March of Dimes, the nation’s leader in mom and baby health, released its 2021 Report Card revealing that for the first time in six years, the U.S. preterm birth rate declined slightly from 10.2% to 10.1%, with the nation keeping it’s C- grade. In Florida, preterm births decreased slightly from 10.6% to 10.5% in 2020, again earning the state a D+ grade on this year’s Report Card. Despite fewer preterm births and a continued decline in infant deaths nationwide, maternal deaths and women suffering from severe health complications due to pregnancy are continuing to rise. More than 700 women in the U.S. die from pregnancy-related causes each year and over the last 30 years these deaths have more than doubled.
These statistics are far worse for moms and babies of color, as deeply entrenched structural racism is directly impacting their health. In Florida, there is much work to be done as the preterm birth rate among Black women is 53% higher than the rate of all other women.
The Report Card highlights the stark disparities that cut across all measures of maternal and infant health and outlines the policy actions and partnerships needed to improve the health of our nation’s families. A challenge as complex as the maternal and infant health crisis in Miami, for example, requires the dedication and resources of cross-sector partners working together. Over the past several months, March of Dimes has formed partnerships with the local community and public and private organizations to improve the health of all moms and babies. Through a multi-year effort, the partners of the Local Collective Impact Initiative in Miami, one in Broward County and seven others throughout the country, will align on the underlying challenges affecting moms and babies locally, establish a shared vision, and build infrastructure and partnerships to deploy strategies and solutions that can drive improved, measurable health outcomes.
Stakeholders in Miami finalized a common agenda to guide their work that includes a main objective of ensuring all women and birthing people, especially those who identify as Black and/or Hispanic, in Miami Dade County are healthy before, during and after pregnancy and have positive birth outcomes. The agenda focuses on work in three areas: increasing access to affordable, equitable & respectful care; helping families achieve economic independence; and building safe, connected, and supportive communities.
Even before the COVID-19 pandemic, the U.S. remained among the most dangerous developed nations for childbirth. The Report Card shows the number of preterm births fell in the U.S. from 383,061 to 364,487, but Black and American Indian/Alaska Native women are still up to 60% more likely to give birth preterm compared to White women. We see the same disparities trend with infant death, which has slowly declined over the past several years. However, Black and American Indian/Alaskan Native babies are still twice as likely as White babies to die before their first birthdays. Additionally, Black women are three times more likely to die than their White counterparts are.
The complexity of this crisis is anchored in the fact that it does not have one root cause, nor a single solution. Factors such as where a person lives and the structural and societal systems they live under all impact the health of moms and babies and lead to a health equity gap. For example, in Florida, 17.4% of women receive inadequate prenatal care during their pregnancy. More research and data collection are needed to better understand and track changes in preterm birth rates during the COVID-19 pandemic. For that reason, March of Dimes is working to develop a greater understanding of late-preterm birth and the data during the pandemic overall.
“While we’ve seen a small improvement in preterm births and infant deaths, communities of color are still disproportionately impacted,” said March of Dimes President and CEO Stacey D. Stewart. “We see these same disparities trend with maternal health and are a result of a complex web of factors that are fueling this health equity gap. We know it is possible for every family to have a healthy start and we must work together to change the course of this crisis to ensure that they all do.”
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. These policies that have systematically disadvantaged under-resourced and communities of color over centuries result in persistent, inequitable poor maternal and infant health outcomes for communities of color.
In an effort to address these racial disparities and understand all factors that lead to them, the Report Card features several new measurements aimed to improve birth outcomes and reduce rates of maternal death and illness, including:
- The CDC’s Social Vulnerability Index shows counties with populations that have higher levels of vulnerability and therefore at greater risk of poor health outcomes.
- Midwifery and Doula Care Legislation/Policies: Both of which can help improve access to care in under-resourced areas, improve birth outcomes and reduce rates of maternal death and illness. For example, the Florida Report Card shows direct entry midwives and certified nurse midwives are allowed to practice in the state. However, doulas are not covered by Medicaid.
- Low-risk Cesarean births: A cesarean birth is considered low-risk if a single infant is delivered head-first to a mom who is at least 37 weeks pregnant and has not given birth before. In 2019, one quarter of births (25.6%) were delivered by cesarean birth that were considered low-risk. Looking specifically at Florida, 29.6% of low-risk births were delivered via cesarean.
“By looking at the new social vulnerability measure, low-risk cesarean birth rates, and state adoption of doula and midwifery legislation, we are providing additional information to help us identify under-resourced areas and improve access and quality of care,” said March of Dimes Senior Vice President and Interim Chief Medical and Health Officer Dr. Zsakeba Henderson.
Dr. Henderson noted that even in low-risk women, there are multiple reasons a cesarean birth would be the safest option for mom and baby. Variations in practice patterns among hospitals nationwide may be one of the driving forces behind the overuse of this procedure.
2021 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 top 100 cities. The Report Card shows that overall preterm births worsened in 13 states, with six states and Puerto Rico earning a failing grade, including Alabama, Arkansas, L
Additionally, the Report Card looks at the 100 U.S. Cities with the greatest number of births, assigning a grade based on the preterm birth rate. The 2021 Report Card reveals Orlando received an D grade, with a rate of 11.2% for preterm birth.
Actions to Address the Crisis
March of Dimes leads the fight for all moms and babies through research, education, programs and advocacy. Since its inception, the organization has worked with a multitude of partners on the national and local levels to address the biggest threats facing moms and babies. Towards that end, March is Dimes is rallying partners to urge policymakers to prioritize the health of our nation’s families. Through our #BlanketChange policy agenda we focus on all of these policy items mentioned in our Report Card and the passage of the Black Maternal Health Momnibus Act of 2021. Join the #BlanketChange movement to demand policy makers prioritize our nation’s moms and babies and take immediate action to improve health by visiting BlanketChange.org.
In addition to the Local Collective Impact work in nine U.S. communities, March of Dimes is also working to close the health equity gap on a national level. Serving as convener, March of Dimes mobilizes partners nationally through the Mom and Baby Action Network (M-BAN). M-BAN will engage in cross-sector partnerships that invest in, influence and leverage collective action to lead broad changes in policy, research, funding and systems to address the root causes of inequities in maternal and infant health.
To view the Report Card and actions you can take to support moms and babies, visit marchofdimes.org/