2019 MARCH OF DIMES
REPORT CARD

HEALTHY MOMS. STRONG BABIES.



  
   
   

 

POLICY
ACTIONS

HEALTHY
MOMS.
STRONG
BABIES.

MARCH OF DIMES REPORT CARD
RECOMMENDED POLICY ACTIONS

March of Dimes 2019 Report Card monitors progress on key indicators and actions to improve the
health of moms and babies in the U.S. Overall, the rates of maternal death and premature birth (the
leading contributor to infant death) are increasing. In specific states and among specific racial and
ethnic groups, policy changes have brought about improvements. March of Dimes recommends the
following policy actions for all states. Any policy should be rooted in addressing disparities in maternal
and infant health outcomes.

1. PROTECT COMPREHENSIVE HEALTH CARE COVERAGE FOR MOMS AND CHILDREN
Almost 90% of U.S. women will give birth during their reproductive years.1They all need
access to quality prenatal, labor and delivery and postpartum services to help prevent and
manage complications. It’s imperative that health plans continue to offer the 10 categories of
Essential Health Benefits, including maternity and newborn care, well-woman and well-child
preventive care, prescription drugs and mental health services, which are critical to the health
of both mom and baby. Lawmakers must also preserve existing consumer protections regarding
pre-existing conditions and shield families from high premiums and out-of-pocket costs and
lifetime or annual limits.

2. PROVIDE AFFORDABLE, QUALITY PUBLIC HEALTH INSURANCE PROGRAMS
TO WOMEN BEFORE PREGNANCY, AN ESSENTIAL TIME TO INTERVENE TO
ACHIEVE HEALTHY PREGNANCIES
Research shows one of the best opportunities to achieve healthy pregnancies is to improve the health
of all women before they become pregnant. Medicaid expansion to cover individuals up to 138%
of the federal poverty level can play an essential role in improving maternal and infant health. A
growing number of studies indicate that Medicaid expansion has reduced the rate of women of
childbearing age who are uninsured, improved health outcomes and helped to reduce disparities,
including lower rates of premature birth and low birthweight for Black infants in expansion states.

The uninsured rate for women of childbearing age is nearly
twice as high in states that have not expanded Medicaid
compared to those that
have expanded Medicaid
2
(16 percent vs. 9 percent).

16% vs 9%

Pew Research Center. They’re Waiting Longer, but U.S. Women Today More Likely to Have Children Than a Decade Ago. Available at:
https://www.pewsocialtrends.org/2018/01/18/theyre-waiting-longer-but-u-s-women-today-more-likely-to-have-children-than-a-decade-ago/#fn-24248-1. 2018.
1

Georgetown University Health Policy Institute, Center for Children & Families. Medicaid Expansion Fills Gaps in Maternal Health Coverage Leading to Healthier
Mothers and Babies. Available at: https://ccf.georgetown.edu/2019/05/09/medicaid-expansion-fills-gaps-in-maternal-health-coverage-leading-to-healthier-mothersand-babies/. May 2019.
2

 3. EXTEND MEDICAID COVERAGE FOR POSTPARTUM MOMS
The latest data shows that one-third of all pregnancy-related deaths happen one week to one year
after delivery.3 In too many states, Medicaid maternity coverage ends 60 days after giving birth, ending
access to care at a time when risks of maternal complications and death persist. Comprehensive health
care coverage in Medicaid should be extended to at least 12 months postpartum.

55%

of moms who were insured by Medicaid for their
4
delivery were uninsured six months after giving birth.

4. IMPROVE MOM AND BABY HEALTH THROUGH EXPANSION OF GROUP PRENATAL CARE
Studies demonstrate that group prenatal care reduces premature birth among Black women by
41%, and among women of all races/ethnicities by 33 percent, in addition to other health
benefits for both moms and babies. Enhanced reimbursement models, including delivery and
outcomes-based incentives, can encourage providers to offer it.

5. ADVANCE OUR UNDERSTANDING OF THE CAUSES OF MATERNAL DEATH
In order to implement strategies to prevent maternal death, we need to understand why moms are
currently dying before, during and after pregnancy. Maternal mortality review committees (MMRC)
investigate every instance of maternal death in a state or community, and make recommendations
to stop future tragedies. We must continue to support the work of state MMRCs to collect robust and
standardized data to inform local and national policies to address the nation’s maternal mortality crisis.

6. ELIMINATE RACIAL DISPARITIES IN HEALTH OUTCOMES FOR MOMS AND BABIES
Black, American Indian and Alaska Native women and their babies consistently have worse health
outcomes than their white peers. Implicit bias training for health care providers and increasing access
to and coverage for doula services are among the many strategies to fight unacceptable disparities.

7. REMOVE BARRIERS TO OBTAINING QUALITY CARE IN UNDERSERVED
AND RURAL COMMUNITIES

Each year in the U.S., approximately 150,000 babies are born to moms living in maternity
care deserts or communities without a hospital offering obstetric care and without any obstetric
providers.5 Women in these communities may have difficulty getting appropriate and quality care
before, during and after pregnancy. Increasing access to inpatient obstetrical facilities and qualified
obstetrical providers, including Certified Nurse Midwives, Certified Midwives and midwives whose
education and licensure meets the International Confederation of Midwives standards, is critical to
improving outcomes in these communities.
Centers for Disease Control and Prevention (CDC). Pregnancy-Related Deaths. Available at: https://www.cdc.gov/vitalsigns/maternal-deaths/index.html. May 2019.

3

Daw JR et al. Women In The United States Experience High Rates Of Coverage ‘Churn’ In Months Before And After Childbirth. Health Aff 2017 Apr 1;36(4):598-606.

4

March of Dimes. Nowhere to Go: Maternity Care Deserts Across the U.S. Available at: https://www.marchofdimes.org/materials/Nowhere_to_Go_Final.pdf. 2018.

5

 8. INCREASE INVESTMENTS IN VITAL PUBLIC HEALTH PROGRAMS TO PROMOTE HEALTHY
MOMS AND STRONG BABIES COMMUNITIES
Population-level improvements in maternal and infant health rely on a robust public health
infrastructure to detect contributors to poor outcomes, identify opportunities to address those
contributors and then mobilize providers, health systems, stakeholders and communities to take action.
We must support efforts to improve data on maternal and infant health and bolster programs focused
on implementing strategies that have shown to keep all moms and babies healthy.

DATA TO ACTION
HRSA: Healthy Start, Title V
Maternal and Child Health
Block Grant, Alliance for
Innovation on Maternal Health

DATA
CDC: maternal mortality review
committees (MMRC), Pregnancy Risk
Assessment Monitoring System (PRAMS),
National Vital Statistics System
NIH: National Institute of Child Health
and Development (NICHD), National
Institute of Environmental Health Sciences
(NIEHS), Environmental Influences on
Child Health Outcomes (ECHO)

LEGEND
Women affected
Pregnant women affected
Baby affected

CDC: Perinatal Quality
Collaboratives

 2019
REPORT
CARDS

 

 

2019
MARCH OF DIMES
REPORT CARD

This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health.
Premature birth and its complications are the largest contributors to infant
death in the U.S., and preterm birth rates have been increasing for four years.
Prematurity grades are assigned by comparing the 2018 preterm birth rate to
March of Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to
assign grades for maternal health indicators given the available data, it’s clear
that rates of maternal death and morbidity are unacceptably high. Maternal
health complications, and the social determinants of health, affect the health
and survival of both mom and baby. Highlighted on the second page are
selected actions available to states to help improve maternal and infant health.

UNITED STATES

C

10.0%

Percentage of live
births born preterm

PREMATURITY PRETERM
BIRTH RATE
GRADE

Rate

10.4

10.4

10.1

10.0

9.8

9.8

9.6

2007

9.6

9.6

9.8

9.9

10.0

2018

PRETERM BIRTH RATES AND GRADES BY STATE

MORE INFORMATION
MARCHOFDIMES.ORG/REPORTCARD
For details on data sources and calculations, see Technical Notes.
For more information on how we are working to reduce premature birth, visit www.marchofdimes.org .

©2019 March of Dimes

 UNITED STATES MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS
OF HEALTH
Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Uninsured
among women
(15-44)*

11.7

22.4

Inadequate
Prenatal Care

Rate

15

15.1

Poverty
among women
(15-44)

15.7

0

10
HP 2020

20

30

40

United States

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$65

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$21.1

The estimated societal cost per preterm birth includes medical care for premature children,
maternal delivery costs, early intervention services, special education services and lost productivity.
Cost estimate reflects 2016 adjustments to underlying estimate developed in 2005 (see technical
notes for additional details). Adjustments include birth and infant mortality rate and incidence by
gestational age, service bundle composition and costs and cost inflation.

MATERNAL AND CHILD HEALTH BLOCK GRANT

BILLION
NOT ADOPTED
in 14 STATES

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health. Future Report Cards will assess these actions.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases
healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 2019 MARCH OF DIMES REPORT CARD
RACE & ETHNICITY IN THE U.S.
Asian/Pacific Islander

8.7

Hispanic

9.4

American Indian/Alaska Native

11.3

Black
0

In the United States,
the preterm birth
rate among black
women is 49% higher
than the rate among
all other women.

9.0

White

Race/Ethnicity

Aggregate 2015-2017
preterm birth rates
are shown for each of
the five bridged racial
and ethnic groups.
The racial/ethnic
group with the
highest rate is
compared to the
combined rate for all
other racial/ethnic
groups.

13.6
5

10

15

Percentage of live births in 2015-2017 (average) born preterm

RACE & ETHNICITY DISPARITY BY STATE
The March of Dimes disparity ratio measures and tracks progress towards the elimination of racial/ethnic disparities
in preterm birth. It is based on Healthy People 2020 methodology and compares the group with the lowest preterm
birth rate to the average for all other groups. Progress is evaluated by comparing the current disparity ratio to a
baseline disparity ratio. A lower disparity ratio is better, with a disparity ratio of 1 indicating no disparity.

The U.S. disparity ratio has

Worsened

MORE INFORMATION

from baseline

MARCHOFDIMES.ORG/REPORTCARD
For details on data sources and calculations, see Technical Notes.
For more information on how we are working to reduce premature birth, visit www.marchofdimes.org .

©2019 March of Dimes

 2019 MARCH OF DIMES REPORT CARD
TECHNICAL NOTES
PREMATURE BIRTH: DEFINITION AND SOURCE

Premature or preterm birth is a birth with less than 37 weeks gestation based on the obstetric estimate of gestational age. Data used in this report
card came from the National Center for Health Statistics (NCHS) natality files, as compiled from data provided by the 57 vital statistics
jurisdictions through the Vital Statistics Cooperative Program.1 This national data source was used so that data are comparable for each state and
jurisdiction-specific report card. Data provided on the report card may differ from data obtained directly from state or local health departments
and vital statistics agencies due to timing of data submission and handling of missing data. The preterm birth rates shown at the top of report
card was calculated from the NCHS 2018 final natality data. Preterm birth rates in the trend graph are from the NCHS 2008-2018 final natality
data. County preterm birth rates are from the NCHS 2017 final natality data. Preterm birth rates for bridged racial and ethnic categories were
calculated from NCHS 2015-2017 final natality data. Preterm birth rates were calculated as the number of premature births divided by the number
of live births with known gestational age multiplied by 100.

GRADING METHODOLOGY
Expanded grade ranges were introduced in 2019. Grade ranges remain
based on standard deviations of final 2014 state and District of Columbia
preterm birth rates away from the March of Dimes goal of 8.1 percent by
2020. Grades were determined using the following scoring formula:
(preterm birth rate of each jurisdiction – 8.1 percent) / standard deviation of
final 2014 state and District of Columbia preterm birth rates. Each score
within a grade was divided into thirds to create +/- intervals. The resulting
scores were rounded to one decimal place and assigned a grade. See the
table for details.

PREMATURE BIRTH BY COUNTY
Report cards for states and jurisdictions, except District of Columbia,
display up to 6 counties with the greatest number of live births. Counties
are not displayed if the number of premature births is less than 20. Counties
are ordered alphabetically. Grades were assigned based on the grading
criteria described above. Change from previous year was calculated by
comparing the 2017 county preterm birth rate to the 2016 rate.

PREMATURE BIRTH BY CITY
Report cards for states and jurisdictions, except District of Columbia,
display the city with the greatest number of live births. Cities are not
displayed for Connecticut, Delaware, Maine, Vermont, West Virginia and
Wyoming due to limited availability of data. Grades were assigned based on
the grading criteria described above. Change from previous year was
calculated by comparing the 2017 city preterm birth rate to the 2016 rate.

PREMATURE BIRTH BY RACE/ETHNICITY OF THE
MOTHER
Mother’s race and Hispanic ethnicity are reported separately on birth
certificates. Rates for Hispanic women include all bridged racial
categories (white, black, American Indian/Alaska Native and
Asian/Pacific Islander). Rates for non-Hispanic women are classified
according to race. The Asian/Pacific Islander category includes Native
Hawaiian. To provide stable rates, racial and ethnic groups are shown
on the report card if the group had 20 or more premature births in each
year from 2015-2017. To calculate preterm birth rates on the report
card, three years of data were aggregated (2015-2017). Preterm birth
rates for not stated/unknown race are not shown on the report card.

GRADE

A
AB+
B
BC+
C
CD+
D
DF

PRETERM BIRTH RATE RANGE
SCORING CRITERIA
Preterm birth rate less than or equal to 7.7 percent
Preterm birth rate of 7.8 percent to 8.1 percent
Preterm birth rate of 8.2 percent to 8.5 percent
Preterm birth rate of 8.6 percent to 8.9 percent
Preterm birth rate of 9.0 percent to 9.2 percent
Preterm birth rate of 9.3 percent to 9.6 percent
Preterm birth rate of 9.7 percent to 10.0 percent
Preterm birth rate of 10.1 percent to 10.3 percent
Preterm birth rate of 10.4 percent to 10.7 percent
Preterm birth rate of 10.8 percent to 11.1 percent
Preterm birth rate of 11.2 percent to 11.4 percent
Preterm birth rate greater than or equal to 11.5 percent

PREMATURE BIRTH DISPARITY MEASURES
The March of Dimes disparity ratio is based on Healthy People 2020 methodology and provides a measure of the differences, or disparities, in
preterm birth rates across racial/ethnic groups within a geographic area.2 The disparity ratio compares the racial/ethnic group with the lowest
preterm birth rate (comparison group) to the average of the preterm birth rate for all other groups.
To calculate the disparity ratio, the 2015-2017 preterm birth rates for all groups (excluding the comparison group) were averaged and divided by
the 2015-2017 comparison group preterm birth rate. The comparison group is the racial/ethnic group with the lowest six-year aggregate preterm
birth rate (2010-2015) among groups that had 20 or more premature births in each year from 2010-2015. A disparity ratio was calculated for U.S.
states, the District of Columbia and the total U.S. A disparity ratio was not calculated for Maine, Puerto Rico, Vermont and West Virginia due to
limited availability of data. A lower disparity ratio is better, with a disparity ratio of 1 indicating no disparity.

MARCHOFDIMES.ORG/REPORTCARD
© 2019 March of Dimes

 2019 MARCH OF DIMES REPORT CARD
TECHNICAL NOTES
PREMATURE BIRTH DISPARITY MEASURES

Progress toward eliminating racial and ethnic disparities was evaluated by comparing the 2015-2017 disparity ratio to a baseline (2010-2012)
disparity ratio. Change between time periods was assessed for statistical significance at the 0.05 level using the approach recommended by
Healthy People 2020.2 If the disparity ratio significantly improved because the average preterm birth rate for all other groups got better, we
displayed “Improved” on the report card. If the disparity ratio significantly worsened because the lowest group got better or the average of all
other groups got worse, we displayed “Worsened” on the report card. If the disparity ratio did not significantly change, we displayed “No
Improvement” on the report card.
The report card also provides the percent difference between the racial/ethnic group with the 2015-2017 highest preterm birth rate compared to
the combined 2015-2017 preterm birth rate among women in all other racial/ethnic groups. This percent difference was calculated using only the
racial/ethnic groups displayed on the state or jurisdiction-specific report card. This difference was calculated for each U.S. state with adequate
numbers and the District of Columbia.

SELECTED SOCIAL DETERMINANTS OF HEALTH

March of Dimes recognizes the importance of certain risk factors that are associated with premature birth. Three of these contributing
factors are highlighted for each state. These risk factors are poverty in women (age 15-44 years), lack of health insurance in women (15-44
years) and inadequacy of prenatal care.
A woman was considered uninsured if she was not covered by any type of health insurance.3 The uninsured percent is calculated among
women ages 15-44. Persons in poverty are defined as those who make less than 100% of the poverty threshold established by the US
Census Bureau.4 The Federal poverty threshold for a family of three was $19,749 in 2017. Poverty is reported for women 15-44 years.
Adequacy of prenatal care is measured using the Adequacy of Prenatal Care Utilization Index, which classifies prenatal care received into 1
of 4 categories (inadequate, intermediate, adequate and adequate plus) by combining information about the timing of prenatal care, the
number of visits and the infant's gestational age.5

FINANCIAL AND ECONOMIC INDICATORS

Estimates of the national societal economic burden of preterm birth in 2005 generated for the Institute of Medicine’s (IOM) report6, Preterm
Birth:  Causes, Consequences and Prevention served as the foundation for updating costs to 2016 and for providing separate estimates for each
state and the District and Columbia (see https://marchofdimes.org/peristats/documents/Cost_of_Prematurity_2019.pdf for details)7. Costs were
updated adjusting for price changes over time and for variation in prices of services between states. Changes in the rate of preterm birth, the
distribution of preterm birth by gestational age (GA), and the rate of infant mortality by GA at the national and state levels were also
incorporated. This cost of preterm birth estimates are the most comprehensive national estimates to date, and provide the first profile of such
costs by state for every state and the District of Columbia.
Medicaid expansion is provided as not adopted, adopted and adopted but not implemented. Medicaid expansion has reduced the rates of
uninsured. Increased access and utilization of health care are significantly associated with Medicaid expansion.8
Maternal and child block grant totals are available from Fiscal Year 2019 for each state. The Maternal and Child Health Services Block Grant, Title
V of the Social Security Act, is a federal program devoted to improving the health of all women, children and families. Title V provides funding
to state maternal and child health (MCH) programs, which serve 76 million people in the U.S.9 Maternal and child (MCH) block grants are a key
federal source of support for states to improve the health of moms and babies. Other funding sources and strategies are also available to states
to make an impact on prematurity.

CALCULATIONS

All natality calculations were conducted by the March of Dimes Perinatal Data Center. Calculations for the cost of premature birth were
conducted by the University of Utah.

REFERENCES
1

National Center for Health Statistics, final natality data 2015-2018.

2 Talih

M, Huang DT. Measuring progress toward target attainment and the elimination of health disparities in Healthy People 2020. Healthy People Statistical Notes, no 27.
Hyattsville, MD: National Center for Health Statistics. 2016.

3 IPUMS-USA,
4 PUMS-CPS,

University of Minnesota, ipums.org. American Community Survey, US Census Bureau.

University of Minnesota, ipums.org. Current Population Survey, US Census Bureau.

5 Kotelchuck M. An evaluation of the Kessner Adequacy of Prenatal Care Index and a Proposed Adequacy of Prenatal Care Utilization Index. Am J Public Health 1994; 84:
1414-1420.
6Behrman RE, Stith Butler A, eds. Institute of Medicine, Committee on Understanding Preterm Birth and Assuring Healthy Outcomes. Preterm Birth: Causes, Consequences,
and Prevention. Washington, DC: The National Academies Press; 2007.
7 Waitzman

NJ and Jalali A. Updating National Preterm Birth Costs to 2016 with Separate Estimates for Individual States. Salt Lake City, UT: University of Utah; 2019.

8Kaiser

Family Foundation, https://www.kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/. Retrieved on June
30, 2019.
9Health

Resources and Services Administration. Title V Maternal and Child Block Grant Program. Available at: https://mchb.hrsa.gov/data-research-epidemiology.
Retrieved on September 12, 2019.

