In November 2022, the March of Dimes (2022) published its annual report card about maternal and infant health in the United States. The report reflects national- and state-level outcomes measured against goals developed from the U.S. Department of Health and Human Services (DHHS) Healthy People 2030 targets (DHHS, 2022). A disturbing finding was that racial disparities persisted and were intensified by the COVID-19 pandemic. New this year, March of Dimes program initiatives were outlined and progress on efforts were reported at the state level (March of Dimes, 2022).
Pregnancy and Birth Outcomes
The 2021 U.S. preterm birth rate increased to 10.5%, the highest rate reported since 2007 and up from 10.1% in 2020, causing the report card grade to drop from a C- to a D+. Preterm birth rates increased in 45 states, Washington, D.C., and Puerto Rico; and decreased in four states. The highest preterm birth rates, earning a grade of F, were Georgia (11.9%), Oklahoma (11.9%), Arkansas (12.0%), Kentucky (12.0%), Puerto Rico (12.0%), South Carolina (12.1%), West Virginia (12.8%), Alabama (13.1%), Louisiana (13.5%), and Mississippi (15.0%). States with the lowest rates, earning grades ranging from an A- to B-, were Vermont (8.0%), New Hampshire (8.5%), Oregon (8.9%), Washington (8.9%), Idaho (9.0%), Massachusetts (9.0%), California (9.1%), and New Jersey (9.2%). Preterm birth data are accompanied by a disparity ratio, a measure that tracks state and national progress in eliminating racial and ethnic disparities in preterm birth (March of Dimes, 2022).
The U.S. infant mortality rate declined from 5.6 deaths per 1,000 live births in 2019 to 5.4 in 2020, with 30 states showing an improvement, 13 states unchanged, and in 8 states increases. Lowest rates (0.0 to 3.9 deaths per 1,000 live births) were in Vermont (0.0), California (3.7), Massachusetts (3.8), and New York (3.9). The highest rates were in Alabama (7.2), Arkansas (7.3), Louisiana (7.5), West Virginia (7.5), and Mississippi (8.3). Low-risk cesarean birth rates, also known as nulliparous term singleton vertex rates varied widely, with the highest rates in Alabama (29.8%), Louisiana (29.8%), New York (29.8%), Mississippi (31.2%), and Puerto Rico (47.5%); and lowest rates in South Dakota (18.2%), Idaho (19.0%), Utah (19.4%), and Alaska (19.9%). The national rate was 26.3% (March of Dimes, 2022).
Policy Advocacy
The March of Dimes (2022) supports policies aimed at improving maternal and infant health. These include enactment of The Black Maternal Health Momnibus Act of 2021, which targets legislation to improve maternal health and address racial and ethnic health care disparities; expanding Medicaid coverage to include persons up to 138% of the federal poverty level and extending postpartum coverage to 12 months. The report also called for state-level legislation to expand access to midwifery care and doula support; state funding for Maternal Mortality Review Committees and Perinatal Quality Collaboratives; a national paid family leave system; increased access to telehealth services; and support for vaccination programs.
The Maternal Vulnerability Index (MVI) was added this year, a measure reported at the county level and ranging from 0 to 100, that reflects social determinants of health affecting childbearing people and their babies. A higher MVI indicates greater vulnerability and helps to identify where pregnant persons are most vulnerable in the United States by examining 43 social, contextual, environmental, and clinical risk factors that influence health and birth outcomes (March of Dimes, 2022).
Conclusion
These data show that where people live influences pregnancy and birth outcomes. Perinatal nurses should read the full report to see all data presented. Reports like this can be used by nurses to understand issues affecting childbearing persons in their community to target local improvement initiatives and inform advocacy efforts.
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