Abstract
In July 2019, the Centers for Disease Control and Prevention released data for 2018 that indicated a rise in preterm births (birth at <37 weeks' gestation). This increase marks the fourth consecutive year that the United States has seen an increase in infants born too soon or too small. March of Dimes examined these data for its annual report card, giving the nation a "C" letter grade for this dismal outcome. This rise coincides with an ongoing increase in pregnancy-related death, the rate of which has more than doubled over the last 25 years in the United States. Racial and ethnic minorities suffer inequitably. Women of color are up to 50% more likely to give birth prematurely. Black, American Indian, and Alaska Native women are 2 to 3 times more likely to die from pregnancy-related causes than white women. A new approach is needed to address these crises. That approach must consider a range of population-based systems-level solutions.