MARCHOFDIMES.ORG/REPORTCARD
© 2019 March of Dimes

 100 U.S. CITIES WITH THE GREATEST NUMBER OF BIRTHS
2017 PRETERM BIRTH RATES AND GRADES
March of Dimes

March of Dimes 2020 Goal: 8.1 percent
2020 Goal: 8.1 percent
100
U.S.
CITIES
WITH
THE
GREATEST
NUMBER
OF
BIRTHS
The 2019 U.S. March of Dimes Report Card assigns grades to the 100 cities withThe
the2019
greatest
number
of live Report
births
U.S. March
of Dimes
PRETERM
BIRTH
GRADES
Card
assigns
grades
100 to
cities
in 2017. Premature Birth 2017
Report Card
grades are assigned
byRATES
comparing AND
the 2017
preterm
birth
ratetointhe
a city
thewith

CITY, STATE

Ramapo, NY
Irvine, CA
San Francisco, CA
Irving, TX
Portland, OR
Seattle, WA
Santa Ana, CA
San Diego,
CA
CITY,
STATE

PRETERM
BIRTH
RATE (%)

5.4
5.6
7.8
7.9
8.1
8.1
8.2
PRETERM
BIRTH 8.5
RATE (%)8.5

A

A
AB+ B+
B+
A
A
AB
B+ B+
B+
BB

the greatest number of live births in 2017.
Premature Birth Report Card grades are
assigned
March by
ofcomparing
Dimes the 2017 preterm
birth
rateGoal:
in a city8.1
to the
March of Dimes
2020
percent
goal of 8.1 percent by 2020.
The 2019 U.S. March of Dimes Report
Card assigns
grades
to RATE
the 100
cities with
PRETERM
BIRTH
RANGE
GRADE
the
greatest
number
of live births in 2017.
SCORING
CRITERIA
Premature Birth Report Card grades are
Preterm birth rate less than or equal to 7.7 percent
assigned by
comparing the 2017 preterm
birth rate in a city to the March of Dimes
birth rate of 7.8 percent to 8.1 percent
goal of 8.1Preterm
percent
by 2020.

March of Dimes goal of 8.1 percent by 2020.

Long Beach, CA
San Jose, CA
Denver, CO
Ramapo, NY
Riverside, CA
Irvine, CA
Anaheim, CA
San Francisco, CA
Tucson, AZ
Irving, TX
Oakland, CA
Portland, OR
New York, NY
Seattle, WA
Mesa, AZ
Santa Ana, CA
Aurora, CO
San Diego, CA
Austin, TX
Long
CA
Reno,Beach,
NV
San
Jose,MN
CA
St. Paul,
Denver, CO
Vancouver, WA
Riverside, CA
Sacramento,
Anaheim,
CA CA
Spokane,AZ
WA
Tucson,
Oakland,
CA VA
Virginia Beach,
New York,TX
NY
Arlington,
Mesa, AZ
Salt Lake
City, UT
Aurora,
CO
Austin,
TX CA
Chula Vista,
Reno,
NV CA
Modesto,
St.
Paul, MN
Fontana,
CA
Fresno, CA WA
Vancouver,
Raleigh, NC
Sacramento, CA
Glendale, AZ
Spokane, WA
Los Angeles, CA
Virginia Beach, VA
Hempstead, NY
Arlington, TX
Anchorage, AK
Lubbock,
Salt
Lake TX
City, UT
Chula
Vista, CA
Brookhaven,
NY
Durham, NC
Modesto,
CA
Fontana, CA
Grand Rapids, MI
Fresno, CA
Bakersfield,
Raleigh,
NC CA
Boston, MA
Glendale,
AZ
Fort
Wayne,
Los Angeles,IN
CA
Corpus Christi, TX
Hempstead,
Tacoma, WANY
Anchorage, AK
Philadelphia,
Lubbock, TX PA
Phoenix, AZ
Brookhaven,
NY
Colorado Springs,
Durham,
NC
CO
Lexington-Fayette,
Grand Rapids, MI
KY
Bakersfield, CA
Fort Worth, TX
Boston, MA
Albuquerque,
NM
Fort
Wayne, IN
Tampa, Christi,
FL
Corpus
TX
Tacoma, WA NC
Greensboro,
Des Moines, IA
Philadelphia,
PA
Dallas, TXAZ
Phoenix,
El Paso, TX
Colorado
Springs,
NashvilleCO
Davidson, TN
Lexington-Fayette,
San Bernardino,
KY
CA
Fort Worth, TX
Jersey City, NJ
Albuquerque, NM
Charlotte, NC
Tampa, FL
Minneapolis, MN
Greensboro, NC
Stockton, CA
Des Moines, IA
Lincoln, NE
Dallas, TX
Chicago, IL
El Paso, TX
Orlando, FL
NashvilleWashington,
Davidson,
TNDC
Honolulu,
City and
San
Bernardino,
County, HI
CA
Jersey City, NJ
Kansas City, MO
Charlotte, NC
Knoxville, TN
Miami, FL MN
Minneapolis,
Louisville, CA
KY
Stockton,
Columbus,
Lincoln,
NEOH
Islip, NY IL
Chicago,
Las
Vegas,
Orlando,
FLNV
Laredo,
TX DC
Washington,
Houston,
Honolulu, TX
City and
Omaha, HI
NE
County,
Indianapolis, IN
Kansas City, MO
Tulsa, OK
Knoxville, TN
Fayetteville,
Miami,
FL NC
Wichita, KS
Louisville,
KY
Norfolk, VAOH
Columbus,
Islip,
NY
Jacksonville,
FL
Las Vegas, NV

8.6
8.6
5.4
8.6
5.6
8.6
7.8
8.7
7.9
8.8
8.1
8.9
8.1
8.9
8.2
8.9
8.5
9.0
8.5
9.0
8.6
9.1
8.6
9.1
8.6
9.2
8.6
9.2
8.7
8.8
9.3
8.9
9.3
8.9
9.3
8.9
9.0
9.3
9.0
9.3
9.1
9.4
9.5
9.1
9.5
9.2
9.5
9.2
9.6
9.3
9.6
9.3
9.7
9.7
9.3

9.3
9.8
9.8
9.3
9.4
9.8
9.5
9.9
9.5
9.9
9.5
9.9
9.6
9.9
9.6
9.9
9.7
10.0
9.7
10.1
9.8
9.8
10.1
9.8
10.1
9.9
10.2
9.9
10.2
9.9
10.3
9.9
9.9
10.3
10.3
10.0
10.4
10.1
10.4
10.1
10.4
10.1
10.4
10.2
10.4
10.2
10.5
10.3
10.5
10.3
10.5
10.3
10.5
10.4
10.6
10.4
10.6

C+
BC+C
C CC-

D

D+

10.6
10.4
10.7
10.4
10.4
10.7
10.5
10.7
10.8
10.5
10.8
10.5
10.9
10.5
10.9
10.6
11.1
10.6
11.1
10.6
11.2
11.2
10.7
11.3
10.7
11.4
10.7
11.4
10.8
11.5
10.8
11.6
10.9
10.9
11.7
11.1

A
Abirth rate of 8.2 percent to 8.5 percent
B+ Preterm
PRETERM BIRTH RATE RANGE
GRADE
SCORING CRITERIA
Preterm birth rate of 8.6 percent to 8.9 percent
B
Preterm birth rate less than or equal to 7.7 percent
A
birth rate of 9.0 percent to 9.2 percent
B- Preterm
A- Preterm birth rate of 7.8 percent to 8.1 percent
birth rate of 9.3 percent to 9.6 percent
C+ Preterm
B+ Preterm birth rate of 8.2 percent to 8.5 percent
Preterm birth rate of 9.7 percent to 10.0 percent
C
Preterm birth rate of 8.6 percent to 8.9 percent
B
birth rate of 10.1 percent to 10.3 percent
C- Preterm
B- Preterm birth rate of 9.0 percent to 9.2 percent
birth rate of 10.4 percent to 10.7 percent
D+ Preterm
Preterm birth rate of 9.3 percent to 9.6 percent
C+
Preterm birth rate of 10.8 percent to 11.1 percent
D
Preterm birth rate of 9.7 percent to 10.0 percent
C
birth rate of 11.2 percent to 11.4 percent
D- Preterm
Preterm birth rate of 10.1 percent to 10.3 percent
CPreterm birth rate greater than or equal to 11.5 percent
F
D+ Preterm birth rate of 10.4 percent to 10.7 percent
Notes:
Preterm birth rate of 10.8 percent to 11.1 percent
•D
Preterm is less than 37 weeks gestation based
on obstetric estimate of gestational age.
Preterm birth rate of 11.2 percent to 11.4 percent
• DCities represent those with the greatest
number of live births out of all cities with a
Preterm
birth rate greater
than or equal
11.5 percent
of >100,000,
as defined
by to
the
Fpopulation

D+

D

D

National Center for Health Statistics.
•Notes:
Cities are sorted by preterm birth rates and
alphabetically by city name for cities with the
• Preterm is less than 37 weeks gestation based
same preterm birth rate.
on obstetric estimate of gestational age.
• *Data for Honolulu represent the combined city
• Cities represent those with the greatest
and county of Honolulu. Data are not
number of live births out of all cities with a
comparable to past years.
population of >100,000, as defined by the
• See the U.S. 2019 March of Dimes Report Card
National Center for Health Statistics.
for more information.
• Cities are sorted by preterm birth rates and
Source:
alphabetically
city name
for cities
with the
National by
Center
for Health
Statistics,
2017
final
natality
data.birth rate.
same
preterm
by:Honolulu
March ofrepresent
Dimes Perinatal
Data city
•Prepared
*Data for
the combined
Center,
2019. of Honolulu. Data are not
and county
comparable to past years.
• See the U.S. 2019 March of Dimes Report Card
for more information.

D-

Source: National Center for Health Statistics, 2017
final natality data.
Prepared by: March of Dimes Perinatal Data
Center, 2019.

 Davidson, TN
San Bernardino,
CA
Jersey City, NJ
Charlotte, NC

10.4

Minneapolis, MN
Stockton, CA
Lincoln, NE
Chicago, IL
Orlando, FL

10.5
10.5
10.5
10.6
10.6

Washington, DC
Honolulu, City and
County,
HI
CITY,
STATE

Kansas City, MO
Knoxville, TN
Miami, FL
Ramapo, NY
Louisville, KY
Irvine, CA
Columbus, OH
San
CA
Islip,Francisco,
NY
Irving,
TX NV
Las Vegas,
Portland, OR
Laredo, TX
Seattle, WA
Houston,
TX
Santa
Ana,
Omaha,
NECA
San Diego, CA
Indianapolis, IN
Long
Tulsa,Beach,
OK CA
San Jose, CA
Fayetteville,
Denver, CO NC
Wichita,
KSCA
Riverside,
Norfolk, VA
Anaheim,
CA
Jacksonville,
Tucson,
AZ FL
Cincinnati,CA
OH
Oakland,
New Antonio,
York, NYTX
San
Mesa,
AZ
Atlanta, GA
Aurora,
Buffalo, CO
NY
Austin, TX
Oklahoma
Reno, NV City, OK
Newark,
St. Paul, NJ
MN
Toledo, OH
Vancouver, WA
Brownsville, TX
Sacramento, CA
Milwaukee, WI
Spokane, WA
Birmingham, AL
Virginia
Beach,
Memphis,
TN VA
Arlington, TX
Baton Rouge, LA
Salt
Lake City,
Baltimore,
MD UT

10.4
10.4
10.5

D

100 U.S. CITIES WITH THE GREATEST NUMBER OF BIRTHS
2017 PRETERM BIRTH RATES AND GRADES

D+

10.6
PRETERM
10.7
BIRTH
RATE (%)
10.7
10.7
10.8
5.4
10.8
5.6
10.9
7.8
10.9
7.9
11.1
8.1
11.1
8.1
11.2
8.2
11.2
8.5
11.3
8.5
11.4
8.6
11.4
8.6
11.5
8.6
11.6
8.6
11.7
8.7
11.7
8.8
8.9
11.8
8.9
11.9
8.9
11.9
9.0
12.2
9.0
12.2
9.1
12.3
9.1
12.6
9.2
12.8
9.2
12.9
9.3
13.1
9.3
13.1
9.3
13.2

National Center for Health Statistics.
• Cities are sorted by preterm birth rates and
alphabetically by city name for cities with the
same preterm birth rate.
• *Data for Honolulu represent the combined city
and county of Honolulu. Data are not
comparable to past years.
• See the U.S. 2019 March of Dimes Report Card
for more information.

A

A
B+
B

March of Dimes
2020 Goal: 8.1 percent

A- D
B+ B+

Source: National Center for Health Statistics, 2017
final natality data.
Prepared
March
of Dimes
Perinatal
Data
The 2019by:
U.S.
March
of Dimes
Report
Center,
2019.
Card assigns grades to the 100 cities with

the greatest number of live births in 2017.
Premature Birth Report Card grades are
assigned by comparing the 2017 preterm
birth rate in a city to the March of Dimes
goal of 8.1 percent by 2020.

D-

GRADE

PRETERM BIRTH RATE RANGE
SCORING CRITERIA

Preterm birth rate less than or equal to 7.7 percent
A
A- Preterm birth rate of 7.8 percent to 8.1 percent
B+ Preterm birth rate of 8.2 percent to 8.5 percent
Preterm birth rate of 8.6 percent to 8.9 percent
B
B- Preterm birth rate of 9.0 percent to 9.2 percent
C+ Preterm birth rate of 9.3 percent to 9.6 percent
© 2019 March of Dimes
Preterm birth rate of 9.7 percent to 10.0 percent
C
Notes:
•  Preterm is less than 37 weeks gestation based on obstetric estimate of gestational
C- age.Preterm birth rate of 10.1 percent to 10.3 percent
•  Cities represent those with the greatest number of live births out of all cities with a population of >100,000, as
defined by the National Center for Health Statistics.
D+ Preterm birth rate of 10.4 percent to 10.7 percent
•  Cities are sorted by preterm birth rates and alphabetically by city name for cities with the same preterm birth rate.
Preterm birth rate ofto
10.8
percent
to 11.1 percent
•  *Data for Honolulu represent the combined city and county of Honolulu. Data are
past
years.
D not comparable
•  See the U.S. 2019 March of Dimes Report Card for more information.
D- Preterm birth rate of 11.2 percent to 11.4 percent
Source: National Center for Health Statistics, 2017 final natality data.
Preterm birth rate greater than or equal to 11.5 percent
F
Prepared by: March of Dimes Perinatal Data Center, 2019.

Chula Vista, CA
New Orleans, LA
Modesto, CA
St. Louis, MO
Fontana, CA
Detroit, MI
Fresno, CA
Cleveland, OH
Raleigh, NC
Glendale, AZ
Los Angeles, CA

9.3
13.5
9.3
13.7
9.4
14.3
9.5
14.5
9.5
9.5
9.6

Hempstead, NY
Anchorage, AK
Lubbock, TX

9.6
9.7
9.7

Brookhaven, NY
Durham, NC

9.8
9.8

Grand Rapids, MI

9.8

Bakersfield, CA
Boston, MA
Fort Wayne, IN
Corpus Christi, TX
Tacoma, WA

9.9
9.9
9.9
9.9
9.9

Philadelphia, PA
Phoenix, AZ
Colorado Springs,
CO
Lexington-Fayette,
KY
Fort Worth, TX

10.0
10.1

Albuquerque, NM
Tampa, FL

10.2
10.3

Greensboro, NC
Des Moines, IA
Dallas, TX
El Paso, TX
NashvilleDavidson, TN
San Bernardino,
CA
Jersey City, NJ
Charlotte, NC

10.3
10.3
10.4
10.4

Minneapolis, MN
Stockton, CA
Lincoln, NE
Chicago, IL
Orlando, FL

10.5
10.5
10.5
10.6
10.6

Washington, DC
Honolulu, City and
County, HI

10.6

Kansas City, MO
Knoxville, TN
Miami, FL
Louisville, KY
Columbus, OH
Islip, NY
Las Vegas, NV
Laredo, TX
Houston, TX
Omaha, NE

10.7
10.7
10.8
10.8
10.9
10.9
11.1
11.1
11.2
11.2

Indianapolis, IN
Tulsa, OK

11.3
11.4

Fayetteville, NC
Wichita, KS
Norfolk, VA

11.4
11.5
11.6

Jacksonville, FL

11.7

F

B-

C+

C

10.1
10.1
10.2

C-

10.4
10.4
10.4
10.5

D

D+

10.7

D

Notes:
• Preterm is less than 37 weeks gestation based
on obstetric estimate of gestational age.
• Cities represent those with the greatest
number of live births out of all cities with a
population of >100,000, as defined by the
National Center for Health Statistics.
• Cities are sorted by preterm birth rates and
alphabetically by city name for cities with the
same preterm birth rate.
• *Data for Honolulu represent the combined city
and county of Honolulu. Data are not
comparable to past years.
• See the U.S. 2019 March of Dimes Report Card
for more information.
Source: National Center for Health Statistics, 2017
final natality data.
Prepared by: March of Dimes Perinatal Data
Center, 2019.

D-

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

ALABAMA
Percentage of live
births born preterm

F

PRETERM
BIRTH RATE

12.5%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

12.9

12.5

12.5

11.9

11.9

11.8

11.7

11.7

12.0

2008

12.0

12.5

2018

In Alabama, the
preterm birth rate
among black women
is 50% higher than
the rate among all
other women.

9.5

Hispanic

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

White

10.4

Asian/Pacific Islander

10.5
DISPARITY RATIO:

15.5

Black

0

5

10

1.28

CHANGE FROM BASELINE:

15

Percentage of live births in 2015-2017 (average) born preterm

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Baldwin

C

9.9%

Worsened

Jefferson

F

11.9%

Improved

Madison

F

12.3%

Improved

Mobile

F

13.8%

Improved

Montgomery

F

12.8%

Improved

Tuscaloosa

F

12.8%

Improved

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Birmingham

F

12.9%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 ALABAMA MATERNAL AND INFANT HEALTH:
CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
14.3

22.4

Rate

15.0
18.2

15.1

Poverty
among women
(15-44)

15.7
19.6

0

10
HP 2020

20
United States

30

40

Alabama

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$60

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$11.40

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

NOT ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

ALASKA

9.3%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

C+

PRETERM
BIRTH RATE

8.7

9.0

8.3

8.9

7.6

8.5

8.5

8.9

8.9

2008

Hispanic

9.4

Asian/Pacific Islander

9.5

Black

9.3

In Alaska, the
preterm birth rate
among American
Indian/Alaska Native
women is 48% higher
than the rate among
all other women.

10.2

DISPARITY RATIO:

American Indian/Alaska Native
0

9.0

2018

7.6

White

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

5

12.0

1.36

CHANGE FROM BASELINE:

10

Percentage of live births in 2015-2017 (average) born preterm

No Improvement

PRETERM BIRTH RATES BY BOROUGHS AND CITY
BOROUGH

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Anchorage

C

9.7%

Worsened

Bethel (Census Area)

D+

10.7%

Improved

Fairbanks North Star

A-

7.8%

Improved

Juneau

B+

8.2%

Worsened

Kenai Peninsula

A

7.5%

Improved

Matanuska-Susitna

A-

8.1%

Worsened

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Anchorage

C

9.7%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 ALASKA MATERNAL AND INFANT HEALTH:
CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
15.0

22.4

Rate

15.0
17.1

15.1

Poverty
among women
(15-44)

15.7
14.1

0

10
HP 2020

20
United States

30

40

Alaska

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$66

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$1.08

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

ARIZONA

9.5%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

C+

PRETERM
BIRTH RATE

10.2

10.1

9.7

9.3

9.2

9.1

9.0

9.1

9.1

2008

Asian/Pacific Islander

Hispanic

9.5

In Arizona, the
preterm birth rate
among black women
is 40% higher than
the rate among all
other women.

9.0
9.2

American Indian/Alaska Native

10.2

Black

DISPARITY RATIO:

12.5

0

9.3

2018

8.5

White

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

5

1.21

CHANGE FROM BASELINE:

10

Percentage of live births in 2015-2017 (average) born preterm

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Maricopa

C+

9.4%

Worsened

Mohave

B

8.6%

Worsened

Pima

B+

8.5%

Worsened

Pinal

C+

9.6%

Worsened

Yavapai

B+

8.3%

Improved

Yuma

B+

8.3%

Improved

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Phoenix

C-

10.1%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 ARIZONA MATERNAL AND INFANT HEALTH:
CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
13.0

22.4

Rate

15.0
19.4

15.1

Poverty
among women
(15-44)

15.7
18.8

0

10
HP 2020

20
United States

30

40

Arizona

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$61

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$7.39

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

ARKANSAS

11.6%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

F

PRETERM
BIRTH RATE

11.7

11.1

10.8

10.4

10.2

10.0

10.8

10.9

11.6

In Arkansas, the
preterm birth rate
among black women
is 47% higher than
the rate among all
other women.

9.9

White

10.3

American Indian/Alaska Native

11.2

Black

DISPARITY RATIO:

14.8
5

11.4

2018

8.9

Asian/Pacific Islander

0

10.8

2008

Hispanic

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

10

15

Percentage of live births in 2015-2017 (average) born preterm

1.29

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Benton

C-

10.2%

Worsened

Craighead

F

12.3%

Worsened

Faulkner

D-

11.2%

Worsened

Pulaski

F

11.5%

Improved

Sebastian

F

11.9%

Worsened

Washington

C

9.8%

Improved

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 ARKANSAS MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
10.8

22.4

Rate

15.0

20.9

15.1

Poverty
among women
(15-44)

15.7
19.3

0

10
HP 2020

20
United States

30

40

Arkansas

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$59

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$6.97

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

CALIFORNIA

8.8%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

B

PRETERM
BIRTH RATE

9.1

8.8

8.6

8.5

8.4

8.4

8.3

8.5

8.6

8.7

2008

Asian/Pacific Islander

Hispanic

In California, the
preterm birth rate
among black women
is 43% higher than
the rate among all
other women.

