March of Dimes 2019 Report Card Shines Spotlight on the U.S. Maternal and Infant Health Crisis

ARLINGTON, Va., Nov. 4, 2019 /PRNewswire/ -- March of Dimes, the nation's leader in the fight for the health of all moms and babies, issued the 2019 March of Dimes Report Card that for the first time reveals the nation's current state of maternal and infant health. This new Report Card provides a more comprehensive view of the health of moms and babies?as their health is deeply intertwined?across the country, for major cities, each state, the District of Columbia, Puerto Rico and the U.S. overall.

The Report Card shows that for the fourth year in a row, more babies in the U.S. (approximately one in 10) were born too soon. With the rate of preterm birth increasing from 9.63 percent in 2015 to 10.02 percent in 2018, the nation once again earned a "C" grade. Beside the increasing rates of preterm birth, each year, more than 22,000 babies die in the U.S. before their first birthday?that is two babies every hour. The rates of maternal death and severe pregnancy complications also are unacceptably high. The U.S. is among the most dangerous developed nations in which to give birth.

"Every American should be alarmed about the state of maternal and infant health in this country, because it is an issue that touches each one of us. This is one crisis, not two. The health of moms and babies is powerfully linked, and we need to start treating it as such," said Stacey D. Stewart, President and CEO of March of Dimes.

Approximately every 12 hours a woman dies due to complications resulting from pregnancy (more than 60 percent of these deaths are preventable) and thousands of others face life-threatening health challenges. Significant racial disparity in maternal mortality exists with Black women being three to four times more likely to die from pregnancy compared to White women.^{i ii}

"We designed this year's Report Card to better understand why we are facing this disturbing reality by examining preterm birth rates and the health of moms," said Rahul Gupta, MD, MPH, MBA, FACP, Chief Medical and Health Officer, Senior Vice President of March of Dimes. "Only by evaluating the health of moms and babies together across the continuum of care can we tackle this maternal and infant health crisis." 

State and City Preterm Birth Ratings

The Report Card shows that overall preterm births worsened in 30 states, with six states earning a failing grade compared to only four last year.

• 6 states and Puerto Rico earned a "F" (Alabama, Arkansas, Georgia, Louisiana, Mississippi, West Virginia)
• 3 states earned a "D-" (Kentucky, Oklahoma, South Carolina)
• 2 states earned a "D" (Tennessee, Texas)
• 4 states earned a "D+" (Illinois, Nebraska, Missouri, North Carolina)
• 6 states and Washington, D.C. earned a "C-" (Florida, Hawaii, Indiana, Maryland, Nevada, Ohio)
• 5 states earned a "C" (Iowa, Michigan, New Mexico, Wisconsin, Wyoming)
• 11 states earned a "C+" (Alaska, Arizona, Connecticut, Delaware, Kansas, New Jersey, North Dakota, Pennsylvania, South Dakota, Utah, Virginia)
• 5 states earned a "B-" (Colorado, Idaho, Rhode Island, Montana, New York)
• 4 states earned a "B" (California, Maine, Massachusetts, Minnesota)
• 3 states earned a "B+" (New Hampshire, Vermont, Washington)
• 1 state earned a "A-" (Oregon)

The Report Card also ranks the 100 largest U.S. cities based on their 2017 preterm birth rate. 

• The 10 cities with the highest rate of preterm births are:
• Baltimore, MD
• Baton Rouge, LA
• Birmingham, AL
• Brownsville, TX
• Cleveland, OH
• Detroit, MI
• Memphis, TN
• Milwaukee, WI
• New Orleans, LA
• St. Louis, MO
• The cities with the lowest rate of preterm births are:
• Irvine, CA
• Irving, TX
• Portland, OR
• Ramapo, NY
• San Francisco, CA

One new feature of this year's Report Card is the estimated average cost of preterm birth by state. From 2005 to 2016, the average cost of a preterm birth increased by 25 percent to $64,815. Nationally, at least one out of every three dollars spent on preterm birth is on non-clinical services such as intervention, education, social services and labor market losses.

Actions for All States to Improve Maternal and Infant Health

Beyond the cost of preterm birth, this year's Report Card includes other new features that highlight the collective factors that contribute to maternal and infant mortality and morbidity, which moms and babies face together. These additional features include more fine-grained distinctions with a plus or minus grade for preterm birth and select social determinants of health to highlight the inequalities (e.g. poverty, access to health insurance) that negatively affect moms and babies.

The Report Card also includes an added focus on maternal health as it relates to prematurity by providing solutions and policy actions that can make an impact in each state. Nationally, March of Dimes recommends the following solutions and policy actions for all states to create positive change:

• Expanding programs that work, like group prenatal care.
• Ensuring that women have access to public health insurance programs.
• Expanding Medicaid to cover individuals with incomes up to 138 percent of the federal poverty level to improve maternal and infant health.
• Making sure all women have Medicaid coverage for at least one year postpartum.
• Establishing and funding Maternal Mortality Review Committees nationwide.
• Increasing support for state-based Perinatal Quality Collaboratives, which have proven successful at improving maternal and infant outcomes by enlisting both providers and public health in improving the quality of care for moms and babies.
• Addressing chronic inequities and unequal access to quality health care.
• Reducing toxic stress, which contributes to maternal and infant health complications.
• Addressing implicit bias and structural racism in health care and community settings.

It's Not Fine. But It Can Be.

March of Dimes remains adamant that the poor state of maternal and infant health in the U.S. is unconscionable and must be addressed. This Report Card is a public call to action at the national, state and city levels to fight for the health of all moms and babies.

Join the fight by participating in the March of Dimes #ItsNotFine campaign during #PrematurityAwarenessMonth. Visit MarchofDimes.org to learn more about the actions you can take, including:

• Advocate by signing a petition to encourage lawmakers to improve the health of moms and their babies by passing a comprehensive bill to fight for the health and lives of moms. Visit MarchofDimes.org/ActionCenter to speak up and on social media use #BlanketChange.
• Donate at MarchofDimes.org or create your own #DIYfundraising campaign. Your donation could help in ways such as:
• $25: Provide a meal to a family with a baby staying in the NICU.
• $50: Help NICU babies build bonds with their families through programs that give parents the chance to nurture them, even through a hospital stay.
• $75: Provide quality prenatal care to a mom at risk.

ⁱ Creanga AA, Berg CJ, Syverson C, Seed K, Bruce FC, Callaghan WM. Pregnancy-related mortality in the United States, 2006-2010. Obstet Gynecol 2015;125(1):5-12.
ⁱⁱ Callaghan WM. Overview of maternal mortality in the United States. Semin Perinatol 2012;36(1):2-6.

SOURCE March of Dimes