November 15, 2021

March of Dimes, the nation’s leader in mom and baby health, today released its 2021 Report Card revealing that for the first time in six years that U.S. preterm births declined slightly from 10.2% to 10.1%, with the nation keeping it’s C- grade. Yet rates actually increased for Black and American Indian/Alaska Native women. Despite fewer preterm births and a continued decline in infant deaths, maternal deaths and women suffering from severe health complications due to pregnancy are continuing to rise. More than 700 women in the U.S. still die from pregnancy-related causes each year and over the last 30 years these deaths have more than doubled.

These statistics are far worse for moms and babies of color, as deeply entrenched structural racism is directly impacting their health. The Report Card highlights the stark disparities that cut across all measures of maternal and infant health and outlines the policy actions and partnerships needed to improve the health of our nation’s families.

Even before the COVID-19 pandemic, the U.S. remained among the most dangerous developed nations for childbirth. The Report Card shows the number of preterm births fell from 383,061 to 364,487, but Black and American Indian/Alaska Native women are still up to 60% more likely to give birth preterm compared to White women. Preterm birth rates increased for Black mothers from 14.25% to 14.36% and for American Indian/Alaskan Native mothers from 11.55% to 11.61%. We see the same disparities trend with infant death, which has slowly declined over the past several years. The latest data show a decline from 21,498 babies to 20,921 babies lost the previous year (which is still two babies dying every hour in the U.S.). However, Black and American Indian/Alaskan Native babies are still twice as likely as White babies to die before their first birthdays. Additionally, Black women are three times more likely to die than their White counterparts are and the latest analysis from the Surgeon General shows about 60,000 women suffer from severe maternal morbidity a year in the U.S.

The complexity of this crisis is anchored in the fact that it does not have one root cause, nor a single solution. Factors such as where a person lives and the structural and societal systems they live under all impact the health of moms and babies and lead to a health equity gap. More research and data collection are needed to better understand and track changes in preterm birth rates during the COVID-19 pandemic. For that reason, March of Dimes is working to develop a greater understanding of late-preterm birth and the data during the pandemic overall.

“While we’ve seen a small improvement in preterm births and infant deaths, communities of color are still disproportionately impacted,” said March of Dimes President and CEO Stacey D. Stewart. “We see these same disparities trend with maternal health and are a result of a complex web of factors that are fueling this health equity gap. We know it is possible for every family to have a healthy start and we must work together to change the course of this crisis to ensure that they all do.”

Present day structures and systems, rooted in racist, biased, and unfair policies and practices over centuries contribute to and magnify racial differences in access to resources, social conditions and opportunities. These policies that have systematically disadvantaged under-resourced and communities of color over centuries result in persistent, inequitable poor maternal and infant health outcomes for communities of color.

In an effort to address these racial disparities and understand the factors that lead to them, the Report Card features several new measurements aimed to improve birth outcomes and reduce rates of maternal death and illness, including:

The CDC’s Social Vulnerability Index shows counties with populations that have higher levels of vulnerability and therefore at greater risk of poor health outcomes. The index shows that southern states, Appalachia and pockets of western states have higher levels of vulnerability.

Midwifery and Doula Care Legislation/Policies: Both of which can help improve access to care in under-resourced areas, improve birth outcomes and reduce rates of maternal death and illness.

Low-risk Cesarean Births: A cesarean birth is considered low-risk if a single infant is delivered head-first to a mom who is at least 37 weeks pregnant and has not given birth before. Low -risk cesarean births remained steady since 2018. In 2019, one quarter of births (25.6%) were delivered by cesarean birth that were considered low-risk.

Supplemental Report Cards for each state also showcase the breakdown by race and ethnicity of infant mortality, low-risk cesarean birth rates, inadequate prenatal care and live births.

"By looking at the new social vulnerability measure, low-risk cesarean birth rates, and state adoption of doula and midwifery legislation, we are providing additional information to help us identify under-resourced areas and improve access and quality of care,” said March of Dimes Senior Vice President and Interim Chief Medical and Health Officer Dr. Zsakeba Henderson.

Dr. Henderson noted that even in low-risk women, there are multiple reasons a cesarean birth would be the safest option for mom and baby. Variations in practice patterns among hospitals nationwide may be one of the driving forces behind the overuse of this procedure.

2021 March of Dimes Preterm Birth Grades

Each year, the March of Dimes releases its Report Card with grades for individual states, Washington, D.C., Puerto Rico and top 100 cities. Between 2019 and 2020, 33 states, Washington D.C. and Puerto Rico experienced a decline in preterm birth rates, while 13 states saw an increase and four remained the same. The Report Card shows six states and Puerto Rico earning a failing grade, including Alabama, Arkansas, Louisiana, Mississippi, South Carolina, and West Virginia. Vermont is the only state to receive an “A” grade.

● 6 states and Puerto Rico earned a “F” (Alabama, Arkansas, Louisiana, Mississippi, South Carolina and West Virginia)

● 2 states earned a “D-” (Georgia, Oklahoma)

● 5 states earned a “D” (Missouri, Texas, Tennessee, North Carolina, Kentucky)

● 5 states earned a “D+” (Delaware, Florida, Indiana, Nebraska, Nevada)

● 5 states earned a “C-“ (Illinois, Maryland, Michigan, Ohio, Wyoming)

● 6 states and Washington DC earned a “C” ( Alaska, Hawaii, Iowa, Kansas, Montana, North Dakota, Wisconsin)

● 7 states earned a “C+” (Arizona, New Jersey, New Mexico, Pennsylvania, South Dakota, Utah, Virginia)

● 6 states earned a “B-” (Colorado, Connecticut, Maine, Minnesota, New York, Rhode Island)

● 3 states earned a “B” (California, Massachusetts, Washington)

● 3 states earned a “B+” (New Hampshire, Idaho, Oregon)

● 1 state earned an A (Vermont)


Actions to Address the Crisis

March of Dimes leads the fight for all moms and babies through research, education, programs and advocacy. Since its inception, the organization has worked with a multitude of partners on the national and local levels to address the biggest threats facing moms and babies. Towards that end, March is Dimes is rallying partners to urge policymakers to prioritize the health of our nation's families through its #BlanketChange campaign. This includes the Black Maternal Health Momnibus Act of 2021, which will help fill gaps in existing legislation to improve health outcomes for moms of color. Join the #BlanketChange movement to demand policy makers prioritize our nation’s moms and babies and take immediate action to improve health by visiting

March of Dimes also is working at the national and community-level to help close the health equity gap. Serving as a convener, March of Dimes mobilizes partners at the national level through the Mom and Baby Action Network (M-BAN) and currently in nine U.S. communities through Local Collective Impact Initiatives. At both levels, they leverage Collective Impact, a proven approach of working with multi-sector stakeholders to solve intricate challenges. Learn more at

To view the Report Card and actions you can take support moms and babies, visit