Preterm births are on the rise in the United States and have now reached their highest rate since 2007, according to a new report from March of Dimes—underscoring a growing need to improve maternal and infant health in the country.

Preterm births are worsening in the US

In its 2022 Report Card, March of Dimes graded all 50 U.S. states, the District of Columbia, and Puerto Rico on several measures related to maternal and infant health, including preterm birth and infant mortality rates.

The report found that the U.S. preterm birth rate in 2021 was 10.5%, a 4% increase from the year before and the highest rate measured since 2007. Across the country, preterm birth rates increased in 45 states, as well as the District of Columbia and Puerto Rico. Overall, the United States saw its grade on preterm births fall from a C- to a D+ according to the report's scale.

Of all the jurisdictions included, only one state, Vermont, received an A grade, meaning that its preterm birth rate was between 7.7% and 8.1%. Seven states, including California, Oregon, and Washington, received a B grade (8.2% to 9.2%), while 18 states, including Alaska, Hawaii, and Colorado, received a C grade (9.3% to 10.3%)

The remaining states either received a D grade (10.4% to 11.4%) or an F grade (greater than or equal to 11.5%).

The report also found that racial disparities in maternal and infant health have continued to widen. For example, infants born to Black and Native American mothers are 62% more likely to be born preterm than infants who are born to white women.

"I can't help but highlight the fact that there are huge disparities of preterm birth and that states with the highest populations of, for example, Black mothers and American Indian and Alaska Native-born mothers have the worst grades," said Zsakeba Henderson, SVP and interim chief medical and health officer at March of Dimes. "We also noted persistent racial disparities across maternal and infant health measures that we believed were heightened by the impacts of the COVID-19 pandemic."

The United States' disparity ratio worsened when compared to a baseline from 2012-2014. The states with the highest level of disparities were New York, Wisconsin, and Mississippi, and the states with the lowest were New Hampshire, South Dakota, and Oregon.

However, one encouraging sign for maternal and infant health was a slight decline in infant mortality. Between 2019 and 2020, the infant mortality rate decreased from 5.6 deaths per 1,000 live births to 5.4 deaths. In addition, the report found that 30 states improved their infant mortality rates.

How to improve the preterm birth rate

To improve access to care and health outcomes for mothers and children, March of Dimes has advocated for several policy changes, especially in underserved communities.

The group has advocated to expand Medicaid, which currently covers around 40% of births in the country, to reduce the number of uninsured people, and extend the postpartum coverage period, which would grant more people access to necessary care for longer.

Other potential policies include reimbursing midwifery care and doula services. Currently, only 37 states cover midwifery care and only eight reimburse doula supports.

Preventive measures, such as maternal mortality review committees, better public health infrastructures, and systems for paid family leave, could also help improve care. In addition, 46 states and the District of Columbia currently have perinatal quality collaboratives that work to identify and enact different actions to reduce risks to maternal and infant health.

"Everyone came into this world through birth. Everyone has been born and everyone has a mom. So this is something that I think is a universal issue that crosses the aisle," Henderson said. "Our country, unfortunately ... is one of the least safe places to give birth and be born. And ... there are policy solutions that [lawmakers] can enact to help solve some of the problems that we're seeing." (Treisman, NPR, 11/15; 2022 March of Dimes Report Card, accessed 11/15)