March of Dimes, the nation’s leader in mom and baby health, released its 2022 Report Card today, revealing that the U.S. preterm birth rate increased to 10.5% in 2021 – a significant 4% increase in just one year and the highest recorded rate since 2007.1 Despite reporting a slight decline last year, the preterm birth rate has steadily increased since 2014, earning the country a D+ grade in the Report Card. The data also shows persistent racial disparities across maternal and infant health measures that were compounded by the COVID-19 pandemic, making the U.S. among the most dangerous developed nations for childbirth.
The report shows that the number of preterm births increased from 364,487 to 383,082 for women of all races. Black and Native American women are 62% more likely to have a preterm birth and their babies are twice as likely to die as compared to White women. In 2021, preterm birth rates for Black mothers increased from 14.4% to 14.7% and increased from 11.6% to 12.3% for Native American/Alaskan Native mothers. What’s more, while Asian women saw a 3% decline in births, they had the largest increase (8%) in preterm births compared to all other women.
Several factors may contribute to the high rate of preterm births, including inadequate prenatal care and preexisting maternal health conditions such as hypertension and diabetes. Over 21.1% of Black women and 26.8% of American Indian/Alaskan Native women in the U.S. do not receive adequate prenatal care. The pandemic has further exacerbated the struggle for parents to access maternal care from hospitals and other prenatal providers.
“This year’s report sheds new light on the devastating consequences of the pandemic for moms and babies in our country,” said Stacey D. Stewart, President and CEO of March of Dimes. “While fewer babies are dying, more of them are being born too sick and too soon which can lead to lifelong health problems. Pregnant women with COVID have a 40% higher risk of preterm birth and we know more women are starting their pregnancies with chronic health conditions which can further increase their risk of complications. It’s clear that we’re at a critical moment in our country and that’s why we’re urging policymakers to act now to advance legislation that will measurably improve the health of moms and babies.”
The report also reveals that low-risk Cesarean births remain alarmingly high, with the highest rates among Black mothers (31.2%). Overall Cesarean delivery rates increased from 31.8% to 32.1% in 2021 and represent nearly one third of all births. While Cesarean birth is lifesaving in medically necessary situations, this form of delivery is a major surgery and does have immediate and long-term risks. With about eight in 10 maternal deaths now preventable according to the CDC, reducing rates of Cesarean births may reduce adverse maternal health outcomes associated with medically unnecessary Cesarean birth.
“We know that the pandemic impacted the way that providers delivered care. Low staffing, resource issues, and fears around COVID-19 transmission put added pressure on providers to get patients delivered and out of maternity units in a timely fashion, and may have also contributed to increases in use of obstetric interventions such as inductions and Cesareans,” said Dr. Zsakeba Henderson, Senior Vice President and Interim Chief Medical and Health Officer at March of Dimes. “These interventions have also been shown to contribute to the rise in preterm births, especially late preterm births.”
For this reason, March of Dimes is working to reduce adverse outcomes driven by non-medically indicated inductions and Cesareans.
March of Dimes recognizes that the maternal and infant health crisis does not have one root cause or a singular solution. Present day structures and systems rooted in racist, biased and unfair policies and practices over centuries contribute to and magnify racial differences in access to resources, social conditions and opportunities.
To better understand and address the social drivers to healthcare, this year’s report includes the Maternal Vulnerability Index (MVI) – a new measure of the contextual, clinical, and social determinants of health that impact pregnant people and their babies. Developed by Surgo Ventures, the MVI is the first county-level, national-scale, open-source tool to identify where and why moms in the U.S. are vulnerable to poor health outcomes. It explores 43 indicators across six themes, including reproductive health care, physical health, mental health and substance use, general health care, socioeconomic determinants, and environmental factors. The MVI shows that while some parts of the country are more vulnerable, 4 out of 5 counties have some aspect of maternal health that can be improved. Black women in the lowest vulnerability counties are still at higher risk of death and poor outcomes than White women living in the highest vulnerability counties.