8.0
8.8

American Indian/Alaska Native

10.5

Black

11.9

0

8.8

2018

7.7

White

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

5

DISPARITY RATIO:

1.28

CHANGE FROM BASELINE:

10

Percentage of live births in 2015-2017 (average) born preterm

Worsened

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Los Angeles

B-

9.0%

No change

Orange

A

7.5%

Improved

Riverside

B

8.8%

Worsened

San Bernardino

C+

9.3%

No change

San Diego

B+

8.4%

Improved

Santa Clara

B+

8.4%

Worsened

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Los Angeles

C+

9.6%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 CALIFORNIA MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
8.8

22.4

Rate

15.0
9.5

15.1

Poverty
among women
(15-44)

15.7
16.0

0

10
HP 2020

20
United States

30

40

California

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$75

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$39.66

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

COLORADO

9.2%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

B-

PRETERM
BIRTH RATE

9.6

9.3

9.1

8.8

8.9

8.6

8.4

8.7

8.9

2008

Hispanic

9.1

Asian/Pacific Islander

9.2

American Indian/Alaska Native

9.2

In Colorado, the
preterm birth rate
among black women
is 31% higher than the
rate among all other
women.
10.9

Black

11.3

0

8.8

2018

8.3

White

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

5

DISPARITY RATIO:

1.23

CHANGE FROM BASELINE:

10

Percentage of live births in 2015-2017 (average) born preterm

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Adams

B+

8.4%

Improved

Arapahoe

B

8.9%

Improved

Denver

B

8.6%

Improved

El Paso

C

9.8%

Worsened

Jefferson

A

7.0%

Improved

Weld

A-

8.1%

Improved

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Denver

B

8.6%

Improved

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 COLORADO MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
9.7

22.4

Rate

15.0
15.2

15.1

Poverty
among women
(15-44)

15.7
10.9

0

10
HP 2020

20
United States

30

40

Colorado

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$60

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$7.40

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

CONNECTICUT

9.4%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

C+

PRETERM
BIRTH RATE

10.1

10.0

9.9

9.8

9.7

9.3

9.2

9.3

9.4

2008

Asian/Pacific Islander

9.5

9.4

2018

In Connecticut, the
preterm birth rate
among black women
is 42% higher than
the rate among all
other women.

8.4

White

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

8.6
10.3

Hispanic

DISPARITY RATIO:

1.22

12.6

Black

0

5

10

15

Percentage of live births in 2015-2017 (average) born preterm

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Fairfield

C+

9.4%

Worsened

Hartford

D+

10.4%

Improved

Litchfield

A-

8.1%

Worsened

Middlesex

A

7.5%

No change

New Haven

C

9.8%

Worsened

New London

A

7.6%

Improved

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 CONNECTICUT MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
7.0

22.4

Rate

15.0
10.1

15.1

Poverty
among women
(15-44)

15.7
12.7

0

10
HP 2020

20
United States

30

40

Connecticut

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$72

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$4.67

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

DELAWARE

9.6%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

C+

PRETERM
BIRTH RATE

10.1

10.0

10.1

9.3

9.5

9.4

9.3

9.9

10.1

2008

Asian/Pacific Islander

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

9.6

2018

In Delaware, the
preterm birth rate
among black women
is 41% higher than the
rate among all other
women.

7.9
9.1

White

10.2

9.3

Hispanic

DISPARITY RATIO:

0

1.31

12.7

Black

5

10

15

Percentage of live births in 2015-2017 (average) born preterm

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Kent

D

10.9%

Worsened

New Castle

C

10.0%

Improved

Sussex

C-

10.1%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 DELAWARE MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
7.5

22.4

Rate

15.0
15.6

15.1

Poverty
among women
(15-44)

15.7
13.9

0

10
HP 2020

20
United States

30

40

Delaware

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$74

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$1.99

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

C-

PRETERM
BIRTH RATE

10.1%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination
of racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing
the current disparity ratio to a baseline
disparity ratio. A lower disparity ratio is better,
with a disparity ratio of 1 indicating no
disparity.

MORE INFORMATION

12.2

Rate

11.0

10.4

11.0

9.9

10.4

9.6

10.3

10.7

2008

Asian/Pacific Islander

10.1

In District of
Columbia, the
preterm birth rate
among black women
is 65% higher than
the rate among all
other women.

8.0
9.2

Hispanic

DISPARITY RATIO:

13.2

Black
0

5

10

15

Percentage of live births in 2015-2017 (average) born preterm

1.25

CHANGE FROM BASELINE:

No Improvement

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

10.6

2018

7.4

White

RACE/ETHNICITY

PREMATURITY
GRADE

Percentage of live
births born preterm

DISTRICT OF COLUMBIA

 DISTRICT OF COLUMBIA MATERNAL AND
INFANT HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
2.9

22.4

Rate

15.0

21.3

15.1

Poverty
among women
(15-44)

15.7
15.7

0

10
HP 2020

20
United States

30

40

District of Columbia

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$75

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$6.91

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

FLORIDA

10.3%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

C-

PRETERM
BIRTH RATE

11.2

10.6

10.5

10.3

10.2

10.0

9.9

10.0

10.1

2008

Asian/Pacific Islander

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

10.2

10.3

2018

In Florida, the
preterm birth rate
among black women
is 52% higher than
the rate among all
other women.

8.9

Hispanic

9.1

White

9.1
DISPARITY RATIO:

13.8

Black

0

5

10

15

Percentage of live births in 2015-2017 (average) born preterm

1.17

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Broward

D

10.8%

Improved

Duval

F

11.7%

Worsened

Hillsborough

C-

10.1%

Worsened

Miami-Dade

C

9.8%

No change

Orange

C-

10.3%

Worsened

Palm Beach

C+

9.4%

Worsened

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Jacksonville

F

11.7%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 FLORIDA MATERNAL AND INFANT HEALTH:
CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
18.0

22.4

Rate

15.0
17.9

15.1

Poverty
among women
(15-44)

15.7
17.4

0

10
HP 2020

20
United States

30

40

Florida

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$65

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$19.44

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

NOT ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

GEORGIA

11.5%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

F

PRETERM
BIRTH RATE

11.7

11.3

11.3

11.0

10.9

10.7

10.8

10.8

11.2

2008

Asian/Pacific Islander

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

11.5

2018

In Georgia, the
preterm birth rate
among black women
is 45% higher than
the rate among all
other women.

8.5
9.4

Hispanic

11.4

9.8

White

DISPARITY RATIO:

13.9

Black

0

5

10

15

Percentage of live births in 2015-2017 (average) born preterm

1.31

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Chatham

F

11.7%

No change

Clayton

F

12.7%

Worsened

Cobb

D+

10.7%

Worsened

DeKalb

D+

10.6%

Improved

Fulton

D-

11.4%

Worsened

Gwinnett

C-

10.1%

Improved

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Atlanta

F

11.9%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 GEORGIA MATERNAL AND INFANT HEALTH:
CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
19.0

22.4

Rate

15.0
17.5

15.1

Poverty
among women
(15-44)

15.7
18.4

0

10
HP 2020

20
United States

30

40

Georgia

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$65

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$17.13

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

NOT ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

HAWAII

10.3%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

C-

PRETERM
BIRTH RATE

10.6

11.1

10.5

9.9

9.9

10.2

10.0

10.1

10.5

10.4

2008

10.3

2018

In Hawaii, the
preterm birth rate
among black women
is 27% higher than
the rate among all
other women.

7.7

White

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

10.5

Hispanic

11.3

Asian/Pacific Islander

DISPARITY RATIO:

13.0

Black

0

5

10

15

Percentage of live births in 2015-2017 (average) born preterm

1.50

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Hawaii

D+

10.5%

Improved

Honolulu

D+

10.7%

Worsened

Kauai

C-

10.1%

Worsened

Maui

B-

9.1%

Improved

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Honolulu, City and County

D+

10.7%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 HAWAII MATERNAL AND INFANT HEALTH:
CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
5.5

22.4

Rate

15.0
17.2

15.1

Poverty
among women
(15-44)

15.7
10.9

0

10
HP 2020

20
United States

30

40

Hawaii

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$73

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$2.11

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

IDAHO

B-

PRETERM
BIRTH RATE

9.0%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

9.4

9.0

8.9

8.1

8.5

9.0

8.1

8.1

8.9

2008

Asian/Pacific Islander

RACE/ETHNICITY

PREMATURITY
GRADE

Percentage of live
births born preterm

Rate

9.0

2018

In Idaho, the preterm
birth rate among
American
Indian/Alaska Native
women is 40% higher
than the rate among
all other women.

7.9
8.3

White

8.8

9.8

Hispanic

DISPARITY RATIO:

11.9

American Indian/Alaska Native

0

5

1.18

CHANGE FROM BASELINE:

10

Percentage of live births in 2015-2017 (average) born preterm

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Ada

A-

8.0%

Improved

Bannock

D+

10.6%

Worsened

Bonneville

D+

10.4%

Worsened

Canyon

C-

10.2%

Worsened

Kootenai

A

7.7%

Worsened

Twin Falls

B-

9.0%

Improved

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Boise City

A-

8.0%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 IDAHO MATERNAL AND INFANT HEALTH:
CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
16.5

22.4

Rate

15.0
11.5

15.1

Poverty
among women
(15-44)

15.7
13.0

0

10
HP 2020

20
United States

30

40

Idaho

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$55

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$3.27

MILLION
ADOPTED
BUT NOT
IMPLEMENTED

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT
The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

ILLINOIS

10.7%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

D+

PRETERM
BIRTH RATE

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

10.4

10.0

10.3

10.1

10.0

10.0

10.1

10.2

10.3

10.4

2008

10.7

2018

Asian/Pacific Islander

9.4

White

9.4

In Illinois, the
preterm birth rate
among black women
is 52% higher than
the rate among all
other women.

9.7

Hispanic

DISPARITY RATIO:
Black

0

5

10

14.3

1.14

15

CHANGE FROM BASELINE:

Percentage of live births in 2015-2017 (average) born preterm

Improved

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Cook

D+

10.4%

Improved

DuPage

C+

9.4%

Worsened

Kane

C-

10.1%

Improved

Lake

C-

10.2%

Worsened

Will

C-

10.3%

Improved

Winnebago

D-

11.2%

Worsened

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Chicago

D+

10.6%

Improved

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 ILLINOIS MATERNAL AND INFANT HEALTH:
CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
9.1

22.4

Rate

15.0
15.2

15.1

Poverty
among women
(15-44)

15.7
14.5

0

10
HP 2020

20
United States

30

40

Illinois

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$67

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$21.10

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

INDIANA

10.2%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

C-

PRETERM
BIRTH RATE

10.6

10.2

10.1

10.0

9.6

9.6

9.7

9.6

10.0

2008

Asian/Pacific Islander

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

9.8

10.2

2018

In Indiana, the
preterm birth rate
among black women
is 41% higher than the
rate among all other
women.

8.0

White

9.4

Hispanic

9.5
DISPARITY RATIO:

0

1.33

13.1

Black

5

10

15

Percentage of live births in 2015-2017 (average) born preterm

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Allen

C+

9.6%

Worsened

Elkhart

B-

9.2%

Improved

Hamilton

B

8.9%

Improved

Lake

C+

9.4%

Improved

Marion

D-

11.3%

Improved

St. Joseph

D+

10.5%

Improved

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Indianapolis

D-

11.3%

Improved

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 INDIANA MATERNAL AND INFANT HEALTH:
CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
11.1

22.4

Rate

15.0
16.3

15.1

Poverty
among women
(15-44)

15.7
14.6

0

10
HP 2020

20
United States

30

40

Indiana

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$63

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$12.27

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

IOWA

C

PRETERM
BIRTH RATE

9.9%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

9.8

9.4

9.6

9.2

9.5

9.0

9.3

9.0

9.3

2008

9.2

9.9

2018

In Iowa, the preterm
birth rate among
black women is 33%
higher than the rate
among all other
women.

8.9

White

RACE/ETHNICITY

PREMATURITY
GRADE

Percentage of live
births born preterm

Rate

9.2

Hispanic

Asian/Pacific Islander

9.8
DISPARITY RATIO:

11.8

Black

0

5

1.11

CHANGE FROM BASELINE:

10

Percentage of live births in 2015-2017 (average) born preterm

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Black Hawk

C+

9.5%

Worsened

Johnson

B+

8.3%

Improved

Linn

B

8.8%

Worsened

Polk

B-

9.1%

Improved

Scott

C-

10.3%

Worsened

Woodbury

C

10.0%

Improved

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Des Moines

C-

10.3%

Same

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 IOWA MATERNAL AND INFANT HEALTH:
CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
5.5

22.4

Rate

15.0
11.1

15.1

Poverty
among women
(15-44)

15.7
13.1

0

10
HP 2020

20
United States

30

40

Iowa

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$58

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$6.51

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

KANSAS

9.5%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

C+

PRETERM
BIRTH RATE

9.3

9.2

8.8

9.1

8.9

8.7

8.8

9.1

9.0

American Indian/Alaska Native

10.1

Black

DISPARITY RATIO:

1.19

12.8
5

9.5

In Kansas, the
preterm birth rate
among black women
is 45% higher than
the rate among all
other women.

8.8

Asian/Pacific Islander

9.6

2018

8.6

White

0

9.0

2008

Hispanic

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

10

15

Percentage of live births in 2015-2017 (average) born preterm

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Douglas

D+

10.4%

Worsened

Johnson

B-

9.0%

Worsened

Leavenworth

B+

8.3%

Improved

Sedgwick

D-

11.3%

Worsened

Shawnee

D

10.8%

Worsened

Wyandotte

D+

10.7%

Improved

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Wichita

F

11.5%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 KANSAS MATERNAL AND INFANT HEALTH:
CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
11.3

22.4

Rate

15.0
9.9

15.1

Poverty
among women
(15-44)

15.7
16.6

0

10
HP 2020

20
United States

30

40

Kansas

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$56

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$4.77

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

NOT ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

KENTUCKY

11.3%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

D-

PRETERM
BIRTH RATE

11.8

11.6

11.7

11.3

11.0

11.0

10.7

10.8

11.4

2008

Asian/Pacific Islander

11.1

11.3

2018

In Kentucky, the
preterm birth rate
among black women
is 30% higher than
the rate among all
other women.

8.6

Hispanic

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

8.9
11.0

White

DISPARITY RATIO:

14.0

Black

0

5

10

15

Percentage of live births in 2015-2017 (average) born preterm

1.26

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Boone

B-

9.0%

Improved

Fayette

C-

10.1%

Improved

Hardin

D

11.1%

Worsened

Jefferson

D

10.8%

Improved

Kenton

F

11.8%

Improved

Warren

C

9.7%

Improved

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Louisville

D

10.8%

Improved

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 KENTUCKY MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
7.0

22.4

Rate

15.0
14.0

15.1

Poverty
among women
(15-44)

15.7
18.6

0

10
HP 2020

20
United States

30

40

Kentucky

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$58

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$11.09

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

LOUISIANA
Percentage of live
births born preterm

F

PRETERM
BIRTH RATE

13.0%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

12.6

12.4

12.3

12.4

12.5

12.3

12.3

12.6

11.0

American Indian/Alaska Native

12.9

Black

DISPARITY RATIO:

16.0
5

13.0

In Louisiana, the
preterm birth rate
among black women
is 52% higher than
the rate among all
other women.

10.6

Asian/Pacific Islander

12.7

2018

9.3

White

0

12.5

2008

Hispanic

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

10

1.35

CHANGE FROM BASELINE:

15

Percentage of live births in 2015-2017 (average) born preterm

No Improvement

PRETERM BIRTH RATES BY PARISHES AND CITY
PARISH

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Caddo

F

18.1%

Worsened

Calcasieu

F

13.5%

Worsened

East Baton Rouge

F

12.7%

Improved

Jefferson

D+

10.7%

Improved

Lafayette

D+

10.6%

Improved

Orleans

F

13.5%

Worsened

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Baton Rouge

F

13.1%

Improved

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 LOUISIANA MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
10.2

22.4

Rate

15.0
14.5

15.1

Poverty
among women
(15-44)

15.7
24.5

0

10
HP 2020

20
United States

30

40

Louisiana

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$60

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$12.12

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

MAINE

B

PRETERM
BIRTH RATE

8.6%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

8.7

8.3

8.2

8.3

7.8

8.1

8.4

8.5

8.6

2008

8.7

8.6

2018

8.6

White

RACE/ETHNICITY

PREMATURITY
GRADE

Percentage of live
births born preterm

Rate

Black

9.0

0

5

10

Percentage of live births in 2015-2017 (average) born preterm

PRETERM BIRTH RATES BY COUNTIES
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Androscoggin

A-

8.1%

Improved

Aroostook

D+

10.4%

Worsened

Cumberland

A-

7.9%

Worsened

Kennebec

D+

10.5%

Worsened

Penobscot

B

8.9%

Improved

York

B-

9.0%

Improved

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 MAINE MATERNAL AND INFANT HEALTH:
CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
11.0

22.4

Rate

15.0
9.6

15.1

Poverty
among women
(15-44)

15.7
18.4

0

10
HP 2020

20
United States

30

40

Maine

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$57

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$3.31

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

MARYLAND

10.2%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

C-

PRETERM
BIRTH RATE

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

11.0

10.4

10.4

10.2

10.3

9.8

10.1

10.0

10.1

2008

10.5

10.2

2018

White

8.8

Asian/Pacific Islander

8.9

In Maryland, the
preterm birth rate
among black women
is 45% higher than
the rate among all
other women.

9.3

Hispanic

DISPARITY RATIO:

0

1.17

12.9

Black

5

10

15

Percentage of live births in 2015-2017 (average) born preterm

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Anne Arundel

C

9.8%

Worsened

Baltimore

F

11.5%

Worsened

Howard

C+

9.3%

Improved

Montgomery

B

8.9%

Improved

Prince George's

D

10.8%

Worsened

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Baltimore

F

13.2%

Improved

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 MARYLAND MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
7.7

22.4

Rate

15.0
17.7

15.1

Poverty
among women
(15-44)

15.7
9.1

0

10
HP 2020

20
United States

30

40

Maryland

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$70

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$11.76

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

MASSACHUSETTS

8.9%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

B

PRETERM
BIRTH RATE

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

8.8

8.8

8.6

8.6

8.7

8.8

8.6

8.4

8.7

2008

8.9

8.9

2018

White

7.9

Asian/Pacific Islander

8.0

In Massachusetts, the
preterm birth rate
among black women
is 31% higher than the
rate among all other
women.
9.6

Hispanic

DISPARITY RATIO:

10.9

Black

0

5

1.19

CHANGE FROM BASELINE:

10

Percentage of live births in 2015-2017 (average) born preterm

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Bristol

C+

9.4%

Worsened

Essex

B

8.9%

Improved

Middlesex

B

8.6%

Worsened

Norfolk

B+

8.4%

Improved

Suffolk

C+

9.6%

Worsened

Worcester

B+

8.2%

No change

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Boston

C

9.9%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 MASSACHUSETTS MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
3.1

22.4

Rate

15.0
11.5

15.1

Poverty
among women
(15-44)

15.7
14.6

0

10
HP 2020

20
United States

30

40

Massachusetts

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$71

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$10.93

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

MICHIGAN

10.0%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

C

PRETERM
BIRTH RATE

10.5

10.1

10.2

10.0

9.7

9.8

9.9

10.1

Hispanic

10.0

In Michigan, the
preterm birth rate
among black women
is 57% higher than
the rate among all
other women.

8.7

9.4

American Indian/Alaska Native

11.2

Black

DISPARITY RATIO:

14.3
5

10.2

2018

9.1

White

0

10.1

2008

Asian/Pacific Islander

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

10

15

Percentage of live births in 2015-2017 (average) born preterm

1.21

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Genesee

F

12.4%

No change

Kent

C

9.8%

Improved

Macomb

D-

11.2%

Worsened

Oakland

C-

10.1%

No change

Washtenaw

C+

9.3%

Improved

Wayne

F

11.8%

Worsened

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Detroit

F

14.3%

Improved

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 MICHIGAN MATERNAL AND INFANT HEALTH:
CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
6.1

22.4

Rate

15.0
12.2

15.1

Poverty
among women
(15-44)

15.7
15.6

0

10
HP 2020

20
United States

30

40

Michigan

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$64

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$18.86

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

MINNESOTA

8.9%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

B

PRETERM
BIRTH RATE

8.8

8.7

8.8

8.5

8.3

8.7

8.5

8.8

9.1

Black

9.3

American Indian/Alaska Native
5

8.9

In Minnesota, the
preterm birth rate
among American
Indian/Alaska Native
women is 67% higher
than the rate among
all other women.

