Series on infant mortality in Florida reveals a ‘public health crisis’ that could be averted

As Florida began to pass restrictions on abortion in recent years, my questions grew. 

Did lawmakers consider whether babies in the state, once born, went on to live healthy lives? If abortion restrictions were to lead to an increase in births, how would these babies fare?

Around this time, national media reported that the U.S. infant mortality rate had increased for the first time in decades. I wanted to learn where Florida fit in this trend.

I have been a reporter for several decades, but I have never gathered my own data as a building block for narrative writing. The training and mentoring I received as a USC Health Journalism Data Fellow helped me learn where to extract data and how to analyze it. I then paired my findings with interviews with mothers, doctors, and women’s health leaders — the faces behind the numbers.

The challenge became organizing all my findings into individual, well-reported, impactful stories without being overwhelmed by what the numbers revealed. The result was a four-part series, titled “Born to Die.” 

The first story in the series, “Born to die: Florida’s infant mortality crisis” examined infant deaths.

Florida’s health records reveal its newborns are less likely to survive to a first birthday than infants in 50 foreign countries and nearly half of U.S. states. Six of every 1,000 babies born in Florida will die before their first birthday, a rate slightly higher than the national average, which was 5.6 deaths per 1,000 in 2022. 

The survival rate is even worse for Black babies, who die in Florida twice as often as white non-Hispanic and Hispanic infants. And, as my report illuminates, despite a declining birth rate and millions of dollars spent by the state on maternity programs, research, outreach and reports, the rate of infant mortality has remained stubbornly unchanged for the past 10 years.

Behind the data are heartbreaking stories of loss.

I found Tiffanie Williams, a Jacksonville mother who lost her son during pregnancy, through a grief group she had formed. Tiffanie believes more could have been done to keep her baby alive. She says her complaints, as a Black woman, were dismissed by her obstetrician. 

“I am not saying if those doctors listened to me, my baby would be here. Situations happen, but I wonder if doctors listened more whether situations like mine would have been prevented,” Williams said.

An unacceptable number of women in Florida told me similar personal stories of heartbreak and loss. They want to see more action. They are angry about the lack of maternal care in many areas of the state. They are frustrated by a lack of access to health insurance and doctors who will take their Medicaid plans. They feel dismissed by overworked, underpaid, undertrained and sometimes racially insensitive medical staff. 

I concluded that everything from Florida’s impenetrable insurance structure to ineffective treatment in maternal and prenatal health contributes to the high rate of babies who die within their first year of life — and sadly, sometimes within their first minutes.

Health experts told me the loss of new lives will continue unless the state rethinks how it fails mothers before, during and after pregnancy.

The second story in the “Born to Die” series focused on a less obvious impact of Florida’s policies and misguided spending on maternal health: an epidemic of preterm births. 

My reporting for this story took me to one of the country's busiest neonatal intensive care units: The NICU at Miami’s Jackson Memorial Hospital, part of the public health system. Peering into tiny incubators, I saw the preterm babies with undeveloped organs who were hooked up to machines to keep them alive.

Florida has seen an increase in mothers suffering from diabetes, obesity and other chronic conditions that can prompt early delivery and cause them to give birth to underweight babies who need specialized care in a NICU. Experts say a lack of health insurance plays a key role. The state has not expanded Medicaid to more low-income women of childbearing age who could benefit by having medical conditions managed before becoming pregnant.  

“The state is spending money for programs for preterm babies, but not for prevention,” explained Caroline Valencia, director of maternal and infant health initiatives for March of Dimes Florida.

I interviewed a Jackson Health neonatologist with a front seat to what she called “a public health crisis.” She worries about what’s ahead.

“The good news is neonatology has advanced significantly and we can save more babies,” said Dr. Karen Young. “However, what we don’t know, because we haven’t studied them enough, is the long-term consequences of being born early.”

When these babies leave the NICU, their parents often lack the support they need for their newborn, who requires a high level of care. I visited a mother at home whose daughter had tubes sprouting from her body in every direction. She knows it may be years before the many appointments with doctors and therapists are manageable enough for her to hold a job.

This project has had a profound effect on my continued reporting. I often receive news releases from hospitals celebrating a baby’s discharge from a NICU after a long stay. But the celebration masks the years of struggles ahead for parents and the toll on the public health system. I can now temper these celebrations with the reality of the long-term impacts.

The third article in the “Born to Die” series focused on why infant mortality remains unchanged for the last decade and why pre-term birth rates continue to rise —  despite state spending on maternal and infant health. For this installment, I pored through public records, including the state’s budget, to learn where funds were allocated. I persisted despite “warnings” from state health officials insisting I tell the narrative they wanted me to tell. 

To be fair, Florida has not been sitting idly by while babies die or struggle to live. The state spends millions of dollars each year on maternal health.

I discovered Florida spent more than $170 million in 2023 to address maternal and infant health, about twice what it invested to bring more visitors to Florida. But critics told me the money Florida spends on maternal and infant health doesn’t reach far enough to keep more babies alive. They think the state should shift spending in key areas to improve birth outcomes; adjust the Medicaid insurance structure to increase prenatal care; invest more in communities with the poorest birth outcomes; measure results to ensure accountability; and educate health care providers on how they can deliver higher quality, more racially sensitive care.

“What we have got is the continual spending of money in the same place, in the same cycles, doing the same research, and coming up with the same solutions as if that’s making a difference, and it’s not,” said Orlando midwife Jennie Joseph.

Lastly, I closed the series with solutions. The final installment asked the question: Are midwives and doulas the answer to keeping more Black babies alive?

The state is plagued with maternity care deserts in rural and urban areas as hospitals close their labor and delivery wards. Couple that trend with Florida’s physician shortage and the result is that many women receive no prenatal care until they arrive at the emergency room in preterm labor. 

Doulas represent a potential pathway to address the problem. They are non-medical, trained labor assistants or coaches who provide physical and emotional support during pregnancy, childbirth and recovery.

Doula training has ramped up in the state, and one legislator plans to propose a law mandating that health insurers who cover obstetrical services also cover state-certified doulas. 

Many Medicaid enrollees in Florida’s managed-care plans can now access the doula benefit. In addition, midwives are stepping in to fill the gaps and provide what they call “more culturally sensitive care.”

I spent time with midwives and doulas and saw the personalized care they provide. As my reporting shows, mothers-to-be in Florida greatly need a safety net.

As I continue to cover abortion access in Florida, the research from my fellowship project has helped my reporting on efforts to un-do the state's restrictions through a ballot initiative. I use updated infant mortality records to show the ongoing effects of law changes. 

Perhaps most rewarding is that the project had an impact. The stories reverberated through the maternity support networks and helped a few organizations obtain additional financial support for their efforts. One health foundation even began offering women rides to clinics for prenatal care. 

Not long after my series was published, I ran into a woman whose frustration getting prenatal care had led her to a midwife practice. Now, months later, she cradled a healthy baby, offering hope for more Florida women to have a positive birthing experience.