By [Author Name], Health & Science Reporter
A stark new national report card has assigned the United States a near-failing grade for its rising rates of preterm births, signaling a deepening public health crisis that threatens infant survival and long-term developmental health. The March of Dimes’ 2024 Report Card, released this week, gave the country a “D+”—the lowest grade in nearly a decade—as the rate of babies born before 37 weeks of gestation climbed to a troubling 10.4% in 2023.
An Alarming National Trend
The annual report, which tracks birth outcomes across all 50 states and Washington, D.C., reveals that the preterm birth rate has increased for the third consecutive year. This upward trajectory reverses years of hard-won progress and places the US far behind other high-income nations. According to the March of Dimes, more than 380,000 infants were born preterm last year, representing an increase of more than 13,000 from the previous year.
Preterm birth is the leading cause of infant mortality and a major contributor to lifelong disabilities, including cerebral palsy, vision and hearing loss, and developmental delays. The financial and emotional toll on families is immense, with the Institute of Medicine estimating that the annual societal cost of preterm birth in the US exceeds $26 billion.
State-Level Disparities Worsen
The report card does more than deliver a national average—it highlights stark geographic and racial disparities. Only a handful of states, including Vermont, New Hampshire, and Oregon, earned “A” grades for achieving preterm birth rates below 9%. Conversely, five states and Puerto Rico received failing grades: Mississippi, Louisiana, Alabama, Arkansas, and West Virginia.
“These grades are a wake-up call,” said Dr. Elizabeth Cherot, President and CEO of March of Dimes, in a statement. “We are seeing persistent, unacceptable disparities in maternal and infant health that are costing lives. No mother should face a higher risk of delivering too early because of where she lives or the color of her skin.”
Indeed, the report underscores that Black women are 50% more likely to deliver preterm than white women, a disparity that remains stubbornly unchanged. The preterm birth rate among Black mothers stands at 14.6%, compared to 9.1% for white mothers and 10.2% for Hispanic mothers. These disparities persist even when controlling for income and education, pointing to systemic racism, chronic stress, and unequal access to quality prenatal care.
What Drives the Preterm Birth Epidemic?
Health experts point to a confluence of factors driving the US’s worsening preterm birth rates. Chronic maternal health conditions such as hypertension, diabetes, and obesity are on the rise, and many women enter pregnancy with poorly managed conditions. Additionally, the US has a higher rate of inductions and C-sections before 39 weeks, which can be medically necessary but are sometimes performed without clear justification.
The COVID-19 pandemic also played a role, with infection during pregnancy linked to an increased risk of preterm delivery. Furthermore, the ongoing crisis of maternal mortality—the highest among developed nations—underscores systemic failures in prenatal and postpartum care.
Calls for Systemic Change
Advocacy groups and health experts urge federal and state governments to act swiftly. Recommendations include expanding Medicaid coverage for a full year postpartum, investing in community health workers and doula programs, and enforcing hospital quality standards that limit non-medically indicated early deliveries.
Several states have already begun to respond. For example, California, which earned a “B,” has invested in maternal mortality review committees and quality improvement collaboratives. Yet, national progress remains stalled.
“We know what works,” said Dr. Cherot. “Centering equity, improving access to prenatal care, and addressing social determinants of health can change these numbers. What we need is the political will and sustained investment.”
Conclusion
The “D+” grade awarded to the United States is more than a symbol—it is a diagnostic tool that reveals a broken system. As preterm birth rates climb and racial inequities persist, the health of the next generation hangs in the balance. Without urgent, systemic intervention, the US risks falling further behind its global peers, leaving thousands of infants vulnerable to a lifetime of health challenges. The report is not a final verdict, but a pressing call to action for policymakers, healthcare providers, and communities to prioritize the health of mothers and babies.