8.3

Hispanic

8.9

2018

8.5

White

0

8.6

2008

Asian/Pacific Islander

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

DISPARITY RATIO:

14.4
10

15

Percentage of live births in 2015-2017 (average) born preterm

1.24

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Anoka

A-

8.0%

Worsened

Dakota

B

8.7%

Improved

Hennepin

C+

9.6%

Worsened

Olmsted

A

7.3%

Improved

Ramsey

B

8.7%

Worsened

Washington

A-

7.9%

No change

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Minneapolis

D+

10.5%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 MINNESOTA MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
5.6

22.4

Rate

15.0
11.0

15.1

Poverty
among women
(15-44)

15.7
10.7

0

10
HP 2020

20
United States

30

40

Minnesota

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$64

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$9.10

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

MISSISSIPPI
Percentage of live
births born preterm

F

PRETERM
BIRTH RATE

14.2%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

13.7

13.9

13.8

13.5

13.8

12.9

13.0

13.6

13.6

In Mississippi, the
preterm birth rate
among black women
is 44% higher than
the rate among all
other women.

9.6
9.9

White

11.4

American Indian/Alaska Native

14.6

Black

16.3
5

14.2

2018

Asian/Pacific Islander

0

13.1

2008

Hispanic

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

10

DISPARITY RATIO:

1.36

CHANGE FROM BASELINE:

15

Percentage of live births in 2015-2017 (average) born preterm

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

DeSoto

D+

10.5%

Worsened

Harrison

D+

10.6%

Improved

Hinds

F

16.2%

Worsened

Jackson

F

12.2%

Improved

Madison

F

12.9%

Worsened

Rankin

F

13.4%

Worsened

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Jackson

F

17.3%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 MISSISSIPPI MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
17.2

22.4

Rate

15.0
13.5

15.1

Poverty
among women
(15-44)

15.7
22.8

0

10
HP 2020

20
United States

30

40

Mississippi

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$58

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$9.23

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

NOT ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

MISSOURI

10.7%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

D+

PRETERM
BIRTH RATE

10.3

9.9

10.0

9.6

9.6

9.8

10.0

10.2

White

10.7

In Missouri, the
preterm birth rate
among black women
is 49% higher than
the rate among all
other women.

9.0

9.5

American Indian/Alaska Native

10.9

Black

DISPARITY RATIO:

14.2
5

10.6

2018

9.3

Hispanic

0

9.9

2008

Asian/Pacific Islander

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

10

15

Percentage of live births in 2015-2017 (average) born preterm

1.23

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Clay

B+

8.5%

Improved

Greene

C-

10.2%

Worsened

Jackson

D+

10.6%

Worsened

St. Charles

C

9.9%

Improved

St. Louis

D-

11.2%

Improved

St. Louis (city)

F

13.7%

Worsened

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Kansas City

D+

10.7%

Improved

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 MISSOURI MATERNAL AND INFANT HEALTH:
CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
13.1

22.4

Rate

15.0
15.0

15.1

Poverty
among women
(15-44)

15.7
14.6

0

10
HP 2020

20
United States

30

40

Missouri

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$59

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$12.19

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

NOT ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

MONTANA

9.1%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

B-

PRETERM
BIRTH RATE

9.9

9.0

10.1

8.8

9.4

9.0

9.3

8.4

8.8

2008

9.1

In Montana, the
preterm birth rate
among American
Indian/Alaska Native
women is 59% higher
than the rate among
all other women.

9.2

Hispanic

9.5

2018

8.2

White

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

DISPARITY RATIO:

13.2

American Indian/Alaska Native

0

5

10

15

Percentage of live births in 2015-2017 (average) born preterm

1.37

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Cascade

D

11.1%

Worsened

Flathead

A

7.5%

Worsened

Gallatin

A

7.7%

Improved

Lewis and Clark

A-

8.0%

Worsened

Missoula

A-

7.9%

Worsened

Yellowstone

C-

10.1%

Worsened

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Billings

C-

10.3%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 MONTANA MATERNAL AND INFANT HEALTH:
CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
11.3

22.4

Rate

15.0
14.4

15.1

Poverty
among women
(15-44)

15.7
14.4

0

10
HP 2020

20
United States

30

40

Montana

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$60

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$2.30

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

NEBRASKA

10.5%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

D+

PRETERM
BIRTH RATE

9.6

9.7

9.8

9.1

8.7

9.1

9.9

9.6

Hispanic

10.5

In Nebraska, the
preterm birth rate
among American
Indian/Alaska Native
women is 39% higher
than the rate among
all other women.

9.0

9.9

Black

13.1

American Indian/Alaska Native
5

9.9

2018

9.4

White

0

9.3

2008

Asian/Pacific Islander

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

13.5
10

15

Percentage of live births in 2015-2017 (average) born preterm

DISPARITY RATIO:

1.27

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Buffalo

D-

11.3%

Worsened

Douglas

D

11.1%

Worsened

Hall

B+

8.2%

Improved

Lancaster

D+

10.5%

Worsened

Madison

A-

7.8%

Worsened

Sarpy

C+

9.6%

Worsened

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Omaha

D-

11.2%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 NEBRASKA MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
12.3

22.4

Rate

15.0
15.0

15.1

Poverty
among women
(15-44)

15.7
12.6

0

10
HP 2020

20
United States

30

40

Nebraska

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$56

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$4.02
MILLION

ADOPTED
BUT NOT
IMPLEMENTED

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT
The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

NEVADA

10.1%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

C-

PRETERM
BIRTH RATE

11.2

10.8

10.9

10.5

9.8

10.1

9.9

10.4

10.7

In Nevada, the
preterm birth rate
among black women
is 41% higher than the
rate among all other
women.

9.7

American Indian/Alaska Native

10.6

Asian/Pacific Islander

10.8

Black

DISPARITY RATIO:

13.8
5

10.1

2018

9.5

White

0

10.4

2008

Hispanic

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

10

15

Percentage of live births in 2015-2017 (average) born preterm

1.04

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Carson City (city)

C

9.9%

Improved

Clark

D

11.1%

Worsened

Elko

C+

9.5%

Improved

Lyon

C+

9.5%

Improved

Nye

F

12.3%

Worsened

Washoe

C+

9.6%

Worsened

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Las Vegas

D

11.1%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 NEVADA MATERNAL AND INFANT HEALTH:
CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
15.1

22.4

Rate

15.0
17.9

15.1

Poverty
among women
(15-44)

15.7
13.7

0

10
HP 2020

20
United States

30

40

Nevada

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$65

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$2.12

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

NEW HAMPSHIRE
Percentage of live
births born preterm

B+

PRETERM
BIRTH RATE

8.3%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

8.5

8.7

8.4

8.5

8.6

8.2

8.2

7.9

7.8

2008

8.3

8.3

2018

In New Hampshire, the
preterm birth rate
among Asian/Pacific
Islander and Hispanic
women is 8% higher
than the rate among all
other women.

7.9

White

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

8.3

Asian/Pacific Islander

DISPARITY RATIO:

0

1.01

8.5

Hispanic

2

4

6

8

10

Percentage of live births in 2015-2017 (average) born preterm

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Cheshire

A-

7.9%

Improved

Grafton

B+

8.3%

Worsened

Hillsborough

B+

8.2%

Worsened

Merrimack

A

7.7%

Worsened

Rockingham

B+

8.5%

Worsened

Strafford

C

9.7%

Worsened

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Manchester

C+

9.3%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 NEW HAMPSHIRE MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
7.4

22.4

Rate

15.0
9.6

15.1

Poverty
among women
(15-44)

15.7
8.8

0

10
HP 2020

20
United States

30

40

New Hampshire

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$64

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$1.97

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

NEW JERSEY

9.5%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

C+

PRETERM
BIRTH RATE

10.5

10.0

9.7

9.9

9.7

9.7

9.6

9.8

9.9

2008

Asian/Pacific Islander

9.5

9.5

2018

In New Jersey, the
preterm birth rate
among black women
is 46% higher than
the rate among all
other women.

8.6

White

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

8.9
10.0

Hispanic

DISPARITY RATIO:

13.3

Black

0

5

10

15

Percentage of live births in 2015-2017 (average) born preterm

1.19

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Bergen

C+

9.6%

Improved

Essex

D+

10.6%

Improved

Hudson

C+

9.5%

Improved

Middlesex

B

8.9%

No change

Ocean

A

7.7%

Improved

Union

B

8.8%

Improved

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Jersey City

D+

10.4%

Improved

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 NEW JERSEY MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
10.9

22.4

Rate

15.0
15.0

15.1

Poverty
among women
(15-44)

15.7
11.0

0

10
HP 2020

20
United States

30

40

New Jersey

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$72

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$11.64

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

NEW MEXICO

9.8%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

C

PRETERM
BIRTH RATE

9.8

9.3

9.1

9.7

9.3

9.2

9.5

10.0

10.3

In New Mexico, the
preterm birth rate
among black women
is 29% higher than
the rate among all
other women.

9.1
9.8

White

9.8

American Indian/Alaska Native

10.1

Black

DISPARITY RATIO:

1.02

12.6
5

9.8

2018

Hispanic

0

9.5

2008

Asian/Pacific Islander

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

10

15

Percentage of live births in 2015-2017 (average) born preterm

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Bernalillo

C-

10.1%

Improved

Dona Ana

C+

9.3%

Worsened

Lea

F

12.0%

Worsened

San Juan

B

8.8%

Improved

Sandoval

C-

10.3%

Improved

Santa Fe

D

11.1%

Worsened

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Albuquerque

C-

10.2%

Improved

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 NEW MEXICO MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
12.4

22.4

Rate

15.0

23.1

15.1

Poverty
among women
(15-44)

15.7
22.8

0

10
HP 2020

20
United States

30

40

New Mexico

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$62

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$4.13

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

NEW YORK

9.0%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

B-

PRETERM
BIRTH RATE

9.6

9.5

9.4

9.2

9.1

8.9

8.9

8.7

9.0

2008

Asian/Pacific Islander

9.0

In New York, the
preterm birth rate
among black women
is 48% higher than
the rate among all
other women.

8.1

Hispanic

9.3

American Indian/Alaska Native

11.4

Black

12.3

0

9.0

2018

7.7

White

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

5

DISPARITY RATIO:

1.26

CHANGE FROM BASELINE:

10

Percentage of live births in 2015-2017 (average) born preterm

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Bronx

C

10.0%

Worsened

Kings(Brooklyn)

B+

8.5%

Improved

Nassau

B-

9.2%

Improved

New York (Manhattan)

B

8.6%

No change

Queens

B

8.8%

Worsened

Suffolk

C

9.9%

No change

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

New York

B

8.9%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 NEW YORK MATERNAL AND INFANT HEALTH:
CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
7.0

22.4

Rate

15.0
12.5

15.1

Poverty
among women
(15-44)

15.7
15.3

0

10
HP 2020

20
United States

30

40

New York

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$73

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$38.09

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

NORTH CAROLINA

10.4%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

D+

PRETERM
BIRTH RATE

10.7

10.6

10.4

10.2

9.9

9.7

10.2

10.4

10.4

In North Carolina,
the preterm birth rate
among black women
is 48% higher than
the rate among all
other women.

8.6
8.9

White

9.3

American Indian/Alaska Native

11.9

Black

DISPARITY RATIO:

13.8
5

10.5

2018

Hispanic

0

10.1

2008

Asian/Pacific Islander

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

10

15

Percentage of live births in 2015-2017 (average) born preterm

1.28

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Cumberland

D-

11.2%

Improved

Durham

C-

10.1%

Worsened

Forsyth

F

12.6%

Worsened

Guilford

D

10.8%

Worsened

Mecklenburg

C-

10.3%

Worsened

Wake

B

8.9%

No change

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Charlotte

D+

10.5%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 NORTH CAROLINA MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
14.9

22.4

Rate

15.0
16.3

15.1

Poverty
among women
(15-44)

15.7
18.7

0

10
HP 2020

20
United States

30

40

North Carolina

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$64

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$17.41

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

NOT ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

NORTH DAKOTA

9.6%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

C+

PRETERM
BIRTH RATE

9.8

9.2

9.7

8.5

9.1

8.5

8.4

8.4

9.1

2008

9.6

In North Dakota, the
preterm birth rate
among American
Indian/Alaska Native
women is 56% higher
than the rate among
all other women.

9.5

Hispanic

8.8

2018

8.3

White

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

DISPARITY RATIO:

0

5

1.36

13.1

American Indian/Alaska Native

10

15

Percentage of live births in 2015-2017 (average) born preterm

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Burleigh

B

8.9%

Worsened

Cass

B

8.6%

Worsened

Grand Forks

C+

9.5%

Improved

Stark

A

6.3%

Improved

Ward

A

7.5%

Improved

Williams

A

6.9%

Worsened

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Fargo

A-

8.1%

Improved

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 NORTH DAKOTA MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
10.4

22.4

Rate

15.0
13.8

15.1

Poverty
among women
(15-44)

15.7
13.1

0

10
HP 2020

20
United States

30

40

North Dakota

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$66

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$1.74

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

OHIO

C-

PRETERM
BIRTH RATE

10.3%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

10.7

10.4

10.3

10.2

10.5

10.3

10.3

10.3

10.4

10.4

2008

Asian/Pacific Islander

RACE/ETHNICITY

PREMATURITY
GRADE

Percentage of live
births born preterm

Rate

2018

In Ohio, the preterm
birth rate among
black women is 49%
higher than the rate
among all other
women.

8.7
9.5

White

10.3

10.8

Hispanic

DISPARITY RATIO:

14.2

Black

0

5

10

15

Percentage of live births in 2015-2017 (average) born preterm

1.33

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Cuyahoga

F

12.2%

Worsened

Franklin

D+

10.5%

Improved

Hamilton

D

11.1%

Worsened

Lucas

F

11.6%

Worsened

Montgomery

F

11.7%

Worsened

Summit

B-

9.2%

Improved

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Columbus

D

10.9%

Improved

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 OHIO MATERNAL AND INFANT HEALTH:
CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
7.3

22.4

Rate

15.0
16.5

15.1

Poverty
among women
(15-44)

15.7
16.9

0

10
HP 2020

20
United States

30

40

Ohio

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$62

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$21.96

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

OKLAHOMA

11.4%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

D-

PRETERM
BIRTH RATE

11.0

10.9

11.2

10.8

10.6

10.3

10.3

10.6

11.4

In Oklahoma, the
preterm birth rate
among black women
is 38% higher than
the rate among all
other women.

9.3

White

10.4

American Indian/Alaska Native

10.7

Black

DISPARITY RATIO:

14.2
5

11.1

2018

9.8

Hispanic

0

10.9

2008

Asian/Pacific Islander

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

10

15

Percentage of live births in 2015-2017 (average) born preterm

1.14

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Canadian

D-

11.4%

Worsened

Cleveland

C-

10.2%

Improved

Comanche

C

9.7%

Improved

Oklahoma

F

11.7%

Worsened

Rogers

F

11.8%

Worsened

Tulsa

D-

11.3%

Worsened

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Oklahoma City

F

12.2%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 OKLAHOMA MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
20.3

22.4

Rate

15.0
16.5

15.1

Poverty
among women
(15-44)

15.7
16.2

0

10
HP 2020

20
United States

30

40

Oklahoma

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$54

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$7.05

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

NOT ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

OREGON

7.8%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

A-

PRETERM
BIRTH RATE

7.9

7.8

7.9

7.4

7.5

7.6

7.7

7.6

8.0

2008

Hispanic

8.5

Black

9.4

American Indian/Alaska Native
0

5

7.8

In Oregon, the
preterm birth rate
among American
Indian/Alaska Native
women is 30% higher
than the rate among
all other women.

8.1

Asian/Pacific Islander

8.3

2018

7.7

White

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

10.3

DISPARITY RATIO:

1.18

CHANGE FROM BASELINE:

10

Percentage of live births in 2015-2017 (average) born preterm

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Clackamas

B

8.6%

Worsened

Jackson

C+

9.6%

Worsened

Lane

B+

8.3%

Worsened

Marion

C+

9.6%

Worsened

Multnomah

B+

8.4%

Worsened

Washington

A

7.6%

Improved

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Portland

A-

8.1%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 OREGON MATERNAL AND INFANT HEALTH:
CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
8.8

22.4

Rate

15.0
11.6

15.1

Poverty
among women
(15-44)

15.7
14.0

0

10
HP 2020

20
United States

30

40

Oregon

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$64

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$6.17

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

PENNSYLVANIA

9.5%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

C+

PRETERM
BIRTH RATE

10.3

10.1

9.9

9.6

9.5

9.3

9.4

9.4

9.3

2008

Asian/Pacific Islander

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

9.5

2018

In Pennsylvania, the
preterm birth rate
among black women
is 47% higher than
the rate among all
other women.

8.2
8.6

White

9.4

10.0

Hispanic

DISPARITY RATIO:

1.28

12.8

Black

0

5

10

15

Percentage of live births in 2015-2017 (average) born preterm

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Allegheny

C

9.8%

Worsened

Bucks

C+

9.3%

Worsened

Delaware

C+

9.4%

Improved

Lancaster

B-

9.1%

Improved

Montgomery

A-

7.8%

No change

Philadelphia

C

10.0%

Improved

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Philadelphia

C

10.0%

Improved

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 PENNSYLVANIA MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
6.9

22.4

Rate

15.0
16.1

15.1

Poverty
among women
(15-44)

15.7
14.6

0

10
HP 2020

20
United States

30

40

Pennsylvania

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$65

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$23.73

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

PUERTO RICO

F

PRETERM
BIRTH RATE

11.9%

Percentage of live
births born preterm

PREMATURITY
GRADE

Rate

19.6

17.6

16.7

17.4

13.2

11.2

11.8

11.4

11.5

2008

11.4

11.9

2018

PRETERM BIRTH RATES BY MUNICIPALITIES
MUNICIPALITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Bayamón

B

8.7%

Improved

Caguas

F

15.8%

Worsened

Carolina

C

9.7%

Improved

Ponce

F

12.6%

Worsened

San Juan

F

12.0%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 PUERTO RICO MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS

15.79

MILLION

MATERNAL AND CHILD HEALTH BLOCK GRANT
The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
Rate
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

RHODE ISLAND

9.0%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

B-

PRETERM
BIRTH RATE

10.0

10.0

9.6

9.0

9.7

8.7

8.6

8.6

9.3

2008

Asian/Pacific Islander

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

9.0

2018

In Rhode Island, the
preterm birth rate
among black women
is 39% higher than
the rate among all
other women.

6.8
8.1

White

8.3

9.3

Hispanic

DISPARITY RATIO:

11.7

Black

0

5

1.14

CHANGE FROM BASELINE:

10

Percentage of live births in 2015-2017 (average) born preterm

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Bristol

B+

8.5%

Worsened

Kent

A

7.5%

Improved

Newport

A

6.3%

Improved

Providence

B

8.7%

Improved

Washington

A-

8.0%

Improved

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Providence

C+

9.6%

Improved

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 RHODE ISLAND MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
5.8

22.4

Rate

15.0
6.9

15.1

Poverty
among women
(15-44)

15.7
12.8

0

10
HP 2020

20
United States

30

40

Rhode Island

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$68

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$1.65

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

SOUTH CAROLINA

11.3%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

D-

PRETERM
BIRTH RATE

11.8

11.7

11.5

11.5

11.3

11.1

10.8

11.1

11.2

2008

11.2

11.3

2018

In South Carolina,
the preterm birth rate
among black women
is 56% higher than
the rate among all
other women.

9.4

Hispanic

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

White

9.6

Asian/Pacific Islander

9.8
DISPARITY RATIO:

14.8

Black

0

5

10

15

Percentage of live births in 2015-2017 (average) born preterm

1.21

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Charleston

D+

10.6%

Worsened

Greenville

D-

11.3%

Worsened

Horry

D-

11.3%

Improved

Lexington

D

10.8%

Worsened

Richland

F

12.4%

Improved

Spartanburg

D

11.1%

Worsened

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Columbia

F

13.2%

Improved

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 SOUTH CAROLINA MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
15.6

22.4

Rate

15.0
17.0

15.1

Poverty
among women
(15-44)

15.7
17.2

0

10
HP 2020

20
United States

30

40

South Carolina

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$63

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$11.50

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

NOT ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

SOUTH DAKOTA

9.4%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

C+

PRETERM
BIRTH RATE

8.6

7.9

8.6

7.9

7.8

8.1

8.5

8.5

9.0

2008

9.4

In South Dakota, the
preterm birth rate
among American
Indian/Alaska Native
women is 47% higher
than the rate among
all other women.

