Mississippi Today
State’s first family medicine obstetrics fellowship hopes to increase access to maternal care in rural areas

The state’s first fellowship to train family physicians to care for pregnant and postpartum women is poised to start next July.
The proposed fellowship will train two to three family physicians a year in obstetrics, which the medical community hopes will provide rural and underserved areas with prenatal, delivery and postpartum care.
More than half of Mississippi’s counties are considered maternity care deserts, meaning there are no practicing OB-GYNs and no hospitals that deliver babies. For family physicians looking to practice obstetrics, the lack of training programs and difficulty getting affordable malpractice insurance coverage are challenging.
Aside from two hospitals that have been able to cut through the red tape and use family physicians in maternal care, nearly all pregnancies are handled by OB-GYNs, who are in short supply in Mississippi and mostly practice in urban areas.
The state is an outlier when it comes to how little it uses family physicians in obstetrics. Across the country, family physicians play a significant role in providing obstetric care to expectant mothers. Neighboring Alabama, for instance, boasts five fellowships in obstetrics for family physicians.
Family physicians deliver babies in more than 40% of U.S. counties, and “are the sole maternity care clinicians delivering babies in 181 (maternity care deserts) … serving more than 400,000 women” nationwide, according to a report by the American Academy of Family Physicians.
Dr. James Lee Valentine and Dr. Melissa Stephens of EC Health Net, a family medicine residency program in Meridian, are designing the new one-year training program to focus on increasing access to rural maternal care.
“The fellowship will train family physicians to be able to go into some of our rural, underserved communities, and provide obstetric care for these women close to home, who may have limited access and are facing challenges,” Stephens said.
University of Mississippi Medical Center is home to the only OB-GYN residency in the state, which graduates five or six residents each year. Of those, an average of two residents remain and practice in Mississippi.
On the other hand, a record 37 family physicians graduated in 2023 from residencies in Mississippi – more than any year in the past five years, according to the Office of Mississippi Physician Workforce.
Meanwhile, the state’s maternal and infant mortality rates are worsening. Valentine and Stephens see the fellowship as one way to combat that.
“These patients sometimes don’t get any (prenatal care) and they show up in the emergency room, delivering … that’s got to change,” Valentine said. “And I’m not saying that we ought to put family practice doctors out there doing all kinds of GYN surgeries and all that, but we got to deliver better prenatal care to our patients in the rural areas.”
The fellowship will set physicians up on three-month rotations between EC Health Net in Meridian, South Sunflower Hospital in Indianola, and Wayne General Hospital in Waynesboro. Valentine and Stephens hope to also add a stint at a larger hospital studying gynecological surgeries.
South Sunflower and Wayne General are the only two hospitals in the state currently using family medicine OBs, despite the bureaucratic challenges. The family physician OBs at these two hospitals are attending the majority of births in their counties.
Dr. Kelvin Sherman, the only practicing family medicine OB at Wayne General, delivers between 180 and 280 babies a year from Wayne County and some neighboring counties. In 2022, 256 babies were born in Wayne County, which has no practicing OB-GYN, alone.
Sherman, who did his obstetrics fellowship in Alabama, said in his experience, women who are farther from obstetrical care tend not to seek help when experiencing symptoms because they can’t justify the long drive or using the county’s only ambulance. Having a family doctor nearby can make a huge difference in pregnancy outcomes.
“If they’ve got some place to go that’s 15 minutes away, then maybe they go get something checked on and find out that ‘Yeah, you are in preterm labor, but it’s early and we can stop it, and we can prolong your pregnancy and you can have a healthier baby – a baby that goes home with you rather than having to deliver early a small baby that ends up in the NICU that stays sick a lot in the first few years of life,’” he explained.
Sherman is breaking ground not only as one of the state’s only family medicine OBs, but also by working closely with a certified nurse midwife, a rarity in Mississippi – a state with no certified midwife program. Opening the doors to certified midwives could increase the amount of care available to women.
Advanced nurse practitioners are also qualified to give prenatal care. But in Mississippi, restrictive and expensive collaboration agreements limit the care nurse practitioners can provide.
Sherman’s partnership with the certified nurse midwife is the kind that Wayne General CEO Andrew Porter hopes the new fellowship will facilitate.
“The FMOB (a family medicine physician who practices obstetrics) can really be a multiplier,” Porter said. “They can be the captain of a ship that has these other providers working under them and it just multiplies the amount of care that can be provided to patients.”
South Sunflower in Indianola has three family physician OBs on staff who average about 250 births a year in a county that had 263 live births in 2022.

