March of Dimes: U.S. gets D+ in preterm birth rates, maternal equity

U.S. defined by disparities in birthing outcomes

It is not new that racial/ethnic minorities, as well as individuals insured by Medicaid or living in rural areas, have poorer birthing outcomes.

In this year's March of Dimes report card, researchers found that the preterm birth rate by maternal race/ethnicity was steeper for Black mothers (14.7%) than for Asian or White mothers (9.1% and 9.5%, respectively).

Similar racial health disparities emerged when looking at infant mortality by maternal race/ethnicity. The infant mortality rate for babies born to Black mothers was 10.8 deaths per 1,000 live births, compared to 3.5 deaths among babies born to Asian mothers and 4.5 for babies born to White mothers.

Overall, the national infant mortality rate has declined by nearly 20% in the past two decades, but babies born to Black mothers still see about 1.9 times the national rate.

For maternal mortality, rates have returned to pre-pandemic levels, March of Dimes said, but disparities are still steep. There were 60.8 maternal deaths per 100,000 live births among American Indian/Alaska Native women, and 53.7 among Black women.

But for White women, that figure was 19.5, while for Hispanic women it was 17.5 and for Asian women it was 13.4.

It's not just race or ethnicity that predicts poor birthing outcomes. The researchers found worse preterm birth rates among mothers covered by Medicaid (11.7%) compared to those with private health insurance (9.6%).

Poor healthcare access begets poor outcomes

Suboptimal birthing outcomes are, in part, the result of poor healthcare access, March of Dimes stressed.

According to the report, the rate of inadequate prenatal care access was 16.1%. The organization defined inadequate prenatal care as "the percentage of babies whose mom received care beginning in the fifth month or later or less than 50% of the appropriate number of visits for the infant's gestational age."

Similarly, the rate of first-trimester initiation of prenatal care was 75.5%, meaning around a quarter of moms didn't start getting prenatal care during their first trimester.

Access to adequate and appropriate prenatal care is critical, as it allows for patient education and engagement, as well as for providers to flag pregnancy risk factors, such as smoking, hypertension, unhealthy weight, diabetes and hypertension in pregnancy.

Without regular access to prenatal care, these risk factors may slip through the cracks and affect birthing outcomes.

Key policy actions could support better birthing outcomes

According to March of Dimes, numerous public policy programs could support better birthing outcomes, but those programs aren't adopted equally across U.S. states.

The good news is there is widespread adoption of some programs, such as mortality review, which has been implemented in all 50 states, D.C. and Puerto Rico. Another 40 states and Washington D.C. have adopted Medicaid expansion, which March of Dimes said promotes better healthcare access before, during and after pregnancy.

Finally, 48 states and D.C. have adopted policies that extend Medicaid coverage for women up to one year postpartum.

But other policies aren't as popular.

For example, only about half of states, plus Washington D.C., have adopted reimbursement for doula care, despite the fact that doulas are linked to a more sustainable maternal care workforce and better outcomes. Only 11 states require and reimburse for maternal mental health screenings, despite mental health conditions being the leading underlying cause of pregnancy-related death in the U.S.

Meanwhile, only nine states, plus D.C., have adopted policies mandating up to 12 weeks of paid family leave.

Notably, some states have made more progress in adopting birthing-friendly policies than others. Many states in the West and Northeast have adopted five or six birthing-friendly policies, while many in the Southeast have adopted around two or three. In the Midwest, policymakers have enacted three or four policies.

The piecemeal approach to supportive maternal and infant health policies contributes to the geographic and racial disparities observed in birthing outcomes.

"This year's Report Card shows that while we remain stalled in our progress on preterm birth, we are also losing ground in other critical areas of maternal and infant health," Cindy Rahman, president and CEO of March of Dimes, said in the press release.

"Our country is stuck in a maternal and infant health crisis where too many families are being forgotten," Rahman continued. "We must confront the systemic inequities that leave families of color and those covered by Medicaid at higher risk, improve access to early prenatal care, and tackle the growing burden of chronic disease -- because every mom and baby deserves the chance for a healthy start."

Sara Heath as reported news related to patient engagement and health equity since 2015.