. Five of the top 10 states (Texas, Oklahoma, Idaho, Tennessee and Louisiana) are in the South or Southern-Central United States, regions that also feature the most urgent lack of maternity care resources and some of the nation’s poorest maternal health outcomes.
The financial burden of parenthood compounds these challenges. Raising a child from birth to the age of 18 costs parents an estimated average of $320,000 to $500,000: that works out at roughly $18,000 to $28,000 a year before any college costs are contemplated. Families in high birth-rate states that feature limited maternity care therefore face increased financial strain as well as elevated medical risk.
One of the consequences of birth that extends far beyond any financial measure is maternal mortality: the likelihood of a mother dying while giving birth.
Maternal Mortality Rates
The U.S. state in which a mother gives birth can profoundly impact her safety. Tennessee is currently the most dangerous state for childbirth due to its maternal mortality rate of 42.1 deaths per 100,000 live births between 2019 and 2023. Louisiana, Mississippi, Arkansas, Alabama, Virginia, South Carolina, Indiana, Kentucky, and Arizona complete the list of 10 states that feature the highest maternal mortality rates in America. While the list heavily features Southern states, the presence of Indiana and Arizona on the list shows that elevated maternal risk isn’t confined to the Deep South.
At the opposite end of the danger spectrum, California is the safest U.S. state, with a maternal mortality rate of just 10.1, followed by Minnesota, Massachusetts, Utah, and Connecticut.
To put the differential between opposite ends of the maternal danger scale into perspective, a mother in Tennessee is more than four times more likely to die during or shortly after childbirth than a mother in California.
Maternal age is an additional major risk factor. Women aged 40 and older suffer 62.3 maternal deaths per 100,000 live births, far more than women aged between 25 and 39 (16.5) and women under the age of 25 (13.7). Because the rate of women over 40 giving birth has risen every year since 2018, an increasing number of mothers enter pregnancy subject to an elevated risk of maternal mortality.
When age and geography combine in high-risk states such as Tennessee, Mississippi, and Louisiana, the level of danger substantially rises.
Race adds yet another layer: Black mothers experience 44.8 maternal deaths per 100,000 live births, nearly three times higher than the rate recorded for White mothers. A Black mother over the age of 40 who gives birth in a high-risk state faces multiple compounding, overlapping risk factors.
Such disparities emphasize the fact that maternal mortality is driven as much by systems as by levels of individual health. Preventable complications, delayed emergency care, understaffed maternity units, and inadequate postpartum care are issues that are particularly prevalent in the highest-risk states.
National averages mask these differences. While the U.S. maternal mortality rate is 17.9 deaths per 100,000 live births, that figure combines state rates that range from 10.1 in California to Tennessee’s 42.1. A mother’s actual maternal mortality risk can only be fully measured by considering the combined effects of where she lives, her age, and her race.
Another key risk factor that’s also variable by state: the rate of preterm births.
Preterm Births and Infant Risk Factors
Whether or not a baby has enough time to fully develop before birth heavily depends on where it’s born.
In 2024, Mississippi featured the nation’s highest preterm birth rate, with 15% of babies born before 37 weeks (that’s about 1.71 preterm births per 1,000 residents). Louisiana followed (13.99%), with Alabama, Arkansas and West Virginia also featuring rates well above the national average (10.4%).
South Dakota, Texas, Nebraska, Kentucky and Georgia complete the top 10, maintaining a Southern and Southern-Central pattern already evident in maternal mortality rankings.
The overlap is significant. The fact that Mississippi, Louisiana, Alabama, Arkansas and Kentucky rank as among the most dangerous U.S. states for both mothers and babies suggests common underlying causes like limited prenatal care, hospital closures and a shortage of obstetric services.
Preterm birth is rarely due to any single factor. Delayed or inadequate prenatal care makes it harder to identify complications like preeclampsia, gestational diabetes and infections before they trigger premature labor. Chronic conditions, hypertension, obesity, and substance abuse also increase risk and are more likely to go untreated in states that feature limited maternity care. Ultimately, preterm birth is often a consequence of inadequate healthcare access.
In terms of safest states, New Hampshire recorded the nation’s lowest preterm birth rate (7.93%), followed by Vermont (8.19%), Oregon, Rhode Island, and Massachusetts.
