US Earns Another Low Grade on Maternal Health

The latest March of Dimes report card showed that the US maternal and infant health crisis remains dire, with the nation earning a D+ for its 2023 preterm birth rate for the third year in a row.¹

Black birthing people continue to experience significantly worse maternal outcomes in the US. Image credit: pressmaster – stock.adobe.com

Preterm births occur when a baby is born too early, before 37 weeks of pregnancy.² Despite efforts to improve outcomes—or a lack thereof—10.4% of babies were born prematurely, translating to more than 370,000 preterm births last year.¹

The US has not gotten a grade above a C+ since 2013, as the preterm birth rate has gone up almost a whole percentage point in the past decade. The only decrease was seen in 2020 when it was 10.1%, though this was sandwiched between a rate of 10.2% the year before and 10.5% the year after.

Vermont received the only A grade in the country, with a preterm birth rate of 7.7%. Washington, Oregon, Idaho, California, New Hampshire, and Massachusetts followed closely in the B category, all keeping their rates at 9.2% and below.

Most other states fell in the C and D categories, but a concerning amount had preterm birth rates above 11.5%. South Dakota, Arkansas, Louisiana, Alabama, Georgia, South Carolina, West Virginia, and Mississippi all got Fs on their report cards, with Mississippi having the worst maternal health in the country, measured by a severely high preterm birth rate of 15%.

One-third of the 100 US cities with the most live births received an F grade for preterm birth rates in 2023. Of these 100 cities, Detroit, Michigan, had the worst rate with a 15.6%, followed by a 14.8% in Cleveland, Ohio. Only 4 of these states landed in the A range: Ramapo, New York (5.2%); Irvine, California (7.0%); Gilbert, Arizona (7.8%); and Seattle, Washington (8.1%).

The report card highlighted racial disparities in birth outcomes, with Black birthing people continuing to experience significantly worse maternal outcomes in the US. The preterm birth rate for this population was 1.4 times higher than for all others at 14.7%; Pacific Islander and American Indian/Alaska Native birthing people both had failing rates of 12.4%. Meanwhile, the rate was 10.1% among Hispanic people, 9.5% among White people, and 9.2% among Asian people.

The impact of preterm births isn’t the only alarming trend. Infant mortality, which rose in 2022 for the first time in 20 years, claimed the lives of over 20,000 babies, with the South and Midwest regions having the highest rates. Maternal mortality returned to prepandemic levels in 2022, with over 800 maternal deaths, with clear racial disparities persisting.

The Black infant mortality rate was 10.6—nearly double the national average of 5.6—and this rate was again higher for Pacific Islander and American Indian/Alaska Native birthing people. The maternal mortality rate was also highest among these 3 groups, with an obvious racial gap in this category.

One key driver of adverse outcomes is inadequate prenatal care. In 2023, 15.7% of women either received care starting after their fifth month of pregnancy or had less than half of the recommended visits. Additionally, low-risk cesarean (C-section) birth rates were high, with 26.6% of women having a C-section under conditions where a vaginal birth would be expected.

Experts say tackling these issues requires addressing chronic health conditions before pregnancy, educating communities about environmental risks, and pushing for policy reforms.

References

1. 2024 March of Dimes report card for United States. March of Dimes. November 2024. Accessed November 18, 2024. https://www.marchofdimes.org/peristats/reports/united-states/report-card
2. Preterm birth. CDC. Accessed November 18, 2024. https://www.cdc.gov/maternal-infant-health/preterm-birth/index.html