A new report from Tulane University’s Newcomb Institute connects Louisiana’s population decline to the state’s deeper failures on public health, maternal care, rural access and economic opportunity.
Louisiana is not just losing people.
It is losing people while struggling to keep too many of its remaining residents healthy, safe and economically stable.
That is the clearest takeaway from a new report by Tulane University’s Newcomb Institute, “What’s Shaping Louisiana’s Future? Population change, health disparities, and the road ahead.” The report brings together data from the U.S. Census Bureau, Centers for Disease Control and Prevention, Louisiana Department of Health and other sources to examine the demographic and public health forces shaping the state.
The findings are blunt. Louisiana is dealing with slow population growth, sustained out-migration, high maternal and infant mortality, racial health disparities, rural healthcare gaps, premature death and a long-term workforce challenge that cannot be separated from the state’s policy choices.
Here are the key takeaways.
1. Louisiana’s population problem is being driven by people leaving.
Louisiana’s population grew modestly over the last several decades, from about 4.2 million residents in 1990 to about 4.6 million in 2020. But since then, the state has largely moved in the wrong direction.
According to the report, Louisiana lost more than 60,000 residents between April 2020 and July 2024. That decline happened even though the state recorded more births than deaths during that same period.
The math matters.
Louisiana had 237,446 births and 228,482 deaths during that period. In a vacuum, that would mean modest natural population growth. But the state also lost 70,376 residents through net migration.
In plain English: Louisiana had enough births to grow. People leaving wiped that out.
That should be treated as a major warning sign. A state cannot keep talking about workforce development, economic competitiveness and business growth while ignoring the fact that tens of thousands of people are choosing to build their futures somewhere else.
2. Most Louisiana parishes are shrinking.
The population loss is not evenly distributed.
The report found that most Louisiana parishes lost population between April 2020 and July 2024. Only 11 of the state’s 64 parishes recorded growth during that period.
Those growing parishes included Bienville, Vernon, East Baton Rouge, Caddo, St. Charles, West Carroll, Tangipahoa, Tensas, Lafourche, Assumption and Madison.
Some rural parishes saw especially steep losses. Catahoula Parish lost 16.8% of its population, while Morehouse Parish lost 9.1%.
This is where the demographic story becomes a governing story. Population loss affects local tax bases, school systems, hospitals, infrastructure and workforce availability. When a parish loses residents, it does not just lose numbers on a spreadsheet. It loses workers, families, students, patients, customers and civic capacity.
For rural Louisiana, that becomes a spiral: fewer people, fewer services, fewer jobs, fewer reasons for young people to stay.
3. Louisiana is aging without enough new population growth to offset it.
Louisiana is not dramatically older than the country as a whole, but it is aging at roughly the same pace while also struggling with weak population growth and out-migration.
In 2023, 17.4% of Louisiana residents were 65 or older, compared with 17.7% nationally. The state also has relatively low immigration and linguistic diversity compared with the United States overall, which the report notes limits demographic renewal and future workforce growth.
That matters because an aging population creates greater demand for healthcare, caregiving and public services. Normally, states can offset some of that pressure through in-migration, immigration, workforce growth and family formation.
Louisiana is not doing enough of that.
The result is a state facing normal aging pressures without the population momentum needed to absorb them.
4. Louisiana’s fertility rate is above the national average, but still declining.
Louisiana’s total fertility rate remains slightly above the national average. In 2023, Louisiana’s rate was 1.829, compared with 1.621 nationally.
But that does not mean the state can shrug off its demographic problems. Louisiana’s fertility rate has declined over the past two decades, falling by about 0.33 children. Fertility also varies widely by parish, with higher rates generally concentrated in rural areas.
That creates a complicated picture. Louisiana is still seeing births, but not enough population stability. The problem is not simply that people are having fewer children. It is that the state is not retaining enough people, attracting enough new residents or creating the conditions for long-term family and economic stability.
5. Louisiana’s teen birth rate remains one of the highest in the country.
Louisiana ranks third in the nation for teen births, behind only Mississippi and Arkansas.
The state’s teen birth rate has fallen substantially since the mid-2000s, but it remains far above the national average. In 2022, Louisiana recorded 23.7 births per 1,000 females ages 15 to 19. The national rate was 13.6.
The report is careful not to frame teen pregnancy as a moral failing. That is important. Teen births are better understood as an indicator connected to education, poverty, reproductive healthcare access and long-term economic opportunity.
When young people become parents earlier in life, it can shape educational pathways, job opportunities and family economics. That does not mean teen parents are doomed or deficient. It means policymakers should care about whether young people have access to sex education, contraception, healthcare, stable schools and realistic economic opportunity.
In Louisiana, too many do not.
6. Louisiana’s infant mortality rate remains unacceptably high.
Louisiana has made some progress on infant mortality since the 1990s, but the state still performs worse than the country overall.
In 2023, Louisiana’s infant mortality rate was 7.14 deaths per 1,000 live births. The national rate was 5.61.
The racial disparities are even more alarming. From 2021 to 2023, Louisiana’s overall infant mortality rate averaged 7.4 deaths per 1,000 live births. But for Black infants, the rate was 11.6. For non-Hispanic White infants, it was 4.8. For Hispanic infants, it was 4.6.