Connecticut, Montana, California, Washington, and Pennsylvania round out the list of ten safest states. New Hampshire’s overall performance reflects its robust healthcare infrastructure and replete maternity care resources.
The gap between safe and unsafe states is significant. Mississippi’s 5,021 preterm births in 2024 are over five times the 933 recorded in New Hampshire.
Even after we’ve considered population differences, mothers in Mississippi are more than twice as likely to experience a preterm birth. Preterm births are the leading cause of infant death and long-term disability in the United States.
A comparatively high preterm birth rate also represents higher rates of low birth weight, respiratory problems, developmental delays, extended NICU stays, and a greater financial burden for families.
Clearly, these cumulative findings confirm that geography plays a major role in pre-determining safety levels for both mothers and babies. The highest-risk states are defined by limited access to prenatal care, provider shortages, and low-resource healthcare systems.
So, how do U.S. states compare when it comes to access to maternity care?
Access To Maternity Care
In the U.S., access to maternity care primarily depends on geography. For millions of women, their geographical location means they’re nowhere near a hospital, birth center, or obstetrician.
More than 35% of U.S. counties (over 1,100 in total) are classified as maternity care deserts (which means they have no birthing facility or obstetrician). Every year, this lack of resources affects over 2.3 million women and over 150,000 births.
In this regard, North Dakota is the most affected state and features the highest concentration of maternity care deserts: 39 of its 53 counties (almost three-quarters) lack maternity care. Oklahoma, Nebraska, South Dakota, and Arkansas also feature a high number of maternity deserts, each with roughly half or more of their counties thus classified. Texas represents a particularly significant challenge: although 49.6% of its counties are affected, its size means 126 counties (the most of any state) have no birth facility or obstetric services.
Provider shortages are usually a key factor. In this respect, Arkansas ranks last nationally with just 98.1 obstetric clinicians per 10,000 births, with Oklahoma, Alabama, Mississippi and Texas also ranking low. Generally, women who live in maternity care deserts take an average 38 minutes to reach obstetric services (compared to 14.4 minutes for counties featuring full access). The longest travel times for expectant mothers were recorded in Alaska, West Virginia, Wyoming, Hawaii and Montana.
Midwives help address some shortages, but availability varies. Arkansas (0.4%), Alabama and Mississippi reported the nation’s lowest rates of midwife attendance at births, while Alaska, Vermont, and New Hampshire rely on midwives for nearly one in four births.
Overall, the issue is getting worse. Between 2021 and 2022 in the U.S., 1 in 25 obstetric units closed due to a low number of births, staff shortages, and poor reimbursement rates, which disproportionately affected rural communities. Insurance is another access blocker, with nearly one in four reproductive-age women in Texas lacking health insurance (the highest uninsured rate in the country).
Several states show that broad access is possible. Massachusetts provides full maternity care access in all of its counties, with Connecticut, Delaware, Hawaii, Maine, New Hampshire, New Jersey, and Rhode Island also all providing virtually full maternity care access.
California (despite its size) features only a relatively small number of counties classed as maternity care deserts (8.6%), proving that strong infrastructure can mitigate geographic challenges.
Yet it’s also true that around 70% of the country’s birth centers are in just 10 states, including California, Washington, Texas, Florida, and Virginia. States such as Oklahoma, Nebraska, Arkansas, and Texas rank poorly for maternity care access and suffer disproportionately high maternal mortality and preterm birth rates.
Ultimately, long travel distances for routine prenatal visits and emergency obstetric care take their toll. Conversely, Massachusetts and California consistently rank among the safest states for maternal and infant health, reinforcing that access to maternity care is a key indication of overall success.
The Birth Danger Index: America’s Most Dangerous Birth States
Overall, by combining maternal mortality, preterm birth rates, and access to maternity care into a single composite score, we can provide a clear picture of birth safety in America.
By this combined measure, Mississippi ranks as the most dangerous state to give birth, with a danger score of 86.2 out of 100. The state features the nation’s highest preterm birth rate (15%), a maternal mortality rate of 39.68 deaths per 100,000 live births, and 48.8% of its counties are classified as maternity care deserts.
Louisiana, Arkansas, Alabama, and Tennessee complete the ranking of the five most dangerous states, each scoring over 60 out of 100 due to high maternal mortality, high preterm birth rates, and limited maternity care access.