8.4

Black

9.3

2018

8.1

White

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

10.3

Hispanic

DISPARITY RATIO:

12.2

American Indian/Alaska Native

0

5

1.27

CHANGE FROM BASELINE:

10

Percentage of live births in 2015-2017 (average) born preterm

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Brookings

A

6.7%

Improved

Brown

A

6.5%

Improved

Codington

B

8.7%

Worsened

Lincoln

B-

9.1%

Worsened

Minnehaha

A-

8.1%

Worsened

Pennington

D+

10.7%

Worsened

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Sioux Falls

B+

8.2%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 SOUTH DAKOTA MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
12.1

22.4

Rate

15.0
16.7

15.1

Poverty
among women
(15-44)

15.7
17.3

0

10
HP 2020

20
United States

30

40

South Dakota

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$54

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$2.17

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

NOT ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

TENNESSEE

11.1%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

D

PRETERM
BIRTH RATE

11.5

11.3

11.4

11.1

11.2

11.1

10.8

11.0

11.3

2008

Asian/Pacific Islander

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

11.1

2018

In Tennessee, the
preterm birth rate
among black women
is 45% higher than
the rate among all
other women.

8.9
9.6

Hispanic

11.1

10.3

White

DISPARITY RATIO:

14.8

Black

0

5

10

15

Percentage of live births in 2015-2017 (average) born preterm

1.31

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Davidson

D+

10.4%

Improved

Hamilton

D

10.9%

Improved

Knox

C

10.0%

Worsened

Montgomery

C-

10.1%

Worsened

Rutherford

F

12.4%

Worsened

Shelby

F

12.5%

Improved

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Nashville-Davidson

D+

10.4%

Improved

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 TENNESSEE MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
11.5

22.4

Rate

15.0
16.7

15.1

Poverty
among women
(15-44)

15.7
16.9

0

10
HP 2020

20
United States

30

40

Tennessee

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$57

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$11.80

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

NOT ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

TEXAS

D

PRETERM
BIRTH RATE

10.8%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

11.2

11.1

10.9

10.7

10.4

10.3

10.2

10.4

10.6

In Texas, the preterm
birth rate among
black women is 38%
higher than the rate
among all other
women.

9.1

Hispanic

10.2

American Indian/Alaska Native

11.0

Black

DISPARITY RATIO:

13.7
5

10.8

2018

9.5

White

0

10.5

2008

Asian/Pacific Islander

RACE/ETHNICITY

PREMATURITY
GRADE

Percentage of live
births born preterm

Rate

10

15

Percentage of live births in 2015-2017 (average) born preterm

1.03

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Bexar

F

11.8%

Worsened

Dallas

C

9.9%

Worsened

Harris

D

11.1%

Improved

Hidalgo

F

12.8%

Worsened

Tarrant

C

9.7%

Improved

Travis

B-

9.0%

Improved

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Houston

D-

11.2%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 TEXAS MATERNAL AND INFANT HEALTH:
CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
24.4

22.4

Rate

15.0

21.6

15.1

Poverty
among women
(15-44)

15.7
16.8

0

10
HP 2020

20
United States

30

40

Texas

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$62

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$34.48

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

NOT ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

UTAH

C+

PRETERM
BIRTH RATE

9.4%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

9.7

9.8

9.5

9.4

9.1

9.2

9.1

9.3

9.6

2008

Hispanic

10.1

Black

10.2

American Indian/Alaska Native

10.6

Asian/Pacific Islander
0

5

9.4

9.4

2018

9.2

White

RACE/ETHNICITY

PREMATURITY
GRADE

Percentage of live
births born preterm

Rate

11.1

In Utah, the preterm
birth rate among
Asian/Pacific
Islander women is
19% higher than the
rate among all other
women.
DISPARITY RATIO:

1.15

CHANGE FROM BASELINE:

10

Percentage of live births in 2015-2017 (average) born preterm

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Cache

C+

9.5%

Improved

Davis

C-

10.1%

Worsened

Salt Lake

C+

9.5%

Worsened

Utah

B-

9.1%

No change

Washington

B

8.8%

Improved

Weber

C+

9.5%

Improved

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Salt Lake City

C+

9.3%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 UTAH MATERNAL AND INFANT HEALTH:
CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
10.9

22.4

Rate

15.0
9.6

15.1

Poverty
among women
(15-44)

15.7
10.2

0

10
HP 2020

20
United States

30

40

Utah

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$56

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$6.16

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

VERMONT

B+

PRETERM
BIRTH RATE

8.5%

Percentage of live
births born preterm

PREMATURITY
GRADE

Rate

8.4

8.2

7.2

7.6

7.6

7.6

7.9

7.3

8.0

2008

7.5

8.5

2018

PRETERM BIRTH RATES BY COUNTIES
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Chittenden

A

7.2%

Improved

Franklin

A

6.4%

Improved

Rutland

A

6.3%

Improved

Washington

A

7.4%

Improved

Windham

A

6.6%

Improved

Windsor

B

8.8%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 VERMONT MATERNAL AND INFANT HEALTH:
CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
4.9

22.4

Rate

15.0
5.0

15.1

Poverty
among women
(15-44)

15.7
12.9

0

10
HP 2020

20
United States

30

40

Vermont

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$65

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$1.63

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

VIRGINIA

9.4%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

C+

PRETERM
BIRTH RATE

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

10.5

10.2

10.1

9.5

9.5

9.4

9.2

9.2

9.6

2008

9.5

9.4

2018

White

8.5

Asian/Pacific Islander

8.6

Hispanic

8.7

In Virginia, the
preterm birth rate
among black women
is 52% higher than
the rate among all
other women.
DISPARITY RATIO:

0

1.15

12.9

Black

5

10

15

Percentage of live births in 2015-2017 (average) born preterm

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Chesterfield

C

9.9%

Worsened

Fairfax

C+

9.3%

Worsened

Henrico

C+

9.6%

Improved

Loudoun

B

8.7%

Worsened

Prince William

C+

9.4%

Worsened

Virginia Beach (city)

C+

9.3%

Improved

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Virginia Beach

C+

9.3%

Improved

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 VIRGINIA MATERNAL AND INFANT HEALTH:
CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
11.7

22.4

Rate

15.0
12.7

15.1

Poverty
among women
(15-44)

15.7
13.5

0

10
HP 2020

20
United States

30

40

Virginia

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$65

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$12.28

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

WASHINGTON

8.3%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

B+

PRETERM
BIRTH RATE

8.9

8.5

8.5

8.2

8.3

8.1

8.1

8.1

8.1

2008

Asian/Pacific Islander

8.8

Black

10.2

American Indian/Alaska Native
0

8.3

In Washington, the
preterm birth rate
among American
Indian/Alaska Native
women is 53% higher
than the rate among
all other women.

8.3

Hispanic

8.4

2018

7.7

White

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

5

DISPARITY RATIO:

12.4

1.28

CHANGE FROM BASELINE:

10

Percentage of live births in 2015-2017 (average) born preterm

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Clark

B

8.7%

Worsened

King

A-

8.1%

Worsened

Pierce

B-

9.2%

Worsened

Snohomish

A-

8.1%

Worsened

Spokane

B

8.7%

Improved

Yakima

B+

8.2%

Improved

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Seattle

A-

8.1%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 WASHINGTON MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
7.9

22.4

Rate

15.0
14.6

15.1

Poverty
among women
(15-44)

15.7
13.5

0

10
HP 2020

20
United States

30

40

Washington

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$64

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$8.89

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

WEST VIRGINIA

11.8%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

F

PRETERM
BIRTH RATE

11.9

10.8

10.6

10.7

10.5

10.8

11.3

11.8

12.0

11.8

2018

In West Virginia, the
preterm birth rate
among black women
is 22% higher than
the rate among all
other women.

11.6

Black

0

11.2

2008

White

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

14.2

5

10

15

Percentage of live births in 2015-2017 (average) born preterm

PRETERM BIRTH RATES BY COUNTIES
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Berkeley

D-

11.2%

Worsened

Cabell

F

14.9%

Worsened

Kanawha

F

15.0%

Worsened

Monongalia

C+

9.4%

Improved

Raleigh

F

12.8%

Worsened

Wood

F

13.8%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 WEST VIRGINIA MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
7.5

22.4

Rate

15.0
16.3

15.1

Poverty
among women
(15-44)

15.7
20.6

0

10
HP 2020

20
United States

30

40

West Virginia

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$52

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$6.11

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

WISCONSIN

9.9%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

C

PRETERM
BIRTH RATE

8.5

8.2

8.2

9.3

9.0

9.2

9.4

9.6

9.4

American Indian/Alaska Native

11.4

Black

DISPARITY RATIO:

14.4
5

9.9

In Wisconsin, the
preterm birth rate
among black women
is 62% higher than
the rate among all
other women.

8.9

Hispanic

9.6

2018

8.2

White

0

9.4

2008

Asian/Pacific Islander

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

10

15

Percentage of live births in 2015-2017 (average) born preterm

1.34

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES AND CITY
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Brown

C+

9.5%

Improved

Dane

B-

9.0%

Worsened

Milwaukee

F

11.6%

Worsened

Outagamie

C

9.7%

No change

Racine

D-

11.2%

No change

Waukesha

B+

8.5%

Improved

CITY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Milwaukee

F

12.8%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 WISCONSIN MATERNAL AND INFANT
HEALTH: CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
6.5

22.4

Rate

15.0
11.1

15.1

Poverty
among women
(15-44)

15.7
15.0

0

10
HP 2020

20
United States

30

40

Wisconsin

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$61

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$10.80

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

NOT ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 This year, in addition to monitoring progress on key indicators, Report Cards
include selected state actions to improve maternal and infant health. Premature
birth and its complications are the largest contributors to infant death in the
U.S., and preterm birth rates have been increasing for four years. Prematurity
grades are assigned by comparing the 2018 preterm birth rate to March of
Dimes’ goal of 8.1 percent by 2020. While it’s not yet possible to assign grades
for maternal health indicators given the available data, it’s clear that rates of
maternal death and morbidity are unacceptably high. Maternal health
complications, and the social determinants of health, affect the health and
survival of both mom and baby. Highlighted on the second page are selected
actions available to states to help improve maternal and infant health.

2019

MARCH OF DIMES
REPORT CARD

WYOMING

9.8%

PRETERM BIRTH
RATE BY RACE
AND ETHNICITY
The March of Dimes disparity ratio measures
and tracks progress towards the elimination of
racial/ethnic disparities in preterm birth. It's
based on Healthy People 2020 methodology
and compares the group with the lowest
preterm birth rate to the average for all other
groups. Progress is evaluated by comparing the
current disparity ratio to a baseline disparity
ratio. A lower disparity ratio is better, with a
disparity ratio of 1 indicating no disparity.

Percentage of live
births born preterm

C

PRETERM
BIRTH RATE

10.2

9.9

10.5

9.9

9.0

10.4

11.2

9.8

9.5

2008

9.8

In Wyoming, the
preterm birth rate
among American
Indian/Alaska Native
women is 63% higher
than the rate among
all other women.

9.9

Hispanic

8.9

2018

9.2

White

RACE/ETHNICITY

PREMATURITY
GRADE

Rate

DISPARITY RATIO:

15.2

American Indian/Alaska Native

0

5

10

15

Percentage of live births in 2015-2017 (average) born preterm

1.36

CHANGE FROM BASELINE:

No Improvement

PRETERM BIRTH RATES BY COUNTIES
COUNTY

GRADE

PRETERM BIRTH RATE

CHANGE IN RATE FROM LAST YEAR

Albany

A

5.9%

Improved

Campbell

C

9.7%

Improved

Fremont

C+

9.6%

Improved

Laramie

A-

7.9%

Improved

Natrona

D

10.9%

Worsened

Sweetwater

C+

9.3%

Worsened

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 WYOMING MATERNAL AND INFANT HEALTH:
CONTEXT AND ACTIONS
SELECTED SOCIAL
DETERMINANTS OF
HEALTH

Uninsured
among women
(15-44)*

Our unequal society has negative consequences
for health. Factors such as these are linked to
adverse maternal and infant health outcomes
overall. Many other structural factors and
inequities influence the health of mothers and
babies, especially for Black, American Indian and
Alaska Native women. For example, income,
health insurance status and prenatal care access
are traditionally considered protective factors,
but if they are held constant, racial and ethnic
disparities persist. March of Dimes is
collaborating with others to confront social and
structural determinants of health, while
identifying solutions that help alleviate the
negative impacts of such inequities.

Inadequate
Prenatal Care

11.7
17.3

22.4

Rate

15.0
14.6

15.1

Poverty
among women
(15-44)

15.7
13.3

0

10
HP 2020

20
United States

30

40

Wyoming

*The Healthy People 2020 goal is for all women (15-44) to be insured.

$65

AVERAGE COST OF A PRETERM BIRTH

THOUSAND

$1.08

The estimated societal cost per preterm birth includes medical care for premature children, maternal
delivery costs, early intervention services, special education services and lost productivity. State
estimates reflect 2016 adjustments to underlying national estimates developed in 2005 (see
technical notes for additional details). Adjustments per state include birth and infant mortality rate
and incidence by gestational age, service bundle composition and costs and cost inflation. 

MATERNAL AND CHILD HEALTH BLOCK GRANT

MILLION

The Maternal and Child Health (MCH) Block Grant is one source of federal support for states to
improve the health of moms and children. States have some flexibility in allocating funds, which
can be used to increase access to quality health care for pregnant women. State MCH block grant
amounts provide an example of the limited amount of available funds in comparison to the costs
of prematurity and other complications.

NOT ADOPTED

MEDICAID EXPANSION
Medicaid expansion to cover individuals up to 138% of the federal poverty level can play an
essential role in improving maternal and infant health. A growing number of studies indicate that
Medicaid expansion has reduced the rate of women of childbearing age who are uninsured,
improved health outcomes and helped to reduce disparities, including lower rates of premature
birth and low birthweight for Black infants in expansion states.

OTHER RECOMMENDED STATE ACTIONS
March of Dimes recommends key policy actions to improve maternal and infant health in all states. Future Report Cards will assess these actions at the
state level.

•

COMPREHENSIVE MEDICAID COVERAGE EXTENSION FOR ALL WOMEN TO AT LEAST ONE YEAR POSTPARTUM In too many states,
Medicaid maternity coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

•

GROUP PRENATAL CARE ENHANCED REIMBURSEMENT Group prenatal care has shown significant benefits to maternal health, increases

•

MATERNAL MORTALITY REVIEW COMMITTEES Establishment, funding and reporting of state data to CDC through Maternal Mortality Review

healthy behaviors and reduces adverse birth outcomes. Increased benefits were seen in Black women who participated in group prenatal care.
Enhanced reimbursement models, including delivery and outcomes-based incentives, can encourage providers to offer it.
Committees is essential to understanding and addressing the causes of maternal death.

MORE INFORMATION

MARCHOFDIMES.ORG/REPORTCARD

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2019 March of Dimes

 2019 MARCH OF DIMES REPORT CARD
TECHNICAL NOTES
PREMATURE BIRTH: DEFINITION AND SOURCE

Premature or preterm birth is a birth with less than 37 weeks gestation based on the obstetric estimate of gestational age. Data used in this report
card came from the National Center for Health Statistics (NCHS) natality files, as compiled from data provided by the 57 vital statistics
jurisdictions through the Vital Statistics Cooperative Program.1 This national data source was used so that data are comparable for each state and
jurisdiction-specific report card. Data provided on the report card may differ from data obtained directly from state or local health departments
and vital statistics agencies due to timing of data submission and handling of missing data. The preterm birth rates shown at the top of report
card was calculated from the NCHS 2018 final natality data. Preterm birth rates in the trend graph are from the NCHS 2008-2018 final natality
data. County preterm birth rates are from the NCHS 2017 final natality data. Preterm birth rates for bridged racial and ethnic categories were
calculated from NCHS 2015-2017 final natality data. Preterm birth rates were calculated as the number of premature births divided by the number
of live births with known gestational age multiplied by 100.

GRADING METHODOLOGY
Expanded grade ranges were introduced in 2019. Grade ranges remain
based on standard deviations of final 2014 state and District of Columbia
preterm birth rates away from the March of Dimes goal of 8.1 percent by
2020. Grades were determined using the following scoring formula:
(preterm birth rate of each jurisdiction – 8.1 percent) / standard deviation of
final 2014 state and District of Columbia preterm birth rates. Each score
within a grade was divided into thirds to create +/- intervals. The resulting
scores were rounded to one decimal place and assigned a grade. See the
table for details.

PREMATURE BIRTH BY COUNTY
Report cards for states and jurisdictions, except District of Columbia,
display up to 6 counties with the greatest number of live births. Counties
are not displayed if the number of premature births is less than 20. Counties
are ordered alphabetically. Grades were assigned based on the grading
criteria described above. Change from previous year was calculated by
comparing the 2017 county preterm birth rate to the 2016 rate.

PREMATURE BIRTH BY CITY
Report cards for states and jurisdictions, except District of Columbia,
display the city with the greatest number of live births. Cities are not
displayed for Connecticut, Delaware, Maine, Vermont, West Virginia and
Wyoming due to limited availability of data. Grades were assigned based on
the grading criteria described above. Change from previous year was
calculated by comparing the 2017 city preterm birth rate to the 2016 rate.

PREMATURE BIRTH BY RACE/ETHNICITY OF THE
MOTHER
Mother’s race and Hispanic ethnicity are reported separately on birth
certificates. Rates for Hispanic women include all bridged racial
categories (white, black, American Indian/Alaska Native and
Asian/Pacific Islander). Rates for non-Hispanic women are classified
according to race. The Asian/Pacific Islander category includes Native
Hawaiian. To provide stable rates, racial and ethnic groups are shown
on the report card if the group had 20 or more premature births in each
year from 2015-2017. To calculate preterm birth rates on the report
card, three years of data were aggregated (2015-2017). Preterm birth
rates for not stated/unknown race are not shown on the report card.

GRADE

A
AB+
B
BC+
C
CD+
D
DF

PRETERM BIRTH RATE RANGE
SCORING CRITERIA
Preterm birth rate less than or equal to 7.7 percent
Preterm birth rate of 7.8 percent to 8.1 percent
Preterm birth rate of 8.2 percent to 8.5 percent
Preterm birth rate of 8.6 percent to 8.9 percent
Preterm birth rate of 9.0 percent to 9.2 percent
Preterm birth rate of 9.3 percent to 9.6 percent
Preterm birth rate of 9.7 percent to 10.0 percent
Preterm birth rate of 10.1 percent to 10.3 percent
Preterm birth rate of 10.4 percent to 10.7 percent
Preterm birth rate of 10.8 percent to 11.1 percent
Preterm birth rate of 11.2 percent to 11.4 percent
Preterm birth rate greater than or equal to 11.5 percent

PREMATURE BIRTH DISPARITY MEASURES
The March of Dimes disparity ratio is based on Healthy People 2020 methodology and provides a measure of the differences, or disparities, in
preterm birth rates across racial/ethnic groups within a geographic area.2 The disparity ratio compares the racial/ethnic group with the lowest
preterm birth rate (comparison group) to the average of the preterm birth rate for all other groups.
To calculate the disparity ratio, the 2015-2017 preterm birth rates for all groups (excluding the comparison group) were averaged and divided by
the 2015-2017 comparison group preterm birth rate. The comparison group is the racial/ethnic group with the lowest six-year aggregate preterm
birth rate (2010-2015) among groups that had 20 or more premature births in each year from 2010-2015. A disparity ratio was calculated for U.S.
states, the District of Columbia and the total U.S. A disparity ratio was not calculated for Maine, Puerto Rico, Vermont and West Virginia due to
limited availability of data. A lower disparity ratio is better, with a disparity ratio of 1 indicating no disparity.

MARCHOFDIMES.ORG/REPORTCARD
© 2019 March of Dimes

 2019 MARCH OF DIMES REPORT CARD
TECHNICAL NOTES
PREMATURE BIRTH DISPARITY MEASURES

Progress toward eliminating racial and ethnic disparities was evaluated by comparing the 2015-2017 disparity ratio to a baseline (2010-2012)
disparity ratio. Change between time periods was assessed for statistical significance at the 0.05 level using the approach recommended by
Healthy People 2020.2 If the disparity ratio significantly improved because the average preterm birth rate for all other groups got better, we
displayed “Improved” on the report card. If the disparity ratio significantly worsened because the lowest group got better or the average of all
other groups got worse, we displayed “Worsened” on the report card. If the disparity ratio did not significantly change, we displayed “No
Improvement” on the report card.
The report card also provides the percent difference between the racial/ethnic group with the 2015-2017 highest preterm birth rate compared to
the combined 2015-2017 preterm birth rate among women in all other racial/ethnic groups. This percent difference was calculated using only the
racial/ethnic groups displayed on the state or jurisdiction-specific report card. This difference was calculated for each U.S. state with adequate
numbers and the District of Columbia.

