Objectives To compare the fetal mortality rate in the Delta counties of a state in the Mississippi Delta region of the United States with that of the non-Delta counties of the same state. Methods Hospital discharge data for maternal hospitalizations were linked to fetal death and birth certificates for 2004-2010. Data on maternal characteristics and comorbidities and pregnancy characteristics and outcomes were evaluated. The frequency of characteristics of pregnant women and pregnancy outcomes between Delta and non-Delta areas of the state was compared. Results There were a total of 248,255 singleton births, of which 35,605 occurred in the Delta counties. Delta patients were more likely to be younger than 20 years old, African American, multigravida, Medicaid recipients, smokers, and not married (P < 0.001) when compared with the non-Delta patients. The overall odds of fetal death within Delta counties are 1.40 times (95% confidence interval [CI] 1.22-1.61) higher than the non-Delta counties, and the odds of fetal death at ≤28 weeks are 1.56 times (95% CI 1.28-1.91) higher. After controlling for maternal age, race/ethnicity, level of prenatal care, and maternal comorbidities, the odds of fetal death remained 1.21 times higher (95% CI 1.05-1.41) and 1.28 times higher at ≤28 weeks' gestational age (95% CI 1.03-1.60). Conclusions Fetal mortality is significantly greater in the Delta counties compared with the non-Delta counties, with a 21% increase in the odds of overall fetal death in the Delta counties compared with non-Delta counties and a 28% increase in the odds of fetal death at ≤28 weeks.