March of Dimes Report Card: US Scores Low on Preterm Birth Rates for Fourth Year

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Last year, the US earned a D+ for preterm birth on the March of Dimes Report Card.  

The March of Dimes Report Card is an annual report that signifies where states and the rest of the country are in terms of infant and maternal mortality and morbidity.  

This year, the US is following up its last poor rating with another D+, making it the fourth consecutive year the country has earned the substandard score.  

Of the births that occurred in the US in 2024, nearly 380,000 babies were born preterm, accounting for every 1 in 10 births, according to the report.  

Let’s take a closer look at the March of Dimes Report Card and what it means for infant and maternal health in the US.  

Preterm Births in the US 

March of Dimes, which pushes for better maternal and infant health outcomes, identifies preterm birth rates as a critical health issue in its new report. 

Preterm birth means babies were born before 37 weeks gestation.  

One of the biggest contributing factors to the United States’ low rating was the fact that half of all states received a D rating or lower, with the average preterm birth rate in the US being 10.4%, according to the report. 

Many of those states were concentrated in the south. 

States that received a D (10.8 for every 100 births), D+ (10.4 for every 100 births), or D- (11.2 for every 100 births) include Texas, Oklahoma, Florida, Tennessee, and North Carolina.  

Louisiana (14 for every 100 births), Arkansas (12.1 for every 100 births), Mississippi (15 for every 100 births), Georgia (11.8 for every 100 births), Alabama (12.7 for every 100 births), and South Carolina (11.6 for every 100 births) were among the states with the worst preterm birth rates in the US, receiving a failing grade.  

Only 11 states met the Healthy People 2030 target for a preterm birth rate of 9.4% of all live births. 

Since last year, 19 states had improved preterm birth rates, 21 states had worse preterm birth rates, and 12 states had no change in preterm birth rates. 

For cities, large cities such as Baltimore (13.1), Cleveland (15.0), New Orleans (14.0), Houston (12.1), and San Antonio (12.2) had failing grades when it came to greatest number of live births born preterm in 2024.  

Those that ranked the best in preterm birth rate were Ramapo, New York (5.6), Irvine, California (6.8), and Seattle, Washington (7.9). 

Preterm Births in the US by Background, Insurance, and Lifestyles 

When it comes to preterm births by background, the preterm birth rate was significantly better among Asian (9.1 for every 100 births) and White (9.5) mothers.  

Hispanic/Latino (10.1), Pacific Islander (12.3), American Indian/Alaska Native (12.5), and Black (14.7) mothers had the worst preterm birth rates. 

Preterm birth rates were also measured by maternal insurance.  

Mothers with Medicaid were among the worst affected by preterm births (11.7).  

Conversely, those with private insurance had a preterm birth rate of 9.6. 

Higher preterm birth rates were influenced by a number of factors, including lifestyle factors such as smoking. 

According to the report, 3% of preterm births were exposed to smoking, 3.4% to hypertension, 34.8% to unhealthy weight, 1.3% to diabetes, and 10.4% to hypertension in pregnancy.  

Infant Mortality in the US 

There were over 20,000 infant deaths in the US for a rate of 5.6 deaths for every 1,000 live births.  

The majority of deaths occurred in the South and Midwest regions.  

What’s more, only 17 states managed to meet the Healthy People 2030 target for infant mortality (5.0 deaths per 1,000 deaths).  

By background, babies born to Asian, White, and Hispanic/Latino mothers had an infant mortality rate of 3.5, 2.5, and 4.9, respectfully.  

The infant mortality rate was worse among babies born to Pacific Islander, American Indian/Alaska Native, and Black mothers at 8.2, 8.6, and 10.8, respectfully.  

The leading cause of infant death was birth defects at 19.8, preterm birth and low birth weight at 17.9, sudden unexpected infant death at 16.1, and accidents at 5.7.  

Maternal Death Rates in the US 

While maternal death rates have returned to pre-pandemic rates, it’s still a persistent problem in the US with 669 deaths occurring in 2023. 

Those deaths vary by background, access to healthcare, and more.  

The maternal mortality rate was 18.6 per 100,000 live births, with deaths accounting for pregnancy and childbirth complications or within 6 weeks after pregnancy ends. 

The rate was worse among American Indian/Alaska Native women at 60.8 followed by 53.7 Black women, and 40.7 Pacific Islander. 

What’s more, Asian women had the best maternal death rate at 13.4 followed by 17.5 Hispanic/Latino, and 19.5 White women.  

Maternal Health in the US 

Many of these deaths come at a time when access to maternal healthcare is not only scarce but is being challenged in many states. 

In fact, many women are living in what are known as maternity care desert, which are classified as counties where there is limited or no access to maternity care services, including obstetric clinicians, OB/GYNs, midwives, birthing centers, and hospitals, according to March of Dimes.  

According to a 2024 March of Dimes report, 35% of countries are designated as maternity care deserts in the US, impacting 2.3 million reproductive aged women.  

Without access to maternal care, many women are delaying vital first trimester visits when mother and baby can be at their most vulnerable and giving birth in vehicles.  

The latest March of Dimes report has only 75.5% of women initiating first trimester prenatal care.  

When it comes to cesarean births, 26.6% of first-time moms are subject to a c-section birth.  

And 93.1 per 10,000 hospital deliveries result in complications that have short or long-term health consequences for the mother.  

To address some of these inconsistencies of care, many states have adopted policies that aid pregnant women and their babies.  

These policies include expanded Medicaid, extended Medicaid, doula reimbursement, paid family leave, mental health screenings, and morality review.  

Six states have adopted only two of these policies, including Texas. These states also happen to be states that have some of the worst infant and maternal health outcomes in the US.  

As of the publication of the report, 48 states have adopted Medicaid extension policies, 40 have expanded Medicaid, 25 states reimburse doulas, 9 states have implemented paid family leave, 11 states require mental health screenings, and all of the states and territories review maternal mortality.  

Improve Infant and Maternal Health in Your Community 

How does infant and maternal health stack up where you live? 

Find out by downloading a Salud America! Health Report Card for your town! 

Enter your county name and get auto-generated local data with interactive maps and comparative gauges on several health indicators. This can help you visualize and explore local issues in education, housing, transportation, food, health, and more. 

See how your county stacks up compared to the rest of your state and nation. 

Then email the Report Card to local leaders to raise awareness, include the data in a presentation or grant proposal, or share it on social media to drive healthy change in your community! 

GET YOUR HEALTH REPORT CARD!