SELECTED SOCIAL DETERMINANTS OF HEALTH

March of Dimes recognizes the importance of certain risk factors that are associated with premature birth. Three of these contributing
factors are highlighted for each state. These risk factors are poverty in women (age 15-44 years), lack of health insurance in women (15-44
years) and inadequacy of prenatal care.
A woman was considered uninsured if she was not covered by any type of health insurance.3 The uninsured percent is calculated among
women ages 15-44. Persons in poverty are defined as those who make less than 100% of the poverty threshold established by the US
Census Bureau.4 The Federal poverty threshold for a family of three was $19,749 in 2017. Poverty is reported for women 15-44 years.
Adequacy of prenatal care is measured using the Adequacy of Prenatal Care Utilization Index, which classifies prenatal care received into 1
of 4 categories (inadequate, intermediate, adequate and adequate plus) by combining information about the timing of prenatal care, the
number of visits and the infant's gestational age.5

FINANCIAL AND ECONOMIC INDICATORS

Estimates of the national societal economic burden of preterm birth in 2005 generated for the Institute of Medicine’s (IOM) report6, Preterm
Birth:  Causes, Consequences and Prevention served as the foundation for updating costs to 2016 and for providing separate estimates for each
state and the District and Columbia (see https://marchofdimes.org/peristats/documents/Cost_of_Prematurity_2019.pdf for details)7. Costs were
updated adjusting for price changes over time and for variation in prices of services between states. Changes in the rate of preterm birth, the
distribution of preterm birth by gestational age (GA), and the rate of infant mortality by GA at the national and state levels were also
incorporated. This cost of preterm birth estimates are the most comprehensive national estimates to date, and provide the first profile of such
costs by state for every state and the District of Columbia.
Medicaid expansion is provided as not adopted, adopted and adopted but not implemented. Medicaid expansion has reduced the rates of
uninsured. Increased access and utilization of health care are significantly associated with Medicaid expansion.8
Maternal and child block grant totals are available from Fiscal Year 2019 for each state. The Maternal and Child Health Services Block Grant, Title
V of the Social Security Act, is a federal program devoted to improving the health of all women, children and families. Title V provides funding
to state maternal and child health (MCH) programs, which serve 76 million people in the U.S.9 Maternal and child (MCH) block grants are a key
federal source of support for states to improve the health of moms and babies. Other funding sources and strategies are also available to states
to make an impact on prematurity.

CALCULATIONS

All natality calculations were conducted by the March of Dimes Perinatal Data Center. Calculations for the cost of premature birth were
conducted by the University of Utah.

REFERENCES
1

National Center for Health Statistics, final natality data 2015-2018.

2 Talih

M, Huang DT. Measuring progress toward target attainment and the elimination of health disparities in Healthy People 2020. Healthy People Statistical Notes, no 27.
Hyattsville, MD: National Center for Health Statistics. 2016.

3 IPUMS-USA,
4 PUMS-CPS,

University of Minnesota, ipums.org. American Community Survey, US Census Bureau.

University of Minnesota, ipums.org. Current Population Survey, US Census Bureau.

5 Kotelchuck M. An evaluation of the Kessner Adequacy of Prenatal Care Index and a Proposed Adequacy of Prenatal Care Utilization Index. Am J Public Health 1994; 84:
1414-1420.
6Behrman RE, Stith Butler A, eds. Institute of Medicine, Committee on Understanding Preterm Birth and Assuring Healthy Outcomes. Preterm Birth: Causes, Consequences,
and Prevention. Washington, DC: The National Academies Press; 2007.
7 Waitzman

NJ and Jalali A. Updating National Preterm Birth Costs to 2016 with Separate Estimates for Individual States. Salt Lake City, UT: University of Utah; 2019.

8Kaiser

Family Foundation, https://www.kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/. Retrieved on June
30, 2019.
9Health

Resources and Services Administration. Title V Maternal and Child Block Grant Program. Available at: https://mchb.hrsa.gov/data-research-epidemiology.
Retrieved on September 12, 2019.

MARCHOFDIMES.ORG/REPORTCARD
© 2019 March of Dimes

 STATE
SPOTLIGHTS

HEALTHY
MOMS.
STRONG
BABIES.

SPOTLIGHT

CALIFORNIA

SUMMARY STATEMENT
Through collaboration and partnerships, The California Department of Public Health, Maternal Child and Adolescent
Health Division (CDPH/MCAH) has been working to turn the curve on the State’s prematurity rate by tackling
disparities in preterm births. In 2017, the Black preterm birth rate was 1.7 times more than the White preterm birth rate.
Multiple focused initiatives launched in counties with the highest number of Black preterm births have been sparked
to address inequity in birth outcomes.

ACTIVITIES AND RESULTS
In collaboration with 14 Local Health Jurisdictions (which represent over 90 percent of all Black births in the State,)
CDPH/MCAH leads and funds the implementation of the Black Infant Health Program (BIH) to improve Black birth
outcomes. BIH focuses its implementation strategy on the key contributing factors of disparities, namely the toxic
stress of chronic racism. Participants learn proven strategies to reduce stress and develop life skills through a
group-based approach with complementary case management. MCAH has observed improvements in the Black
preterm birth rate between 2007 and 2017 in eight counties currently implementing BIH. In addition, through a
legislative proposal brought to fruition in 2018 by March of Dimes and other California stakeholders, CDPH/MCAH has
established the Perinatal Equity Initiative (PEI) with $8 million State General Funds to complement the BIH program.
In partnership with the March of Dimes, CDPH/MCAH continues to lead the Community Birth Plan initiative that unites
hospitals in Los Angeles with high Black prematurity rates and the Black communities delivering at these hospitals.
The goal is to unite the community and hospitals around the problem and evidence-based interventions that can
reduce prematurity.
The Maternal and Infant Health Assessment (MIHA) survey, implemented by the MCAH Division provides insights on
the relationship between maternal experiences and birth outcomes to help guide programs. MIHA data reveal a sharp
increase in chronic worry about racial discrimination among Black women. In 2017, nearly two-thirds of Black women
worried often about experiencing racial discrimination for themselves or a loved one, and seven in 10 Black women
experienced incidents of racial discrimination. Worry about racial discrimination has been linked to preterm birth,
maternal hypertension and symptoms of maternal depression.
The 2018-20 California Preconception CoIIN, led by CDPH/MCAH, March of Dimes, and other state preconception
health experts, aims to improve the preconception health status of women of reproductive age, particularly lowincome women and women of color.

The Spotlight documents were prepared by state health departments to highlight state progress toward improving birth outcomes.
©2019 March of Dimes

 HEALTHY
MOMS.
STRONG
BABIES.

SPOTLIGHT

CONNECTICUT

SUMMARY STATEMENT
Unplanned pregnancies and poor preconception health increase the risk for adverse outcomes, including preterm
birth. Optimizing a woman’s health before pregnancy and increasing birth intentionality and spacing is essential
to improving maternal and infant outcomes, as well as reducing disparities in these outcomes. The Connecticut
Department of Public Health (DPH), in collaboration with the CT MCH Coalition and March of Dimes CT Chapter, is
engaged in an initiative called Every Woman Connecticut (EWCT). This initiative is a learning collaborative that seeks to
promote pre- and interconception health care as an integral part of routine care within both clinical and communitybased settings. EWCT is utilizing the One Key Question (OKQ) screening tool in communities with high volume/burden
of poor birth outcomes and among communities expressing interest and readiness.

ACTIVITIES AND RESULTS
The EWCT Learning Collaborative is made up of clinical and community-based partners who serve women of
childbearing ages across Connecticut. Communities with high volume/high burden of poor birth outcomes were
sought for their participation in EWCT, as well as their level of expressed interest and readiness. The main goal
of EWCT is to increase expertise and self-efficacy in implementing routine pregnancy intention screening and
appropriate care, education, and services to ultimately improve birth spacing, increase pregnancy intentionality, and
the proportion of Connecticut women who deliver a live birth who report discussing pre- and interconception health
with a healthcare worker. An estimated total of 326 of providers from 39 cities/towns, as well as from 9 statewide
programs, have been involved with the initiative since its inception in May 2016. The EWCT Learning Collaborative is
planning activities to strengthen the existing participating communities, by adding additional partners and providing
more technical support. A multi-stage collective impact evaluation of the EWCT/OKQ initiative will begin in late 2019
and will examine both process and outcomes of the initiative.
The EWCT Advisory Committee also convened a workgroup focusing on increasing access to contraception, a
continuation of efforts that were started under the ASTHO IAC project. The workgroup, co-chaired by March of
Dimes and the Connecticut Maternal and Child Health Coalition, has representation from DPH, Department of Social
Services (Medicaid), Department of Mental Health and Addiction Services (DMHAS), Ct Office of Early Childhood
(OEC), ACOG, Community Health Centers, Inc., Planned Parenthood of Southern New England, and other valued
organizational members. Through this workgroup, EWCT is identifying and addressing system barriers that limit the
uptake of comprehensive contraceptive care for Connecticut people of childbearing ages who wish to avoid or delay
a pregnancy.

The Spotlight documents were prepared by state health departments to highlight state progress toward improving birth outcomes.
©2019 March of Dimes

 HEALTHY
MOMS.
STRONG
BABIES.

SPOTLIGHT

DELAWARE

SUMMARY STATEMENT
In 2014, Upstream USA met with then Delaware Governor Jack Markell to discuss the state’s participation in a
statewide initiative to reduce unintended pregnancy in Delaware. This initiative would later be named Delaware
Contraceptive Access Now (Delaware CAN). Around the same time, the Governor-appointed Delaware Healthy
Mother and Infant Consortium (DHMIC) had identified the reduction of unintended pregnancies as one of its strategic
priorities to reduce infant mortality and improve birth outcomes.
The Delaware CAN initiative started as a public-private partnership between the State of Delaware and Upstream
USA. Delaware CAN includes a set of policy changes focused on reducing unintended pregnancies and improving
access to the full range of contraception, including long-acting reversible contraceptives (LARCs). The goal is to
ensure all women of reproductive age in Delaware, regardless of insurance or ability to pay, have same-day access
to the full range of contraceptive methods at low or no cost. This initiative was designed to remove barriers related
to cost, education, and access to contraceptives by implementing policy changes, providing trainings and technical
assistance to clinical sites, and developing a statewide public awareness campaign. Delaware CAN is supported by a
combination of private individuals and foundations, as well as state investments. The privately funded total budget for
the five-year initiative is approximately $20 million. Current Delaware Governor John Carney recommended that the
Fiscal Year 2020 budget for the state Division of Public Health (DPH) include $1.5 million to sustain ongoing statewide
support for Delaware CAN. The funding was approved and the program will be administered by DPH’s Family Health
Systems Section. DPH will provide funding to purchase contraceptive methods for individuals who are uninsured or
underinsured through the Title X Family Planning network of providers and in the hospital setting for Immediate PostPartum (IPP) contraception.

ACTIVITIES AND RESULTS
Much of the foundation to implement Delaware CAN was laid in 2015. In January, the Delaware Division of Medicaid
and Medical Assistance (DMMA) began allowing separate reimbursement for LARC devices via the Medicaid pharmacy
benefit, when occurring concurrently with childbirth-related services. This enabled hospitals to provide LARC
placement and be reimbursed for the device for Medicaid patients IPP, (after childbirth but before hospital discharge).
Starting May 2015, DPH made public funding available to purchase LARC devices. Some funding was provided
directly to Title X agencies to purchase LARCs while the rest was used to purchase LARC stock for the State Pharmacy.
In January 2016, former Delaware Governor Jack Markell formally announced the launch of Delaware CAN, which
included private funding from individual philanthropists and foundations, as well as funding from the Delaware DPH. In
June 2016, DPH provided additional funding to purchase more LARC stock for the State Pharmacy
In June 2017, a Delaware Medicaid State Plan Amendment (17-003) was approved and retroactively effective
from January 2, 2017 to provide a mechanism for federally qualified health centers (FQHCs) in Delaware to obtain
compensation for LARCs. This allowed FQHCs to maintain adequate stock of LARCs, and replaced the need for direct
state purchase of devices.
Upstream USA launched the public awareness campaign, “Be Your Own Baby” in spring 2017. The target demographic
for the campaign, which ran through fall 2018, was Delaware women ages 18-29. Campaign messaging was informed
by focus groups and survey responses, and focused on access to “free” birth control. Messages were designed to
be “fun” and “empowering.” Central message formats included a professionally produced music video hosted on
YouTube, online streaming music advertisements, social media posts and online advertising. The call to action for all
messaging was to visit the Be Your Own Baby website, beyourownbaby.org, where visitors could find nearby clinic
locations that provide free same-day contraceptive services. Three sites from a large family planning outpatient clinic
enabled online scheduling through the website. Website visitors could also submit reimbursement for transportation
to a clinic or for any out-of-pocket contraceptive costs. The website provided information about different
contraceptive method types and linked to Bedsider.org for more information.

©2019 March of Dimes

 HEALTHY
MOMS.
STRONG
BABIES.

SPOTLIGHT

DELAWARE

CONTINUED...

Currently, Delaware CAN is focused on sustainability. Upstream is working with DE CAN partners to ensure that key
elements are in place including stocking methods, patient educational materials, optimal billing and coding practices,
policies and procedures and training maintenance plans etc. Upstream has a plethora of web-based materials
and resources including e-learning courses on patient centered contraceptive counseling and billing/coding for
contraception.
The University of Maryland and the University of Delaware were independently contracted to conduct a robust
evaluation of the DECAN intervention and to study the ways in which the initiative may have changed access to
LARCs and other family planning services in the state of Delaware, if it improved clinical outcomes and if the program
reduced unintended pregnancies over time for women of childbearing age. They will follow the sustainability program
over the next five years.
Child Trends, a research organization focused on improving the lives of children and youth, performed an evaluation
and issued a report using available contraceptive data from 2014 to 2017 in Delaware among Delaware Title X family
planning clients ages 20–39. The observed movement from moderately effective contraception to highly effective
long acting reversible contraception paired with a small decrease in no method, was linked to a substantial simulated
decrease (24.2 percent) in the unintended pregnancy rate among this population. The complete report, including
methodology and limitations, was commissioned by Upstream and can be found at ChildTrends.org.

The Spotlight documents were prepared by state health departments to highlight state progress toward improving birth outcomes.
©2019 March of Dimes

 HEALTHY
MOMS.
STRONG
BABIES.

SPOTLIGHT

GEORGIA

SUMMARY STATEMENT
Evidence-based Home Visiting
The Maternal, Infant, Early Childhood Home Visiting (MIECHV) program is a federal initiative dedicated to expansion
of access to voluntary evidence-based home visiting in the US and tribal communities and territories. The Georgia
Department of Public Health (DPH) oversees administration of Georgia’s MIECHV program and partners with 15 Local
Implementing Agencies (LIAs). In addition to the 15 MIECHV LIAs, DPH has expanded home visiting to 6 different agencies.
These LIAs utilizes one of the following Evidenced-Based Home Visiting (EBHV) models: (1). Early Head Start-Home
Visiting (EHS-HV), (2) Healthy Families Georgia (HFG), (3) Parents as Teachers (PAT) and (4) Nurse-Family Partnership (NFP).
Decades of scientific research show that home visits during pregnancy and early childhood improve the lives of children
and families, and can be cost-effective in the long term, with the largest benefits coming through decreasing families’
need for public assistance programs and increased individual earnings.
Group Prenatal Care
CenteringPregnancy® has been implemented in three public health locations with high numbers of preterm births.
Family Planning
DPH launched a campaign to increase access to long acting reversible contraceptive devices (LARCs) for women who
chose to space or delay pregnancy.

ACTIVITIES AND RESULTS
Evidence-based Home Visiting
The Georgia EBHV system includes identification, referral, screening, parent education, and linkage to appropriate
community services. Georgia has a proven track record of implementing quality EBHV programs throughout the state
and between the periods of October 1, 2017 to September 30, 2018, certified home visitors completed 24,042 visits to
at-risk families and 5,946 community referrals. In order to measure program’s performance, provide continuous quality
improvement, and evaluation, Georgia collects data on 19 performance measures. The performance measures reflect
a two-generation approach aimed at improving the well-being of both parents and children across the lifespan. The
performance measures are intended to help tell the story of home visiting in Georgia and demonstrate the impact of the
program on parents and their children. For example in FY 2018 (10/1/17 to 9/30/18):
Depression Screening: 80% of Georgia MIECHV caregivers were screened for depression.
Developmental Screening: 67% of children enrolled in Georgia MIECHV had a timely screening for developmental delays.
Intimate Partner Violence (IPV) Screening: 79% of MIECHV caregivers were screened for IPV.
Families are linked to other community services based upon the results of the assessments and screenings.
Additionally:
9% of women enrolled prenatally delivered preterm.
38% of mothers were breastfeeding their child at 6 months.
81% of children received their last well child visit.
76% of mothers received a postpartum visit within 8 weeks of delivery.
93% of primary caregivers who used tobacco products at enrollment received a referral to cessation services.
80% of primary caregivers consistently practiced safe sleep methods with their infants.

The Spotlight documents were prepared by state health departments to highlight state progress toward improving birth outcomes.
©2019 March of Dimes

 HEALTHY
MOMS.
STRONG
BABIES.

SPOTLIGHT

GEORGIA

CONTINUED...

Of all households served:
1% had an investigated case of maltreatment following enrollment.
3% had an injury related emergency department visit.
The Georgia Department of Public Health is committed to providing a quality comprehensive community-based
Maternal and Early Childhood system which includes evidenced-based home visiting services as a major strategy to
improve the well-being of mothers, children and families which will ultimately ensure thriving communities in rural and
urban areas alike.
Group Prenatal Care
State funding was allocated to expand Medicaid reimbursement of group prenatal care in 2018. A reimbursement pilot
is underway in four CenteringPregnancy® locations in the state including one in a public health setting. Successful
results from the pilot and full state rollout of expanded reimbursement will increase sustainability and access to group
prenatal care and a decrease in preterm births.
Family Planning
The campaign included a media awareness component and increased the number of midlevel providers and LARC
inventory in public health clinics. Since the launch of the campaign in 2015, nearly 30,000 LARCs have been provided
resulting in an increase of 67%.

The Spotlight documents were prepared by state health departments to highlight state progress toward improving birth outcomes.
©2019 March of Dimes

 HEALTHY
MOMS.
STRONG
BABIES.

SPOTLIGHT

LOUISIANA

SUMMARY STATEMENT
Louisiana has worked tirelessly for several years to reduce pre-term births and infant mortality through focused
interventions, Medicaid reforms, education, and increased access to reproductive health services, sexually
transmitted infection (STI) prevention, testing and treatment and smoking cessation for Louisiana residents of childbearing age. Addressing health disparities like those seen in our premature birth report card requires a long-term
commitment with multiple partners to implement effective changes. We still have a long way to go, but we are
confident that by continuing to work together with health care providers, community leaders and individual Louisiana
residents, we can change the future of our children’s health.

ACTIVITIES AND RESULTS
In recent years, there has been a significant push through federal funding and with Medicaid Expansion to increase
access to family planning and STI services. More consistent health coverage for women across the life span –
preconception, post-partum, and interconception periods improves maternal health. Reducing the number of
Louisiana babies born to mothers with STIs helps reduce premature births, and reducing preterm births reduces the
number of days babies spend in neonatal intensive care units and improves infant health trajectories. Medicaid now
covers all FDA-approved contraceptive methods, including long-acting, reversible contraceptives (LARC), which
is critical to improving birth spacing and reducing the 60% of unintended pregnancies in Louisiana, both of which
contribute to poor birth outcomes. For decades OPH Parish Health Units (PHU) – funded by Title X and the state – have
been a critical safety net for these services. Medicaid Expansion has increased access to these services for all, both in
and outside of the PHUs.
In addition to Medicaid expansion, the Louisiana Department of Health (LDH) has partnered on several additional
activities to improve birth outcomes. Since 2014, LDH, Medicaid, and all Louisiana hospitals have committed to
curb the practice of early inductions and Cesarean Sections, implement extensive birth outcomes quality metrics
for Medicaid managed care organizations, and introduce payment reform. LDH is also working in partnership with
the March of Dimes (MoD), Medicaid, and the Louisiana Perinatal Commission to make sure 17P is available (17P is
progesterone medicine that can help prevent preterm birth in some pregnant women who have already had a preterm
birth).
Additionally, MoD is partnering with LDH to address health equity head-on in the Shreveport area. In 2015, Shreveport
had the highest preterm birth rate among the 100 U.S. cities where the most babies are born. MoD’s Healthy Babies
are Worth the Wait® is partnering with City MatCH’s Institute for Equity in Birth Outcomes to address health disparities
relating to birth outcomes with emphasis on prematurity, birth spacing, infant mortality, social determinants of health
and health access.

The Spotlight documents were prepared by state health departments to highlight state progress toward improving birth outcomes.
©2019 March of Dimes

 HEALTHY
MOMS.
STRONG
BABIES.