Overall, we classify 17 states as ‘Dangerous’ (all with a score of 47.9 or higher). The states in question are mainly situated in the South and rural Great Plains, where hospital closures, provider shortages, and long travel distances overlap.
At the other end of the scale, Massachusetts (9) and California (9.3) lead the ‘Safe’ tier. Both report maternal mortality rates below 15 per 100,000 live births, preterm birth rates under 9.1%, and either no or relatively few maternity care deserts. Fifteen other states also scored below 30: they include Connecticut, New Hampshire, Vermont, Rhode Island, Maine, Minnesota, Wisconsin, and Washington.
The remaining states fall into the ‘Moderate Risk’ category (states earning a rating between 30 and 47.2). These states might have performed well in some areas but not in others.
For example, Arizona has one of the nation’s lowest maternity care desert rates (6.7%) yet its maternal mortality rate (30.44) diminishes its overall ranking, while Idaho combines a relatively low maternal mortality rate (19.85) with a high proportion of maternity care deserts (31.8%).
Generally, the index reveals significant state consistency across all three measures. States that feature a high maternal mortality rate generally also experience high preterm birth rates and feature limited maternity care resources. North Dakota exemplifies this: despite a relatively low preterm birth rate (9.4%), it ranks as the 12th most dangerous state overall because 73.6% of its counties (the highest national share) are maternity care deserts.
By contrast, the safest states almost always perform well across all three indicators, showing that obstetric access, hospital availability, and consistent prenatal care are usually elements of an interconnected system.
When a maternal care system is strong, mothers and babies benefit. When it’s weak or incomplete, risks often overlap or have a knock-on effect. Overall, the gap in the United States between safe and endangered mothers and babies is shocking, as our ranking emphasizes: the 77-point gap between Mississippi’s danger score of 86.2 and Massachusetts’s danger score of 9 tells a worrying story.
The U.S. Maternal Care Gap
Where an expectant mother lives largely determines the quality of available maternal care. This study has clearly ranked every state using maternal mortality, preterm birth rates, and access to maternity care to identify the safest and most dangerous places to give birth.
Utah features the highest birth rate per capita, while Northeastern states feature the lowest. Several high birth-rate states (including Oklahoma and Louisiana) also feature relatively inadequate maternal health and limited maternity care, which in turn puts a greater financial and medical burden on families.
A mother in Tennessee is more than four times more likely to die during or shortly after childbirth than a mother in California
Maternal mortality differs dramatically by state. Tennessee features the highest rate at 42.1 deaths per 100,000 live births, compared with just 10.1 in California. Risk also increases significantly for mothers aged 40 and older and remains disproportionately high for Black mothers.
Preterm birth follows a similar pattern, with Mississippi reporting the nation’s highest rate (15%) and New Hampshire the lowest (7.93%). These differences are closely linked to healthcare access as opposed to individual behavior.
Access to maternity care remains a critical challenge. More than 1,100 U.S. counties are maternity care deserts, which affects 2.3 million women of reproductive age. States with the poorest access consistently experience higher maternal mortality and preterm birth rates, while states like Massachusetts and California combine strong healthcare infrastructure with some of the nation’s best maternal results.
Combining all three measures as part of our Birth Danger Index has identified Mississippi as the most dangerous state to give birth, followed by Louisiana, Arkansas, Alabama, and Tennessee.
Massachusetts and California rank as the safest, highlighting that geography, healthcare infrastructure, and access to obstetric care are among the strongest indicators of good maternal care in the United States. Yet a mother living in a state ranked as dangerous is not at fault for the care she receives, nor for any subsequent care issues that may arise.
And with a gap of 77 points on the danger scale between best and worst states, the gap urgently needs to be narrowed. Our rankings clearly provide a list of states with the highest need of more maternal help.
The birth of a child is an incredibly special event. But when something goes wrong, it can turn your family upside down and cause you immeasurable pain.
When a preventable mistake injures your newborn, the future you dreamt of for your child can vanish. You may also become overwhelmed by having to deal with bills and caretaking duties.
The nationally recognized Birth Injury Lawyers Group dedicates its time to helping the parents of injured children fight for their rights. We offer hope and possible financial compensation to families who have been harmed by a medical professional’s mistake. Get in touch with us today to find out more.