The hospital has been using the family medicine OB model since it opened in the 1930s, according to hospital CEO Courtney Phillips. It’s a lifeline today, where the next closest hospital is 30 miles away, and even there, there aren’t enough OB-GYNs to take care of all the deliveries.
“So, even though the next closest hospital to deliver is 30 miles away, they may have to travel all the way to Grenada if we weren’t here, which is close to 80 miles away,” Phillips explained.
The family medicine obstetrics model is used sparsely because while family physicians receive an unrestricted license to practice medicine, the problem lies in getting insurance and privileges at a hospital.
“There’s a big difference between licensure and credentials,” Stephens, a family medicine physician at EC Health Net in Meridian, said.
While the licensure board allows physicians to practice according to their training without restriction, physicians also need to apply for malpractice insurance coverage, which requires proving competence to the malpractice carrier, and then proving competence to get credentialed by the hospital they are joining. Both became difficult in Mississippi after the explosion of liability insurance costs in the 1990s.
Medical liability premiums skyrocketed across the U.S. at the turn of the century, but particularly in Mississippi – known by 2001 as the “lawsuit capital of the world,” according to a 2011 case study by the American College of Obstetricians and Gynecologists – and affected physicians’ ability to practice specialties like obstetrics or neurosurgery. Mississippi was “perhaps the hardest hit of the ‘red alert states,’” a term used to denote high medical liability regions, the case study said.
Valentine, who worked in obstetrics throughout the 1980s and had proven his competency to the board through documentation of all the procedures he performed and deliveries he attended, suddenly couldn’t afford his malpractice insurance premium when what he refers to as the “malpractice crisis” hit.
“My malpractice insurance went up about 180% premium-wise in a year’s time,” he said. “I couldn’t justify losing money to practice OB, and then take the risk on top of that. It was almost like they were trying to push us out.”
As it stands, Mississippi family physicians interested in obstetrics have few options: pursue an official training program in another state – which often results in those physicians deciding to either leave the state altogether or stay in the state and forego obstetrics – or train unofficially in Mississippi but without the guarantee of affordable malpractice insurance or a hospital that will grant them privileges.

South Sunflower, according to Valentine, is able to utilize family physicians in obstetrics affordably because of its highly regarded staff that helps them get coverage and credentials.
“Places like Indianola, they have a track record,” he said. “Dr. Wade Dowell has been … a champion for family medicine, doing OB and doing general family medicine for years, and so he’s got a track record, and the doctors he’s trained there – they do a good job.”
Valentine and Stephens hope the new fellowship will offer a similar standard that will help family physicians receive credentials and coverage in obstetrics at an affordable rate – though it’s never a guarantee.
“Whether every hospital in the state of Mississippi will recognize that, whether every hospital will open their doors, I don’t know,” said Valentine. “But from the standpoint of being qualified … we want to make sure that our fellowship is substantial enough that when they leave our fellowship, whether it’s one year or two years, they’re ready to practice obstetrics at the level they’re trained to do that.”
The fellowship is one proposed solution to changing the maternal health landscape of Mississippi. But experts believe programs like it are critical in shifting the pendulum.
“It’s not going to be a cure-all for some of the obstetrics needs, and issues like infant mortality, but it’s a step,” Porter, the Wayne General CEO, said. “It’s people who are acknowledging that we have a crisis here in the state and are trying to do something about it. Here in Waynesboro, Mississippi, and the surrounding area of Meridian, and those in the Delta, we're trying to take the matter into our own hands and come up with some solutions.”
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
On this day in 1903, W.E.B. Du Bois urged active resistance to racist policies
April 27, 1903

