Maternal and infant health in the United States remains in crisis, according to the 2022 March of Dimes Report Card, which gives an overall grade of D+ for preterm birth rates in 2021 compared to C- in 2020. Puerto Rico, Washington, DC, and 45 states all saw increases in preterm births while four states had decreases. On the positive side, the report noted a small decline (from 5.6 to 5.4 deaths per 1,000 live births) in U.S. infant mortality from 2019 to 2020, with 30 states posting improvement, 13 unchanged, and eight worsening.

The report attributes these results to multiple factors, including poor access to maternal health services in rural and underserved communities, inadequate insurance coverage for comprehensive prenatal and postpartum care, and the persistence of racial inequities in maternal care, with Black and Native American women 62% more likely than White women to have preterm births.

Each state was graded in terms of overall preterm births, preterm births by race and ethnicity, and infant mortality. The report examines the known determinants of maternal health and also uses a new metric, the Maternal Vulnerability Index, based on county-level data to analyze clinical, social, and environmental risk factors that influence health outcomes. Individual grades were also given to the 100 U.S. cities with the most live births.

The report's policy recommendations mainly focus on prevention and include addressing disparities in maternal and infant health outcomes by expanding midwifery care in all states, reimbursing for doula care, and permanently extending Medicaid postpartum coverage to 12 months. States should fund committees and collaboratives that identify and address trends in adverse health outcomes for mothers and infants. For example, maternal mortality review committees would investigate every maternal death and implement strategies to prevent them. Other recommended prevention measures include paid family leave and providing vaccination and telehealth services for pregnant women.

Learn how your state measures up by reading the full report at http://www.marchofdimes.org/sites/default/files/2022-11/March-of-Dimes-2022-Full.-Gail M. Pfeifer, MA, RN