"Alarmingly High" Rate of Preterm Births Earns US a D+ From March of Dimes

Despite its status as one of the wealthiest nations in the world, experts say America’s health care system is in need of major improvements.

That’s especially true for mothers and infants. Case in point: March of Dimes, the nonprofit organization devoted to "creat[ing] a world where every mom, baby and family is healthy and strong," recently issued its 2024 Report Card for the U.S. The average overall preterm birth rate of 10.4% scored a grade of D+, per the organization, which also calculated America’s infant mortality rate at 5.6 deaths per 1,000 births.

The D+ grade has remained the same now for three years in a row.

March of Dimes issues the US a D+ for high preterm birth rate

Preterm births are live births that occur before 37 weeks of pregnancy, as defined by the World Health Organization (WHO). Preterm birth can be very dangerous for children and is, according to the WHO, the leading cause of death in children under the age of five around the world. Preterm birth can also be associated with an increased risk of lifelong disabilities, including cerebral palsy, anxiety, depression, attention deficit hyperactivity disorder (ADHD) and more.

That’s why a preterm birth rate of 10.4%, which represents more than one in every ten live births, is "alarmingly high," as the March of Dimes puts it. While some states fared better than others, only a single state — Vermont — earned an A from the organization. The Green Mountain State’s preterm birth rate is 7.7%, the lowest in the nation. Its neighbor, New Hampshire, is the runner-up with a preterm birth rate of 8.3% (score: B+).

Meanwhile, Southern states saw the highest preterm birth rates (and lowest grades), with Arkansas, Louisiana, Mississippi, Alabama, Georgia and South Carolina all seeing rates of 11.5% or greater and scoring F’s. Outside of the Southeast, South Dakota, West Virginia and the territory of Puerto Rico also fell into this category. Only seven states earned a B- or higher.

Perhaps unsurprisingly, given the United States’ standing precedent of racial health care disparities, minority ethnic groups saw worse outcomes in many cases. For instance, the preterm birth rate among Black babies — the highest in the country — is 1.4% higher than the rate among all others. Pacific Islanders, American Indians and Alaskan Natives and Hispanic infants all experienced higher rates of preterm birth than White children, according to the March of Dimes report.

Achieving equity — and affordability — in US maternal and infant care

While the March of Dimes’ findings are dire, the organization does provide recommended policy actions — along with detailed data by state — in its full 2024 Report Card. Chief among these is a push to remove regulatory barriers that make it difficult for midwives to offer optimal care to those who need it most.

The organization also calls for a Medicaid maternity coverage extension to 12 months or longer postpartum in every state, in order to help ensure those who experience complications after birth have access to potentially lifesaving care. (In most cases, Medicaid maternity coverage ends 60 days after birth is given.)

New research indicates that digital tools may make maternal health care more equitable and accessible, though such changes are incremental and imperfect. Additionally, those who are pregnant or planning to become pregnant might take the time to research the best health insurance plans ahead of growing their family. Coverage is important: Per 2022 data from KFF, the average costs of childbirth, including pregnancy and postpartum care, can easily approach $20,000 for the uninsured.

In a moment when millions of Americans are at risk of losing their health insurance coverage, planning ahead is more important than ever — no matter your family plans. Open enrollment for marketplace plans lasts now through Jan. 15 in most states, but if you want coverage as the new year begins, you’ll want to finalize your choice by Dec. 15.