Supplemental Report Cards also provide an in-depth analysis of the national and state maternal and infant health data found in the report. New this year, the reports include a summary of March of Dimes programmatic initiatives and legislative advocacy efforts in each state.
2022 March of Dimes Preterm Birth Grades
Each year, the March of Dimes releases its Report Card with grades for individual states, Washington, D.C., Puerto Rico and the 100 cities with the greatest number of births. Between 2020 and 2021, 45 states, Washington D.C. and Puerto Rico experienced an increase in preterm birth rates.
- 9 states and Puerto Rico earned an “F” (Alabama, Arkansas, Georgia, Kentucky, Louisiana, Mississippi, Oklahoma, South Carolina, West Virginia)
- 4 states earned a “D-” (Missouri, Nevada, Tennessee, Texas)
- 6 states earned a “D” (North Carolina, Nebraska, Florida, Indiana, Delaware, Wyoming)
- 5 states earned a “D+” (Ohio, Illinois, Michigan, Maryland, South Dakota)
- 2 states and Washington D.C. earned a “C-“(Hawaii, Alaska)
- 11 states earned a “C” (Arizona, Colorado, Iowa, Kansas, Montana, New Mexico, New York, Pennsylvania, Utah, Virginia, Wisconsin)
- 5 states earned a “C+” (North Dakota, Connecticut, Maine, Minnesota, Rhode Island)
- 4 states earned a “B-” (New Jersey, Massachusetts, California, Idaho,)
- 2 states earned a “B” (Washington, Oregon)
- 1 state earned a “B+” (New Hampshire)
- 1 state earned an “A-” (Vermont)
Actions to Address the Crisis
Alongside the release of the report, March of Dimes is delivering the Mamagenda for #BlanketChange, an emergency call-to-action to Congress to improve the health of moms and babies. The Mamagenda calls for immediate action to advance policies that support equity, access and prevention, advocating for the enactment of the Black Maternal Health Act of 2021 (H.R. 959/S. 346) and the Pregnant Workers Fairness Act (H.R. 1065/S.1486) to help prevent racial and ethnic discrimination in maternity care, expand access to midwifery care, provide reimbursements for doula support, and more. It calls for adopting Medicaid expansion and permanently extending Medicaid postpartum coverage to 12 months as authorized under the American Rescue Plan Act. Additionally, the Mamagenda calls for funding for Maternal Mortality Review Committees and Perinatal Quality Collaboratives that work to improve data collection for maternal deaths and make improvements in quality of care and maternal and infant health outcomes.
Visit BlanketChange.org to learn more and join the growing number of partners committed to improving maternity care for all.
New App and Additional Support for Families
March of Dimes supports families every day through programs, education, research and advocacy to ensure all moms and babies thrive. Toward that end, the organization today introduced Compass by March of Dimes, a new app that provides essential parenting resources to families navigating their parenting journey. The app includes a baby care tracker and can be downloaded from the App Store or Google Play. March of Dimes also recently updated its website – a resource that features timely health information and tools for expecting parents – to create a cohesive experience that further ensures all resources are more accessible and available for families.
Additionally, March of Dimes is expanding its Mom & Baby Mobile Health Centers that are serving as primary health care clinics for thousands of pregnant women and children in Southeast Ohio, Arizona and the Washington, DC. area. UnitedHealthcare Community Plan of Arizona is donating $800,000 to expand Arizona’s Mobile Health Centers, aiming to improve health outcomes for women and babies in the state. Also, a mobile health unit will be added early next year to serve families in New York.
To download the full 2022 Report Card, visit: marchofdimes.org/report-card
About March of Dimes
March of Dimes leads the fight for the health of all moms and babies. We support research, lead programs and provide education and advocacy so that every family can have the best possible start. Building on a successful 84-year legacy, we support every pregnant person and every family. To learn more about March of Dimes, please visit marchofdimes.org.