W.E.B. Du Bois, in his book, “The Souls of Black Folk,” called for active resistance to racist policies: “We have no right to sit silently by while the inevitable seeds are sown for a harvest of disaster to our children, black and white.”
He described the tension between being Black and being an American: “One ever feels his twoness, — an American, a Negro; two souls, two thoughts, two unreconciled strivings; two warring ideals in one dark body, whose strength alone keeps it from being torn asunder.”
He criticized Washington’s “Atlanta Compromise” speech. Six years later, Du Bois helped found the NAACP and became the editor of its monthly magazine, The Crisis. He waged protests against the racist silent film “The Birth of a Nation” and against lynchings of Black Americans, detailing the 2,732 lynchings between 1884 and 1914.
In 1921, he decried Harvard University’s decisions to ban Black students from the dormitories as an attempt to renew “the Anglo-Saxon cult, the worship of the Nordic totem, the disenfranchisement of Negro, Jew, Irishman, Italian, Hungarian, Asiatic and South Sea Islander — the world rule of Nordic white through brute force.”
In 1929, he debated Lothrop Stoddard, a proponent of scientific racism, who also happened to belong to the Ku Klux Klan. The Chicago Defender’s front page headline read, “5,000 Cheer W.E.B. DuBois, Laugh at Lothrup Stoddard.”
In 1949, the FBI began to investigate Du Bois as a “suspected Communist,” and he was indicted on trumped-up charges that he had acted as an agent of a foreign state and had failed to register. The government dropped the case after Albert Einstein volunteered to testify as a character witness.
Despite the lack of conviction, the government confiscated his passport for eight years. In 1960, he recovered his passport and traveled to the newly created Republic of Ghana. Three years later, the U.S. government refused to renew his passport, so Du Bois became a citizen of Ghana. He died on Aug. 27, 1963, the eve of the March on Washington.
This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Mississippi Today
Jim Hood’s opinion provides a roadmap if lawmakers do the unthinkable and can’t pass a budget
On June 30, 2009, Sam Cameron, the then-executive director of the Mississippi Hospital Association, held a news conference in the Capitol rotunda to publicly take his whipping and accept his defeat.
Cameron urged House Democrats, who had sided with the Hospital Association, to accept the demands of Republican Gov. Haley Barbour to place an additional $90 million tax on the state’s hospitals to help fund Medicaid and prevent the very real possibility of the program and indeed much of state government being shut down when the new budget year began in a few hours. The impasse over Medicaid and the hospital tax had stopped all budget negotiations.
Barbour watched from a floor above as Cameron publicly admitted defeat. Cameron’s decision to swallow his pride was based on a simple equation. He told news reporters, scores of lobbyists and health care advocates who had set up camp in the Capitol as midnight on July 1 approached that, while he believed the tax would hurt Mississippi hospitals, not having a Medicaid budget would be much more harmful.
Just as in 2009, the Legislature ended the 2025 regular session earlier this month without a budget agreement and will have to come back in special session to adopt a budget before the new fiscal year begins on July 1. It is unlikely that the current budget rift between the House and Senate will be as dramatic as the 2009 standoff when it appeared only hours before the July 1 deadline that there would be no budget. But who knows what will result from the current standoff? After all, the current standoff in many ways seems to be more about political egos than policy differences on the budget.
The fight centers around multiple factors, including:
- Whether legislation will be passed to allow sports betting outside of casinos.
- Whether the Senate will agree to a massive projects bill to fund local projects throughout the state.
- Whether leaders will overcome hard feelings between the two chambers caused by the House’s hasty final passage of a Senate tax cut bill filled with typos that altered the intent of the bill without giving the Senate an opportunity to fix the mistakes.
- Whether members would work on a weekend at the end of the session. The Senate wanted to, the House did not.
It is difficult to think any of those issues will rise to the ultimate level of preventing the final passage of a budget when push comes to shove.
But who knows? What we do know is that the impasse in 2009 created a guideline of what could happen if a budget is not passed.
It is likely that parts, though not all, of state government will shut down if the Legislature does the unthinkable and does not pass a budget for the new fiscal year beginning July 1.
An official opinion of the office of Attorney General Jim Hood issued in 2009 said if there is no budget passed by the Legislature, those services mandated in the Mississippi Constitution, such as a public education system, will continue.
According to the Hood opinion, other entities, such as the state’s debt, and court and federal mandates, also would be funded. But it is likely that there will not be funds for Medicaid and many other programs, such as transportation and aspects of public safety that are not specifically listed in the Mississippi Constitution.
The Hood opinion reasoned that the Mississippi Constitution is the ultimate law of the state and must be adhered to even in the absence of legislative action. Other states have reached similar conclusions when their legislatures have failed to act, the AG’s opinion said.
As is often pointed out, the opinion of the attorney general does not carry the weight of law. It serves only as a guideline, though Gov. Tate Reeves has relied on the 2009 opinion even though it was written by the staff of Hood, who was Reeves’ opponent in the contentious 2019 gubernatorial campaign.
But if the unthinkable ever occurs and the Legislature goes too far into a new fiscal year without adopting a budget, it most likely will be the courts — moreso than an AG’s opinion — that ultimately determine if and how state government operates.
In 2009 Sam Cameron did not want to see what would happen if a budget was not adopted. It also is likely that current political leaders do not want to see the results of not having a budget passed before July 1 of this year.
This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Mississippi Today
1964: Mississippi Freedom Democratic Party was formed
April 26, 1964

Civil rights activists started the Mississippi Freedom Democratic Party to challenge the state’s all-white regular delegation to the Democratic National Convention.
The regulars had already adopted this resolution: “We oppose, condemn and deplore the Civil Rights Act of 1964 … We believe in separation of the races in all phases of our society. It is our belief that the separation of the races is necessary for the peace and tranquility of all the people of Mississippi, and the continuing good relationship which has existed over the years.”
In reality, Black Mississippians had been victims of intimidation, harassment and violence for daring to try and vote as well as laws passed to disenfranchise them. As a result, by 1964, only 6% of Black Mississippians were permitted to vote. A year earlier, activists had run a mock election in which thousands of Black Mississippians showed they would vote if given an opportunity.
In August 1964, the Freedom Party decided to challenge the all-white delegation, saying they had been illegally elected in a segregated process and had no intention of supporting President Lyndon B. Johnson in the November election.
The prediction proved true, with white Mississippi Democrats overwhelmingly supporting Republican candidate Barry Goldwater, who opposed the Civil Rights Act. While the activists fell short of replacing the regulars, their courageous stand led to changes in both parties.
This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
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