That means Black infants in Louisiana were dying at more than double the rate of White and Hispanic infants.
This is not a small statistical gap. It is a crisis.
7. Black infants are also far more likely to be born at low birth weight.
The report found that low birth weight remains a serious problem in Louisiana.
Low birth weight refers to infants born weighing less than 2,500 grams. In 2024, 11.6% of Louisiana infants were classified as low birth weight. But among Black or African American infants, the rate was 17%.
That matters because low birth weight is tied to infant health, long-term development and broader maternal health conditions.
Once again, the pattern is clear. Louisiana’s worst health outcomes are not distributed randomly. They fall hardest on Black families and communities already facing the accumulated weight of unequal access, economic stress, environmental burdens and underinvestment.
8. Louisiana’s maternal mortality crisis is among the worst in the country.
The report’s maternal mortality findings are some of the most damning.
From 2018 to 2022, Louisiana had a maternal mortality rate of 37.3 deaths per 100,000 live births, compared with 23.2 nationally. The report also cites 2023 data showing Louisiana with the highest maternal mortality rate in the country, at 41.9 deaths per 100,000 live births.
The racial disparity is severe.
Black women accounted for 37% of births in Louisiana but 62% of maternal deaths, according to data cited from the state’s 2020 Pregnancy-Associated Mortality Review report. White women accounted for 49% of births and 35% of maternal deaths.
Many pregnancy-related deaths were considered preventable. The report points to causes including hypertensive disorders of pregnancy, thrombotic embolism and cardiovascular conditions, while also noting contributing factors such as obesity, mental health conditions, substance use disorder, postpartum care gaps and intimate partner violence.
This is where the “bad policy” part matters.
Maternal mortality is not just about what happens inside a delivery room. It is about whether people have access to doctors before pregnancy, consistent care during pregnancy, postpartum care after birth, transportation, insurance, paid leave, safe housing, protection from violence and hospitals close enough to reach in an emergency.
Louisiana’s numbers show what happens when too many systems fail at once.
9. Louisiana residents are dying too early.
The report also highlights Louisiana’s high rate of premature death.
Louisiana’s premature age-adjusted mortality rate is 543 deaths per 100,000 people, compared with 392 nationally. Black Louisianans and American Indian or Alaska Native residents face the highest premature mortality rates.
The leading causes of death in Louisiana in 2023 were heart disease, cancer and unintentional injuries. The report also notes that Louisiana has the second-highest firearm death rate, the third-highest overdose death rate and ranks first for child deaths due to firearms.
Those figures should be impossible to ignore in any serious conversation about the state’s future.
Premature death weakens families. It drains communities. It removes workers from the economy. It increases trauma, caregiving burdens and public costs.
No state can call itself “pro-family” while accepting this level of preventable loss as normal.
10. Medicaid expansion is one of Louisiana’s clearest policy success stories.
The report does identify one major area of progress: health insurance coverage.
Since Louisiana expanded Medicaid in 2016, the uninsured rate has dropped significantly. The report cites Louisiana’s uninsured rate at 5.2%, lower than the national average and far below several neighboring Southern states.
About 1.4 million people, roughly 31% of Louisiana’s population, are enrolled in Medicaid. In some rural parishes, more than half the population relies on Medicaid because private coverage is limited.
That is a big deal. Medicaid expansion did what public policy is supposed to do: it made people’s lives materially better by improving access to healthcare.
But the report also makes clear that insurance coverage alone is not enough. Rural areas still face provider shortages, hospital closures and limited obstetric care. Some communities remain maternity care deserts. Hispanic or Latino Louisianans also face a much higher uninsured rate than White or Black residents.
So Medicaid expansion helped. But Louisiana’s healthcare access problem is far from solved.
11. The report’s recommendations are not complicated. Louisiana just has to choose them.
The report recommends strengthening maternal and child health systems, especially prenatal, obstetric and postpartum care in rural areas and maternity care deserts.
It calls for targeted investments in communities facing the worst health outcomes. It recommends supporting sexual and reproductive healthcare services, including family planning, STI and HIV testing and treatment, maternal healthcare and comprehensive sex education.
It also calls for stronger rural healthcare systems, telehealth services, provider recruitment and broader investments in education, economic opportunity, housing stability and transportation.
None of this is shocking. That may be the most frustrating part.
Louisiana’s problems are not mysterious. The state needs more healthcare access, not less. More reproductive care, not less. More rural investment, not less. More support for families, not more lectures about family values from politicians unwilling to fund the systems that keep families alive.
The bottom line
The Tulane report does not say Louisiana’s decline is inevitable. In fact, Medicaid expansion shows the opposite. Good policy can improve lives.
But the report makes clear that Louisiana’s population future is tied directly to health, opportunity and quality of life.
People leave places where they cannot build stable futures. Families struggle in places where healthcare is hard to access. Mothers and infants die at higher rates when systems fail them. Rural communities shrink when hospitals close, jobs disappear and young people see no path forward.
Louisiana does not have a branding problem.
It has a governing problem.
The numbers are not subtle. The only question is whether state leaders are willing to treat them like they matter.
Read the full report below: