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2024 March of Dimes report card for

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Preterm Birth Grade

D
Rate of 10.8 percent
to 11.1 percent
Learn more
US Rate
10.4
DC Rate
10.8
DC Rank
34

The 2024 March of Dimes Report Card highlights key indicators to describe the current state of maternal and infant health. We continue to provide updated rates and grades for preterm birth as well as data on infant mortality, leading causes of infant death, and maternal health. Indicators by maternal race/ethnicity are included to underscore the persistent impact of racism in our systems and communities, with the goal of eliminating health inequities. The 2024 Report Card now examines supportive midwifery policies and those aimed to increase screening for postpartum depression, which can help to bolster the obstetric workforce and achieve equity in maternal and infant health outcomes. The detailed analyses in the report help inform policies and programs that move us towards improving the health of birthing people and the millions of babies born each year in the US, DC, and Puerto Rico.

Interactive maps can be found in the sections below. