The 2023 March of Dimes Report Card: The State of Maternal and Infant Health for American Families was released today showing the U.S. preterm birth rate remains alarmingly high with data revealing persistent racial disparities across key maternal and infant health indicators. The preterm birth rate improved by a meager 1% to 10.4% from last year’s all-time high of 10.5%, earning the country a D+ grade for a second consecutive year. As the report is published, the U.S. remains among the most dangerous developed nations for childbirth with early data from the Centers for Disease Control and Prevention (CDC) showing a 3% increase in infant mortality in 2022—the largest spike in over two decades.

Preterm birth is one of the leading causes of infant death in the U.S. and globally, and the 2023 Report Card shows that 380,548 babies were born before 37 weeks, only 2,534 less babies than the previous report. Black and American Indian/Alaskan Native (AI/AN) women are 54% more likely to have a preterm birth as compared to White women. The CDC’s 2022 provisional data shows the infant mortality rate increased overall to 5.6 per 1,000 live births, with rates among babies born to Black and AI/AN moms 2.3 times higher than those born to White and Hispanic moms.

The Report Card also highlights that maternal deaths are on the rise, with the rate doubling between 2018 to 2021 from 17.4 to 32.9 deaths per 100,000 live births. Maternal mortality has increased to dangerous levels for all women, primarily due to cardiovascular conditions and hypertensive disorders. Similar to infant health, the risk of maternal death and morbidity is even higher for Black and AI/AN moms who all too often face discrimination and racism in the healthcare systems. What’s more, the Maternal Vulnerability Index reveals that states with the highest level of vulnerability and poor outcomes are in the Southeast, Appalachia, and Midwest.

“This year’s report shows the state of infant and maternal health in the United States remains at crisis-level, with grave disparities that continue to widen the health equity gap,” said Dr. Elizabeth Cherot, March of Dimes President and CEO. “We have long known that many of the factors impacting poor outcomes for moms and babies can and must be addressed if we are to reverse these trends. The fact is, we are not prioritizing the health of moms and babies in this country, and our systems, policies, and environments, as they stand today, continue to put families at great risk.”

The data continues a larger trend over the last decade that has pushed the preterm birth rate to record highs. Since last year’s report, 14 states have seen an increase in preterm birth, potentially due to factors such as inadequate prenatal care, greater rates of hypertension, and higher proportions of birthing women at an unhealthy weight. Conversely, 32 states have improved, and while many factors may influence preterm birth in each population there is no one root cause for this drop. One explanation for the overall improvement could be the difference in COVID-19 variants during the time frame the data was collected.

New to the Report Card this year are additional risk factors that impact healthy pregnancies and birth. In the U.S., over 37% of women have one or more preexisting health conditions before pregnancy that contribute to preterm birth. Women with pre-pregnancy diabetes and hypertension experienced a 28.8% and 23.4% rate of preterm birth (respectively). Additional factors that increase the likelihood of preterm birth include smoking (15.2%), unhealthy weight (12.3%), and having a previous preterm birth (30%).

2023 March of Dimes Preterm Birth grades

Each year, March of Dimes releases its Report Card with grades for individual states, Washington, D.C., Puerto Rico, and 100 cities with the greatest number of births. Between 2021 and 2022, 14 states Washington D.C., and Puerto Rico experienced an increase in preterm birth rates.

• 8 states and Puerto Rico earned an “F” (Alabama, Arkansas, Georgia, Kentucky, Louisiana, Mississippi, South Carolina, West Virginia)
• 4 states earned a “D-” (Missouri, Nebraska, Oklahoma, Texas)
• 5 states earned a “D” (Delaware, Indiana, Nevada, Ohio, Tennessee)
• 6 states earned a “D+” (Florida, Kansas, Michigan, North Carolina, South Dakota, Wyoming)
• 5 states and Washington D.C. earned a “C-” (Iowa, Maryland, New Mexico, North Dakota, Wisconsin)
• 6 states earned a “C” (Alaska, Arizona, Colorado, Hawaii, Montana, Virginia)
• 7 states earned a “C+” (Connecticut, Maine, Minnesota, New Jersey, New York, Pennsylvania, Utah)
• 3 states earned a “B-” (California, Massachusetts, Rhode Island)
• 4 states earned a “B” (Idaho, Oregon, Vermont, Washington)
• 1 state earned a “B+” (New Hampshire)
• **No states earned an “A”

Hope for change

In 2003, March of Dimes created Prematurity Awareness Month, which is recognized each November as part of the organization’s broader work to spark dialogue, advance research and programs, and advocate for policy actions. March of Dimes has published the Report Card annually since 2008 to drive greater public awareness and actions needed to spur positive change. Many of the factors that influence these poor outcomes are preventable and March of Dimes is addressing the crisis through several steps, including:

• Advancing policy initiatives intended to close the gap, expand access, and improve outcomes for moms and babies, including Medicaid postpartum extension, doula legislation, and paid family leave as well as broader expansion of midwifery.
• Championing the annual reauthorization of the Premature Research Expansion and Educate Act for Mothers (PREEMIE ACT) to expand research, education, and services to fight preterm birth.
• Supporting Prematurity Research Centers and making strategic investments in companies positioned to make real, measurable changes in maternal and infant health through our Innovation Fund.
• Expanding March of Dimes Mom & Baby Mobile Health Centers®, which serve as primary health clinics to thousands of patients, to additional cities including Phoenix, New York, and Houston.
• Working to uncover the impact of doulas and midwives in lower rates of maternal deaths and illness at the newly launched March of Dimes Health Equity Center.

March of Dimes believes maternal and infant health is fundamental to the health of our society and calls on all those impacted or concerned by this crisis to take action to improve outcomes for moms and babies. To view the Report Card and actions you can take to support moms and babies, visit marchofdimes.org/reportcard.