SPOTLIGHT

MINNESOTA

EXPANDED HOME VISITING PROGRAMS
National research shows that home visiting results in improved prenatal health. To prevent preterm births, Minnesota
has expanded its home visiting program. Minnesota has successfully supported the start-up or expansion of home
visiting programs in four tribal nations and more than 70 counties over the last two years. This state grant funding was
authorized by the 2017 Legislature and signed into law. MDH currently oversees $35.7 million in federal and state funding
to support home visiting services across Minnesota with 95% of counties and 81% of tribes implementing evidencebased home visiting programs.

DOULAS FOR DADS
Ramsey County is the home of St. Paul and Minnesota’s second most populous county. The Ramsey County Birth Equity
Community Council is a public-private collaborative focused on racial healing and public health strategies to reduce
inequities in birth outcomes. After community conversations, it became clear that though there was some support for
moms, dads were left out of efforts addressing higher infant and maternal mortality rates for black babies and moms.
The group decided to start Doulas for Dads. The idea was that by training men to become certified doulas and lactation
educators, they would also become advocates for women and infants when dealing with medical systems and medical
providers. A total of 10 men have been trained as certified perinatal educators as of July 2019.

INFANT MORTALITY AMONG AFRICAN AMERICANS PROJECT
Hennepin County has the largest concentration of African Americans in Minnesota. The infant mortality rate in the
county among U.S.-born African Americans is 3.4 times higher than whites. The Infant Mortality among African
American Project acknowledges that the difference in the infant mortality rate goes beyond maternal characteristics,
behaviors and access to health care, and is influenced by other factors including social issues and individual and family
circumstances.
To address this complex issue, the Minnesota Department of Health is using a community engagement model that
brings together the perspectives of the community through a Health in All Policies approach. The health department
formed a Community Voices and Solutions leadership team to guide the 5-year project that is funded through 2020. The
leadership team consists of about 20 members representing community groups, grassroots organizations and local and
state health departments. The team is currently working together to determine key conditions and barriers contributing
to health inequities. The group has hosted a summit to develop a sustainability blueprint for addressing U.S.-born African
American infant mortality, proposed strategies for addressing U.S. born African American infant mortality and hosted
two rounds of community co-learning sessions that resulted in four community action teams.

17P QUALITY IMPROVEMENT PROJECT
With Minnesota and the nation as a whole continuing efforts to reduce infant mortality, the Minnesota Department of
Health is highlighting the value of progesterone to prevent preterm births. The most effective strategies for a woman
who has already had a premature infant is a series of progesterone shots called 17P. The health department and other
partners have been working with Minnesota clinics to get this important treatment to expecting mothers. The 17P Quality
Improvement Project started in 2016 is focused on educating providers, identifying women for the treatment, addressing
barriers and sharing best practices for helping expecting mothers complete the series of shots.
Minnesota clinics have already seen success with 17P implementing national guidelines from The American College
of Obstetricians and Gynecologists and The Society for Maternal-Fetal Medicine. Results from clinics in Minnesota are
consistent with national research findings that the progesterone injections can help prevent premature births. The effort
to increase the use of 17P is supported by a coalition of partners formed in 2016. The partnership includes the Minnesota
Department of Health, Minnesota Perinatal Organization, Minnesota Prematurity Coalition and March of Dimes.
The Minnesota Perinatal Quality Collaborative established in 2018 seeks to improve maternal and infant health outcomes
with emphasis on racial and ethnic health inequities. It is facilitated by the Minnesota Department of Health and the
Minnesota Perinatal Organization. The next cohort of the 17P project will be guided by collaborative members and 17P
faculty within the MNPQC.
The Spotlight documents were prepared by state health departments to highlight state progress toward improving birth outcomes.
©2019 March of Dimes

 HEALTHY
MOMS.
STRONG
BABIES.

SPOTLIGHT

NORTH DAKOTA 

SUMMARY STATEMENT
During the past ten years, the pregnancy smoking rate for North Dakota women has steadily declined from 17.0% in
2009 to 11.0% in 2018. Through evaluation from the BABY & ME – Tobacco Free Program (BMTFP) and North Dakota
Vital Records data, the average birth weight of babies born to women in the BMTFP compared to the average birth
weight for pregnant smokers is statistically significantly higher. In fiscal year 2017, the difference was 8 ounces, and in
fiscal year 2018, it was 6.5 ounces.
The BMTFP is an evidence based, smoking cessation program created to reduce the burden of tobacco on the
pregnant and postpartum population. By providing counseling support and resources to pregnant women, the
program helps women quit smoking and stay quit, resulting in improved birth outcomes and long-term positive
outcomes for women, children, and their families. In the postpartum sessions, women receive continued support to
maintain their tobacco free lifestyle as well as diaper vouchers when they test tobacco free.

ACTIVITIES AND RESULTS
Increased education and program outreach had a positive effect on birth outcomes. During the recent year, the North
Dakota Department of Health (NDDoH) funded several Tobacco Treatment Specialist (TTS) trainings, which resulted
in an additional 90 staff from a variety of healthcare settings with increased tobacco treatment and motivational
interviewing skills. Improved documentation of tobacco use and cessation interventions contribute to reducing
tobacco use at any age, especially important to women of child-bear age.
The BMTFP increased promotion and outreach within each location’s community. BMTFP facilitators shared program
information and participants’ successes with other local service locations to spread awareness of the resource for
pregnant tobacco users. A majority of the BMTFP sites are based in health care systems with additional sites at local
public health units and a federally qualified health center. This year, the NDDoH expanded the BMTFP into rural and
American Indian locations. Additionally, the BMTFP enrollment increased 45% this year.

The Spotlight documents were prepared by state health departments to highlight state progress toward improving birth outcomes.
©2019 March of Dimes

 HEALTHY
MOMS.
STRONG
BABIES.

SPOTLIGHT

NEVADA

SUMMARY STATEMENT
National Vital Statistics System data on Nevada rates of prenatal care beginning during the first trimester increased
from 66.8% in 2011 to 74% in 2017. Nevada Title V Maternal and Child Health (MCH) Program efforts to promote adequate
and early prenatal care to reduce preterm births include maternal and infant-specific epidemiological surveillance,
identification and reduction of health disparities, and increasing access to prenatal and antenatal care services.

ACTIVITIES AND OUTCOMES
Title V MCH staff participate in collaborative projects to reduce preterm births, including the Go Before You Show media
campaign to increase public awareness of the importance of accessing prenatal care in the first trimester. This campaign
was launched in response to Title V MCH-funded Fetal Infant Mortality Review recommendations.
Nevada’s Infant Mortality Collaborative for Improvement and Innovation Network (IM CoIIN) project focuses on Social
Determinants of Health and reducing preterm births. It includes participation of local health authorities, March of Dimes,
Nevada Home Visiting, and the Division of Health Care Financing and Policy (Medicaid). CoIIN efforts resulted in policy
changes to better promote Medicaid coverage of alpha hydroxyprogesterone caproate (17P) to increase appropriate
utilization and a provider-focused Project ECHO webinar on 17P.
Title V MCH perinatal quality efforts focus on improving preconception and interconception health among women
of childbearing age (ages 15-44). Promotion of Long Acting Reversible Contraceptive (LARC) use and education on
reimbursements for LARCs now being covered at the time of delivery and immediately postpartum via reimbursement
factsheets are shared widely. Title V MCH co-funded Home Visiting Programs promote birth spacing, well visits,
screenings, and access to services. Title V MCH-led partnerships to reduce early elective deliveries include the Hospital
Recognition Program with the Nevada Hospital Association and March of Dimes. Three Nevada hospitals were recognized
for efforts to reduce rates of early elective deliveries by 5% for two consecutive quarters in 2015; in 2016, 12 Nevada
hospitals were recognized.
Title V MCH’s priority to reduce substance use during pregnancy and reduce children’s exposure to secondhand smoke
resulted in all Title V MCH-funded partners being required to promote and refer eligible women to the Nevada Tobacco
Quitline and the Title V MCH program-funded website http://sobermomshealthybabies.org/. A media campaign promoting
the website and priority admission for pregnant women at state-funded treatment centers continues to be distributed to
partners statewide, and a Substance Use During Pregnancy Provider Toolkit was created and distributed widely, including
tobacco cessation during pregnancy resources. Continuing current activities and trends to increase early and adequate
prenatal care will promote health equity, reduce preterm birth rates and associated disparity ratios, along with formalizing
emerging state perinatal quality collaborative efforts.

The Spotlight documents were prepared by state health departments to highlight state progress toward improving birth outcomes.
©2019 March of Dimes

 HEALTHY
MOMS.
STRONG
BABIES.

SPOTLIGHT

NEW JERSEY

SUMMARY STATEMENT
The New Jersey Department of Health (DOH) is committed to improving birth outcomes and addressing disparities
in infant mortality and morbidity. Prematurity is a leading cause of infant mortality and morbidity. Preterm births can
result in devastating health outcomes as well as emotional and economic impacts. In New Jersey, Black women are
more likely to have preterm births. According to the 2015-2017 NJ birth certificate data, the preterm birth rate for Black
non-Hispanic women was 13.3%, compared to White non-Hispanic of 8.5%, Hispanic of 9.9% and Asian non-Hispanic of
8.8%. Through several initiatives, DOH is working to improve community-based programs and provide quality access
to preconception, prenatal, and inter-conception care for women and reduce health disparities in birth outcomes,
including black infant mortality (BIM).

ACTIVITIES AND RESULTS: NURTURE NJ
Nurture NJ is the First Lady’s statewide awareness campaign that is committed to reducing infant and maternal mortality
and morbidity and ensuring equitable maternal and infant care among women and children of all races and ethnicities.
The campaign, which is devoted to serving every mother, every baby, and every family, includes a multi-pronged, multiagency approach to improve maternal and infant health among New Jersey women and children. Nurture NJ includes
internal collaboration and programing between departments and agencies; an annual Black Maternal and Infant Health
Leadership Summit; the First Lady’s Family Festival event series; and a robust social media strategy to inform and raise
awareness.

HEALTHY WOMEN HEALTHY FAMILIES INITIATIVE: CENTERING
The DOH Healthy Women Healthy Families (HWHF) initiative, launched in July 2018, was developed to improve
pregnancy outcomes and address the high rates of BIM in counties and municipalities. It uses Community Health
Workers to provide intensive, personalized support to women and their families throughout pregnancy. It includes doula
and breastfeeding support, fatherhood initiatives and Centering Pregnancy, an evidence-based model of group prenatal
care designed to empower women and improve birth outcomes. On August 9, 2019, Governor Phil Murphy signed
legislation extending Medicaid prenatal care coverage to Centering Pregnancy, a model where pregnant women receive
health assessments, social, clinical and educational activities in a group setting.

DOULAS
Doulas are trained to provide physical and emotional support and education to help women through pregnancy, birth
and beyond. Studies show doulas reduce the likelihood of cesarean births, increase the probability of vaginal births,
and provide a more positive childbirth experience. Fatherhood initiatives engage the support and involvement of
fathers during prenatal care, birth, and inter-conception care, as well as promote family engagement. Breastfeeding
support includes lactation consultants and peer counselors to educate and support women using a culturally sensitive
approach.
The Doula and HWHF programs target high-risk populations, which includes those who are low-income and/or uninsured
women with chronic health conditions and multiple social or economic stressors, victims of domestic violence, those
impacted by mental health issues, alcoholism and substance abuse, women with minimal social supports and women
with unintended pregnancies. These women on average attend fewer prenatal visits and are more likely to experience
adverse birth outcomes including prematurity.

©2019 March of Dimes

 HEALTHY
MOMS.
STRONG
BABIES.

SPOTLIGHT

NEW JERSEY

CONTINUED...

FAMILY PLANNING
DOH is increasing efforts to help prevent preterm births by increasing access to family planning options through the
restored and continued Family Planning funding. To reduce unintended pregnancies, DOH is increasing access to all
contraceptive methods, including long-term, reversible contraception (LARC). LARC options include intrauterine devices
(IUDs) and implants and are among the most effective methods of contraception according to the CDC. Additionally,
the Family Planning funding supports access to contraceptive counseling, which promotes shared decision making
between patients and their providers so patients can elect to use the contraceptive method that best fits their lifestyle
and reproductive health needs. By prioritizing funding for family planning and reproductive healthcare services, DOH is
working to ensure that women have access to vital healthcare throughout every stage of their reproductive lifecycle.

17P
A medication called 17-alpha hydroxyprogesterone (17P) is proven to prevent preterm births in certain women. The 17P/
Prematurity Prevention Initiative established a leadership team to provide consultation, analysis, and guidance. Gaps
were identified in medical practices that present barriers for women most at risk of preterm birth. These factors impact
Black, Hispanic, uninsured, and undocumented women disproportionately. The DOH and its grantee Family Health
Initiatives (FHI) uses a multi-dimensional strategy to support the clinical needs of mothers with a history of preterm
delivery that (1) provides education and awareness to the community and women most impacted by high preterm births
about the availability of effective interventions for preterm births; (2) educates community program staff about support
available to clients; (3) enlists doctors, nurses, midwives, and hospitals in identifying these women; and (4) assists
medical providers by streamlining the process for quick access to the medication regardless of their socioeconomic or
racial/ethnicity status.
To broaden the dissemination of information in a format that is readily accessible to women around the state, the
Prematurity Prevention Initiative produced an educational video highlighting the stories of two African American
women with preterm birth experiences. Their stories provide answers to many common questions and concerns. The
video, produced in Atlantic County, will be available on social media and in physician offices to educate people on the
availability of 17P as an evidence-based intervention. Also, in Atlantic County, FHI worked with South Jersey Medical
Center, the area’s Federally Qualified Heath Center, to identify and track women eligible for 17P medication based on
previous pre-term birth experiences. The health center established a High-Risk Committee, which conducted a weekly
review of eligible women.

ADDRESSING THE SOCIAL DETERMINANTS
OF HEALTH- INCREASING ACCESS TO CARE
The multi-agency Maternal and Infant Health (MIH) Committee recognized the need to remove transportation as
a barrier to women receiving weekly injections or attending prenatal appointments. As a result, once women are
determined to be eligible, they can contact NJ Transit Access Link, which picks them up at home and transports them to
medical visits, grocery stores, and other locations.
New Jersey is tracking the impact this service has on improving pregnancy outcomes to highlight the strength of this
innovative strategy. Meanwhile, the Murphy Administration has worked to stabilize New Jersey’s health insurance system
through preserving minimum essential coverage and a state-level shared responsibility payment and pursuing a statebased health insurance exchange.

©2019 March of Dimes

 HEALTHY
MOMS.
STRONG
BABIES.

SPOTLIGHT

NEW JERSEY

CONTINUED...

MATERNAL MORTALITY AND MORBIDITY
Maternal and infant outcomes are intertwined. NJ has among the worst pregnancy-related mortality, severe maternal
morbidity, and disparities outcomes in the country. To change course, Governor Phil Murphy signed a law in May 2019
that implements the New Jersey Maternal Care Quality Collaborative, New Jersey Maternal Mortality Review Committee,
and New Jersey Maternal Data Center to ensure that all relevant health systems and stakeholders are learning from the
evidence and pursuing data-driven solutions to avert preventable deaths and injuries. NJ is also implementing laws
including the Report Card of Hospital Maternity Care, promotion of shared decision-making, screening through the
Perinatal Risk Assessment, and prohibition on coverage for non-medically indicated early elective deliveries.

UPCOMING CONFERENCES
FHI and NJ DOH are collaborating with the NJ March of Dimes to host a November 12th Prematurity Awareness month
media event to share outcomes of the 17P collaboration and to increase consumer awareness of the importance of 17P
to reduce repeat preterm birth. Also, the Department of Health’s 2019 Population Health Summit on September 23,
2019—entitled Maternal Outcomes Matter—will feature state and national expertise on maternal and infant health, with
special emphasis on eliminating disparities, innovative services, and data-driven action.

The Spotlight documents were prepared by state health departments to highlight state progress toward improving birth outcomes.
©2019 March of Dimes

 HEALTHY
MOMS.
STRONG
BABIES.

SPOTLIGHT

OHIO

SUMMARY STATEMENT: CELEBRATEONE
The goal of the CelebrateOne Community Connector Corps is to connect disconnected women to reliable medical and
social services that will lower the infant mortality rate in eight priority Columbus neighborhoods where infant mortality
is highest.
To address the needs of the community and connect pregnant and parenting women/families to supportive services,
the program identifies and trains local residents as community health workers (CHWs). The CHWs work within these
targeted neighborhoods with the goal of reducing prematurity and infant mortality. To accomplish this, neighborhoodbased CHWs:
•  Identify and engage women and families to schedule prenatal/primary care appointments through community
outreach and canvassing.
•  Refer women to supportive services that address social determinants of health and the preparation for the arrival of a
new baby (cribs, diapers, and home visiting) so that women can focus on their health and their family’s well-being.
•  Follow up with families to make sure they are connected to services and that barriers or access issues experienced
by the families are documented and addressed.
•  Inform community partners about gaps in services for residents.
Since the first full year of program implementation in 2016, the infant mortality rate within the eight priority
neighborhoods decreased from 11.8 deaths out of 1,000 live births to 10.4 deaths out of 1,000 live births in 2018.

CRADLE CINCINNATI
Because it is the leading cause of infant death, reducing extreme preterm birth is a major focus of Cradle Cincinnati in
Hamilton County. Over the past five years, the county has seen a 12% decline in extreme preterm births. Encouragingly,
the bulk of that improvement has come from a 55% decline in just three neighborhoods where the collaborative has
focused its energy and resources. Those communities were home to 81 extreme preterm births between 2009-2013
and just 36 from 2014-2018. This place-based approach, called Cradle Cincinnati Connections, is led in partnership
with moms from each neighborhood. The work is focused specifically on improving African American preterm birth rate
outcomes and has five central tenants:
1.  Find and deliver measurable results for every woman in a geographic place.
2.  Build trust and empathy through consistency of care and sustained, authentic connection developed by a CHW and
nurse case manager team.
3.  Solve the problems of each mom by “saying yes” and providing tangible resources.
4.  Develop unique, community-driven solutions and strategies.
5.  Reinforce our stakeholders’ sense of ownership with place-based motivation and data about impact.
In partnership with bi3, the state of Ohio and Health Resources and Services Administration, Cradle Cincinnati
Connections is currently expanding to reach 12 zip codes.

FIRST YEAR CLEVELAND
First Year Cleveland has a goal of reducing Cuyahoga County’s infant mortality rate (IMR) of 10.5 to 6.0 in 2020 from
a high of 10.5 in 2015. They are mobilizing the community through action teams and a unified strategy centered on
reducing racial disparities, addressing extreme prematurity, and eliminating sleep-related infant deaths. Early efforts are
encouraging with an over 20% decrease in Cuyahoga County’s IMR over the period of 2015-2017 proving that success
is possible, although their work is not done. Preterm birth is the leading cause of infant deaths in Cuyahoga County and
in African American births. First Year Cleveland is committed to implementing an equity lens throughout its work and
addressing structural racism in order to achieve system changes and better health outcomes.
The Spotlight documents were prepared by state health departments to highlight state progress toward improving birth outcomes.
©2019 March of Dimes

 HEALTHY
MOMS.
STRONG
BABIES.

SPOTLIGHT

OKLAHOMA

SUMMARY STATEMENT
Oklahoma has made improvements in infant mortality, prematurity, and related areas in the last several years. Infant
mortality has decreased from 8.6 deaths per 1000 live births in 2007 to 7.1 in 2018. Additionally, in collaboration with
March of Dimes, non-medically indicated early elective deliveries were reduced by 96% from 6.1% in 2011 to .02% in
2014 through the Preparing for a Lifetime Every Week Counts initiative. Additionally, the rate was reduced in half from
2014 to 2017 (from 4% to 2% CMS PC-01 rate) under the Every Week Still Counts program initiative designed to hold
the gains made.

ACTIVITIES AND RESULTS
The Preparing for a Lifetime: It’s Everyone’s Responsibility (PFL) Every Week Counts (EWC) initiative contributed to a
96% decrease from 2011 to 2014 in the number of non-medically necessary scheduled deliveries (also known as early
elective deliveries or EEDs). This was significant as Oklahoma went from having eight early elective deliveries per day
to averaging only one EED every 3.5 days!
Major components of this initiative included:
•  Creating the EWC collaborative team among birthing hospitals and establishing a voluntary “hard stop” policy on
early elective deliveries;
•  Educating patients on the risks of preterm and early-term births using materials from March of Dimes; and
•  Initiating public service announcements to raise public awareness of the risks of birth prior to 39 weeks.
About 95% of the state’s birthing hospitals (52) participated in the PFL Every Week Counts initiative, and this
engagement was critical to the initiative’s success. Timely data and reporting from hospital partners was essential
because it allowed the EWC initiative to provide quarterly reports on hospitals’ progress and compare outcomes
among hospitals. The collective effort of these partners produced a statewide quality improvement initiative that
decreased early elective deliveries in the state of Oklahoma considerably.
To maintain the gains made through this highly successful initiative, the Every Week Still Counts campaign was
implemented to monitor the continued progress on this initiative under a new measure that hospitals have been
required to submit data on early elective deliveries through CMS utilizing the Joint Commission’s National Quality
Core Measure in Perinatal Care, Elective Delivery (PC-01). This measure indicates that Oklahoma continues to decline
EEDs by approximately 50% from 2014 to 2017.
The state PFL Every Week Counts and Every Week Still Counts initiatives demonstrate that through shared vision and
collaboration amongst state leaders, community partners and committed champions--a positive impact in the lives of
Oklahoma’s mothers, babies, and families can be made.

