Infant mortality rates rose sharply to 11.4 per thousand in the southern state of Mississippi in the United States, up from 9.7 the previous year, according to figures released recently.
Smaller rises also occurred in 2005 in Alabama, North Carolina and Tennessee. Louisiana and South Carolina saw rises in 2004 and have not yet reported on 2005.
There is a disturbing racial angle too. The national average in 2003 was 5.7 for whites and 14.0 for blacks. (The data for subsequent years have not been compiled.)
In Mississippi itself, infant deaths among blacks rose to 17 per thousand births in 2005 from 14.2 per thousand in 2004, while those among whites rose to 6.6 per thousand from 6.1.
The overall jump in Mississippi meant that 65 more babies died in 2005 than in the previous year, for a total of 481.
The toll is visible in Hollandale, a tired town in the impoverished Delta region of northwest Mississippi.
Jamekia Brown, 22 and two months pregnant with her third child, lives next to the black people's cemetery in the part of town called No Name, where multiple generations crowd into cheap clapboard houses and trailers.
So it takes only a minute to walk to the graves her first two children, marked with temporary metal signs because she cannot afford tombstones.
Her son, who was born with deformities in 2002, died in her arms a few months later, after surgery. Her daughter was stillborn the next year. Nearby is another green marker, for a son of Ms. Brown's cousin who died at four months, apparently of pneumonia.
The main causes of infant death in poor Southern regions included premature and low-weight births; Sudden Infant Death Syndrome, which is linked to parental smoking and unsafe sleeping positions as well as unknown causes and congenital defects.
Another contributory factor seems to be the growing epidemics of obesity, diabetes and hypertension among potential mothers, some of whom tip the scales here at 300 to 400 pounds.
Poverty has climbed in Mississippi in recent years, and things are tougher in other ways for poor women, with cuts in cash welfare and changes in the medical safety net.
Dr. William Langston, an obstetrician at the Mississippi Department of Health, said the state was working to extend prenatal care and was experimenting with new outreach programs. But, he added, "programs take money, and Mississippi is the poorest state in the nation."
The state Health Department has cut back its system of clinics, in part because of budget shortfalls and shortage of nurses. Some clinics that used to be open several days a week are now open once a week and some offer no prenatal care.
The department has also suffered management turmoil and reductions in field staff, problems so severe that the state Legislature recently voted to replace the director.
Oleta Fitzgerald, southern regional director for the Children's Defense Fund, said: "When you see drops in the welfare rolls, when you see drops in Medicaid and children's insurance, you see a recipe for disaster. Somebody's not eating, somebody's not going to the doctor and unborn children suffer."
In 2004, Governor Haley Barbour came to office promising not to raise taxes and to cut Medicaid. Face-to-face meetings were required for annual re-enrollment in Medicaid and CHIP, the children's health insurance program; locations and hours for enrollment changed, and documentation requirements became more stringent.
As a result, the number of non-elderly people, mainly children, covered by the Medicaid and CHIP programs declined by 54,000 in the 2005 and 2006 fiscal years.