In August 1964, a Mississippi sharecropper and civil-rights organizer named Fannie Lou Hamer famously told a gathering at the Democratic National Convention in Atlantic City that she was sick and tired of being sick and tired. Her televised testimony about conditions in the rural South packed such a punch that LBJ reportedly announced an impromptu press conference in the middle of it in an effort to divert attention.

Southern politicians have no less reason to be embarrassed 51 years later. As a new report that focuses on Mississippi, Alabama, and Georgia shows, the lives of black women and girls in the rural South are still too often marked by illness and exhaustion. A quarter of residents in the areas studied reported being in poor or fair health, compared to a tenth of residents in each of the states’ major metropolitan counties. One Alabama county had a black infant mortality rate of 29 deaths per 1,000 births, nearly five times the national rate of 6.2 per 1,000. In two Mississippi counties studied, the teen birth rates were 89 and 95 births per 1,000 young women between the ages of 15 and 19. Compare this to the state’s teen birth rate of 59 births per 1,000 and the national rate of 26.5 births per 1,000.

The report, titled “The State of Black Women and Families in the Rural South,” helps fill a gap in recent efforts to include black women and girls in national conversations about structural racism, much of which has focused on police violence and school push-out in urban areas. “The South, particularly the rural South, tends to get less attention,” said Dr. C. Nicole Mason, the report’s author and executive director of the Center and Policy in the Public Interest at the New York Women’s Foundation.

Mason partnered with the Southern Rural Black Women’s Initiative to produce the report, which analyzes data culled from the Census and state agencies as well as stories shared during listening groups with more than 200 women and girls. The nine counties studied were defined as persistently poor by the US Department of Agriculture, meaning that at least 20 percent of population has lived in poverty for more than five consecutive years. Among the key findings about these counties:

• In Alabama’s Lowndes County, 96 percent of black women live in poverty compared to 3.6 percent of white women. In Mississippi’s Sharkey County, 95 percent of black women live in poverty compared to 5 percent of white women. Nationwide, a quarter of black women live in poverty, and the female poverty rate overall is 15 percent.
• A third of black women lacked a high school diploma or its equivalent, compared to between 8 and 17 percent of white women in these counties. Black women were 20 percent less likely than white women to have a bachelor’s degree or higher.
• A quarter of individuals lacked health insurance. Of those who had it, 40 percent or more relied on Medicaid or another form of public health insurance.

The health outcomes reported are particularly distressing: Mississippi leads the nation in gonorrhea infections. The three rural counties studied in Georgia have a teen pregnancy rate more than double the state’s. Policy solutions such as the adoption of comprehensive sex education or the expansion of Medicaid under the Affordable Care Act—which all of these states’ Republican governors have refused—are unlikely to be embraced by elected officials anytime soon. “These women are really vulnerable because of the leadership in these states,” Mason said. She added that if successful, efforts to defund Planned Parenthood and prevent its affiliates from providing testing, treatment and preventive care to low-income women would further disadvantage a population that’s already struggling to stay healthy. Fewer than half of women in the areas studied live within a 30-minute drive to a hospital or clinic. “It presents a particular danger for women in these counties because of the lack of access to quality healthcare,” Mason said.

According to news out of Georgia and Alabama last week, this particular resource is safe for now. In both states, efforts to defund Planned Parenthood hit roadblocks despite the now month-long anti-choice campaign to convince the country that the provider illegally sells fetal tissue for profit. The Georgia Department of Public Health investigated the states’ affiliates and announced that it found no wrongdoing. Alabama Governor Robert Bentley announced earlier this month that the state’s Medicaid recipients could no longer receive health services through Planned Parenthood. Last week, the US Department of Health and Human Services warned that barring a qualified provider could put the state in violation of federal law.