The Spotlight documents were prepared by state health departments to highlight state progress toward improving birth outcomes.
©2019 March of Dimes

 SPOTLIGHT

HEALTHY
MOMS.
STRONG
BABIES.

PENNSYLVANIA

SUMMARY STATEMENT
The mission of the Pennsylvania Department of Health (Department) is to promote healthy lifestyles, prevent injury
and disease, and to assure the safe delivery of quality healthcare for all Commonwealth citizens. When addressing the
health of Pennsylvania’s infants and reducing preterm birth, the biological, social, environmental, and physical factors
influencing maternal and infant health must all be considered. To optimize outcomes, women need to be healthy
physically and mentally before, during and after pregnancy. While national gains have been made in reducing infant
and maternal morbidity and mortality, the U.S. rates are still higher than most other industrialized nations despite major
advances in medical care. Additionally, racial disparities persist with the risk of preterm births for black women one
and a half times higher than those of white women in Pennsylvania. The Centering Pregnancy model of care has shown
positive effects on mental health, prenatal knowledge, and health related behaviors to improve birth outcomes.

ACTIVITIES AND RESULTS
The Department, in collaboration with March of Dimes, the Children’s Hospital of Philadelphia Research Institute Policy
Lab and the Pennsylvania Department of Human Services, has developed a pilot program to help prevent preterm
births through increased awareness about the use of 17-alpha-hydroxy progesterone caproate (17P). This project aims to
identify barriers to receiving 17P and to develop and implement ways to decrease barriers and increase 17P utilization to
reduce the preterm birth rate in Pennsylvania.
The Chester County Child Death Review Team established a subcommittee to review deaths among preterm infants.
The subcommittee, formed in 2009, has allowed for the analysis of clinical circumstances surrounding the death of
premature infants including any medical interventions as well the social, economic and other factors that may have
contributed to the death. The subcommittee includes clinicians from local hospitals, public health professionals and
service providers. The subcommittee will develop recommendations based upon the data collected from case reviews.
Funded by the Pennsylvania Department of Health, Title V Maternal and Child Health Services Block Grant, Centering
Pregnancy Programs (CPP) have been implemented in the cities of Philadelphia and Lancaster, selected because
of their disproportionately high rates of poor birth outcomes among women of color. The tables below outline the
improvements in the rate of preterm birth and low birth weight for CPP participants compared to non CPP participants.
Comparatively, in Pennsylvania for 2015-2017, 9.4% of births were preterm and 8.3% of babies were born at a low birth
weight. These positive program outcomes may help to improve the overall health and well-being of both the mother
and infant throughout the lifetime.
Lancaster 2015-2017

CPP

Non-CPP

Preterm birth

7.83%

11.67%

Low birth weight

7.00%

7.27%

Philadelphia 2015-2017

CPP

Non-CPP

Preterm birth

8.54%

12.29%

Low birth weight

6.43%

9.80%

Albert Einstein Healthcare Network’s CPP in Philadelphia, unlike many
other CPP, allows their high-risk patients to participate to gain from the
psychological and social benefits of the program. The location allows
for direct referrals to a wide range of services including: mental health,
laboratory services, domestic violence counseling, transportation, doula
services and breastfeeding support. Additionally, the program refers to the
Centering Parenting Program to continue this model of care through the
child’s first two years of life.

Lancaster General Health expanded their CPP in 2018 by adding a group specifically for women with Substance Use
Disorder (SUD) to help negate the adverse effects, including an increased likelihood of preterm birth, that SUD has
on infants. The sessions are facilitated by a Licensed Social Worker who is certified in Addictions Counseling. The
group follows the traditional CPP model of prenatal care but incorporates education specifically related to SUD and
pregnancy such as how to calm an infant going through withdrawal, stress management, and what to expect if your
infant must stay in the Neonatal Intensive Care Unit. An additional benefit of this specialized group is having a group of
women who are in similar circumstances which fosters social support in a safe, judgement free space.

The Spotlight documents were prepared by state health departments to highlight state progress toward improving birth outcomes.
©2019 March of Dimes

 HEALTHY
MOMS.
STRONG
BABIES.

SPOTLIGHT

SOUTH DAKOTA 

SUMMARY STATEMENT
Smoking during pregnancy can result in numerous adverse birth outcomes including preterm birth and low
birthweight, birth defects and infant death. In 2017, an estimated 18.1% of women in South Dakota smoked in the three
months prior to pregnancy, and 12.6% smoked while pregnant. Among women who are successful in quitting tobacco
during pregnancy, relapse after delivery is common. In 2016, the rate of postpartum relapse among SD mothers was
38.0%. Relapse in the postpartum period poses risks to the infant from second and third hand smoke exposure, as well
as continued health risks for the mother. The South Dakota QuitLine is available for all South Dakotans aged 13 and
older, including pregnant women, and added a Postpartum Program in June 2016.

ACTIVITIES AND RESULTS
In June 2016, the SD QuitLine launched a relapse prevention program targeting postpartum women. Pregnant women
who enroll in the SD QuitLine are invited to enroll in the Postpartum Program during one of the five standard coaching
calls. The program consists of four coaching calls (in addition to the five calls offered through the standard SD QuitLine
service) completed by a dedicated coach with expertise in postpartum cessation coaching. The additional calls are
structured at designated time points based on the woman’s due date, including 2 weeks before, and 15, 45 and 90 days
after the participant’s due date. If at any point while participating in the Postpartum Program, the woman reports a
relapse, she is automatically re-enrolled into the standard SD QuitLine Program.
A total of 8,570 tobacco users received cessation services in the SD QuitLine from May 1, 2016 to May 31, 2018. Of
these, 147 women (1.7%) indicated they were pregnant, and 46 women (0.5%) were nursing (Figure 1). Of the pregnant
women enrolled into the SD QuitLine standard service, 77 (52.4%) also enrolled in the Postpartum Program. Many
(60.3%) of Postpartum Program enrollees were not reached, or were no longer interested in participating, at the first
Postpartum Program call (2 weeks before due date). Of the 23 Postpartum Program participants, five women reported
using tobacco, and opted to re-enroll into the SD QuitLine standard program. Pregnant women enrolled in the
Postpartum Program were less likely to be White than the pregnant women who chose not to enroll into the program,
and those that enrolled were much more likely to complete at least one coaching session in the SD QuitLine Program
(94.7% of Postpartum Program enrollees compared to just 70.4% of non-enrollees). A 31% intent to treat quit rate was
calculated, which assumes all participants not contacted for participation in the program are using tobacco.
After seeing early success, the Postpartum Program moved out of the pilot stage in Fall 2018 and expanded to include
all pregnant tobacco users who quit during pregnancy, even if they quit on their own. This expanded service has been
promoted through Department of Health regional staff, local coalitions, and Medicaid Health Homes providers across
South Dakota.

The Spotlight documents were prepared by state health departments to highlight state progress toward improving birth outcomes.
©2019 March of Dimes

 HEALTHY
MOMS.
STRONG
BABIES.

SPOTLIGHT

TENNESSEE

SUMMARY STATEMENT
The infant mortality rate in Tennessee decreased from 7.4 per 1,000 live births in 2016 and 2017 to 6.9 per 1,000 live
births in 2018 by targeting interventions across sectors to address root causes. Successful strategies were developed
during the infant mortality reduction strategic planning process led by the Tennessee Department of Health (TDH).
A statewide, diverse group of stakeholders was convened to develop a plan to reduce infant deaths and specifically
addressed strategies to impact preterm birth and health equity.

ACTIVITIES AND OUTCOMES
The Infant Mortality Strategic Planning Committee looked at measures of success to reduce the rate of preterm birth
and improve health equity. Some of the strategies in Tennessee include:
1.  Decreasing the number of unplanned pregnancies through promotion of client-directed family planning services
including Long Acting Reversible Contraceptives (LARCs) and increasing the number of providers utilizing “One
Key Question” and Parenthood/Pregnancy Attitude, Timing, and How (PATH) to facilitate reproductive life planning
conversation;
2.  Decreasing tobacco use by increasing the number of women enrolled in Baby and Me Tobacco Free diaper
incentive program;
3.  Decreasing early elective delivery through promotion of the BEST (breastfeeding, early elective delivery reduction
and safe sleep for Tennessee babies) award to hospitals; and
4.  Increasing the number of women participating in group prenatal care. When implementing these strategies, TDH
looks at data on health disparities. Areas of the state with high disparities are a focus for prevention efforts.
TDH has collaborated with March of Dimes to implement their group prenatal care model known as Supportive
Pregnancy Care in Tennessee. March of Dimes has increased the number of sites and the number of women enrolled in
Supportive Pregnancy Care throughout Tennessee. TDH assists clients and providers with a reproductive life plan tools
to reduce unintended pregnancies. Births resulting from unintended pregnancies can have negative consequences
including birth defects and low birth weight. TDH has increased the number of health departments offering Baby and
Me Tobacco Free with all 95 county health departments now participating in the program. TDH has partnered with the
Tennessee Hospital Association to promote the BEST award. The BEST award is presented to hospitals annually meeting
set criteria around those topics. This is a way to recognize hospitals making strides to reduce infant mortality through
promotion of safe sleep, breastfeeding and reduction of early elective delivery.
Tennessee’s example shows that a multifaceted approach with key leaders and stakeholders can be successful in
reducing preterm birth and achieving health equity.

The Spotlight documents were prepared by state health departments to highlight state progress toward improving birth outcomes.
©2019 March of Dimes

 HEALTHY
MOMS.
STRONG
BABIES.

SPOTLIGHT

UTAH

SUMMARY STATEMENT
Utah has been focused on building collaborations to reduce the preterm birth rate and improve birth outcomes.
Strategies include the Utah Women and Newborns Quality Collaborative (UWNQC) and the Utah Department of Health
Office of Health Disparities working with public health resources, health care professionals and community partners to
focus on the issue and provide education on preterm birth risk reduction.

ACTIVITIES AND RESULTS
The Utah Women and Newborns Quality Collaborative (UWNQC) is a state-wide network of professionals, hospitals
and clinics dedicated to improving the health outcomes for Utah women and babies using evidence based practice
guidelines and quality improvement processes. The UWNQC Preterm Birth Committee focuses on reducing the
incidence of recurrent spontaneous preterm births by increasing provider discussions with eligible women on the
appropriate use of progesterone. The committee, led by a board certified physician in both Obstetrics and Gynecology
and the subspecialty of Maternal-Fetal Medicine consists of clinicians and public health professionals statewide.
Resources developed include a Preterm Birth Prevention Video Series to educate providers and to provide resources
about prevention and What to do After Preterm Birth Guide for Families, available in English and Spanish. Participating
hospitals report data on progesterone with some incorporating data collection of progesterone use into their Electronic
Health Record.
The Utah Department of Health (UDOH) Office of Health Disparities (OHD) pioneered efforts in data-disaggregation of
their Asian and Native Hawaiian/Pacific Islander (NHPI) communities. This uncovered several birth outcomes disparities
for NHPIs compared with Utah overall, including a higher rate of premature births. At that time, no health promotion
interventions existed in Utah or the U.S. tailored to Pacific Islanders to address this and other birth outcomes
disparities. Since 2010, the OHD in collaboration with public health and health care professionals and community
partners has been working to address this issue. One product of these efforts is the It Takes a Village: Giving our babies
the best chance (ITAV) project. ITAV raises awareness and educates NHPI families and community members about
maternal and infant health in the context of Pacific Islander cultural beliefs and practices. Content from the workshops
includes preconception health, prenatal care and birth spacing, which work towards addressing this disparity. ITAV is
one of the outcomes of a birth outcomes disparities project that was originally rooted in the theoretical framework from
the National Partnership for Action to End Health Disparities. In October 2018, the ITAV project became a Promising
Practice in AMCHP’s Innovation Station, with the recommendation to pursue the designation of Best Practice, which
the OHD is currently working toward.
Utah’s example shows that collaboration with stakeholders including clinicians and community organizations and
creating resources specific to populations with birth outcome disparities has assisted with meeting the Healthy People
2020 goal of reducing preterm births to 9.4%.

The Spotlight documents were prepared by state health departments to highlight state progress toward improving birth outcomes.
©2019 March of Dimes

 HEALTHY
MOMS.
STRONG
BABIES.

SPOTLIGHT

VIRGINIA

SUMMARY STATEMENT
The Virginia Department of Health (VDH) is capitalizing on newly announced statewide initiatives to significantly
impact maternal and infant outcomes in the Commonwealth. On June 5, 2019 Governor Ralph Northam announced
the goal to eliminate racial disparity in Virginia’s maternal mortality rate by 2025, and as direct result, on July 1, 2019
the Virginia Department of Medical Assistance Services (DMAS) announced the Health Birthday Virginia initiative to
end maternal and infant mortality through a health equity lens and to ensure all mothers and their infants celebrated
the child’s first birthday together. The VDH shares these visions and the future will highly focus on leveraging existing
activities to increase collaboration, form new partnerships, plan and implement cross-cutting and innovative measures
to achieve the goals set forth.

ACTIVITIES AND RESULTS
By December 2025 VDH aims to decrease the disparity in black-white infant mortality disparity ratio from 2.2 (2017) to
1.24 (2025). VDH already travels many avenues addressing maternal and infant mortality, internally and externally, with
sister agencies and community stakeholders to evaluate and address indicators along the reproductive life course.
Efforts center on continuing engagement with the Virginia Neonatal Perinatal Collaborative (VNPC), a public-private
partnership recognized by the CDC & NICHQ as a State Perinatal Quality Collaborative, and whose work has focused
on the implementation and promotion of hospital based quality improvement activities. These include several levels
of intervention, from surveillance to clinical practice improvements across the state and are focused on Neonatal
Abstinence Syndrome (NAS), Maternal Opioid Use Disorder (OUD), Obstetric Hemorrhage and severe hypertension in
pregnancy. These activities are occurring in almost 100% of Virginia’s birth hospitals.
Also, increased engagement with sister agencies and community based organizations (CBOs) will assist in innovative
public health policy initiatives. VDH is participating in DMAS’s Policy Innovations Program (PIP) to gain insight as to
how public and private agencies and systems can coordinate primary and secondary preventative approaches to
improve monitoring and tracking of service delivery and outcomes of pregnant women with substance use disorder.
VDH will continue to utilize its federal funding in many of its core programming as well. Focused efforts in safe sleep,
unintended pregnancy, substance use and access to care are ongoing in all of its thirty five health districts and Home
Visiting partnerships will aid in current agency and state strategic planning to ensure improving maternal and infant
outcomes, including reducing preterm birth.
Infant mortality is a sentinel measure of population health that reflects the underlying well-being of mothers and
families, as well as the broader community and social environment that cultivate health and access to health
promoting resources. VDH welcomes the Governor’s initiatives to further statewide collaborations and to highlight the
agency’s commitment to ensuring health equity among the Commonwealth’s moms and babies.

The Spotlight documents were prepared by state health departments to highlight state progress toward improving birth outcomes.
©2019 March of Dimes

 HEALTHY
MOMS.
STRONG
BABIES.

SPOTLIGHT

WASHINGTON

SUMMARY STATEMENT
Addressing birth outcome health disparities is a priority for the governor, state government, and Washingtonians, and
is tracked as part of the state’s Results Washington performance management system. Washington has met the Healthy
People 2020 objective to reduce total preterm birth to no more than 11.4 per 100 singleton births, however, significant
disparities remain in preterm deliveries for racial/ethnic and low income groups.
Our state can successfully reduce population-based disparities through culturally appropriate efforts that address
social determinants. In July 2019, Washington State Department of Health launched the Birth Equity Project. Four
grantees will engage in a three-year project to use evidence-based/evidence-informed programs or communityinformed practices that are culturally appropriate and focus on the root causes of inequities.

ACTIVITIES AND RESULTS
Cross-agency collaboration and engagement with partners across the health system is how we are working toward
a state where healthy moms, dads, and babies can thrive. Among the activities:
The Birth Equity Project will support local hospitals and tribal clinics in focusing on enhancing prenatal resources and
linkages through such approaches as home visiting, a Centering Pregnancy program, and prenatal yoga classes with
an emphasis on expanding access in rural and tribal communities. In urban areas, partner organizations will launch
the Culturally Responsive Integrated and Strength-based Parenthood (CRISP) support group, particularly reaching
pregnant people and families from American Indian/Alaska Native and Pacific Islander communities, as well as support
expansion of doula services for African American women.
The state is addressing the maternal/child impact of the opioid epidemic that is leading to premature births by
expanding access to medication-assisted treatment, and expanding residential treatment to allow more women to
bring their newborn with them into treatment.
The state offers expanded Medicaid and Medicaid during pregnancy for undocumented women. Our states’ Medicaid
program covers preventive care use of folic acid for all women of child bearing age, travel vouchers to get to
appointments, and full parity telemedicine coverage for both medical and mental health appointments.
Washington State passed legislation to raise the age to buy tobacco and vaping products from 18 to 21. The law is
expected to prevent tobacco use and addiction starting in the critical teen and young adult years, which we anticipate
will have a positive impact on birth outcomes as we see a decline in smoking prevalence among pregnant women.
By partnering on multi-agency initiatives our state is building healthier communities through regional collaborations
and improving services that address social determinants.

The Spotlight documents were prepared by state health departments to highlight state progress toward improving birth outcomes.
©2019 March of Dimes

 HEALTHY
MOMS.
STRONG
BABIES.

SPOTLIGHT

DISTRICT OF COLUMBIA

SUMMARY STATEMENT
Prematurity is the second leading cause of infant deaths in the District, accounting for 12.5% of infant deaths
in 2015-2016. In DC, during 2015-2016, the percentage of preterm live births among Black women (12.8%) was
significantly higher than white women (7.8%). The rates of preterm birth is also significantly higher (26.9%) for births
to mothers who did not initiate prenatal care compared to mothers who initiated prenatal care during their first
trimester (10.2%). For mothers with a previous preterm, nearly one-third (31.5%) experienced a subsequent preterm
birth in 2015-2016. Medicaid data for Fiscal Years 2015-2016 shows that only about 16% of District pregnant women
with a previous preterm birth received 17 alpha-hydroxyprogesterone caproate (17P), a medication that can prevent
the recurrence of preterm births by 33%. Through collaboration with local hospitals and federally qualified health
centers, DC Department of Health (DC Health) has identified and begun implementing strategies to ensure women
who are at risk for preterm birth are offered evidence-based, high quality care. Two hospitals and two federally qualified
health centers, serving large portions of publically insured Black women, are creating sustainable systems approaches
to preterm birth reduction through clinical quality improvement initiatives. The initial phase of this project focuses
on improving the identification of eligible women and streamlining the administration of 17P. Subsequent phases
of the project plan to increase the use of aspirin when indicated to prevent preeclampsia and early engagement in
prenatal care.

ACTIVITIES AND RESULTS
During the initial phase DC Health, the healthcare organizations and the Department of Healthcare Finance (DHCF)
reviewed existing processes for screening for and administering 17P within their respective institutions. This
exercise allowed the team to identify and resolve barriers to use of 17P. For example, the team identified varying
prior authorization requirements among managed care organizations (MCO) that contributed to inefficiencies for
providers and patients. With the state Medicaid agency at the table (DHCF), the groups’ efforts led to removal of prior
authorization requirement for all MCOs, a practice consistent with the District’s Fee-For-Service Medicaid program.
This has facilitated more timely and streamlined ordering processes among clinical providers. One health center lacked
capacity to monitor and coordinate referrals, and track outcomes for women eligible for 17P. Borrowing a best practice
from another health center on the team, the center added a Perinatal Care Coordination Specialist to their team. This
has led to improvements in their clinic workflow, including routine patient screening and 17P administration.
As a clinical quality improvement project, each facility is tracking their progress and implementing both standard
routine practices and unique innovative approaches to achieve a number of measureable outcomes related to reducing
preterm birth. For example, one provider organization is exploring ways to leverage data from their existing electronic
medical record to better identify and track women by using a mobile app. Another is exploring the use of social
marketing campaigns to target the lack of perceived risk of preterm birth among District women.
This two-year pilot project seeks to demonstrate that collaboration between public health, public insurance, and
clinical medicine (birthing hospitals and community obstetric providers), and implementation of scalable clinical
quality improvement strategies can reduce occurrence of preterm deliveries among District women at greatest risk.

The Spotlight documents were prepared by state health departments to highlight state progress toward improving birth outcomes.
©2019 March of Dimes

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BABIES.



@2019 March of Dimes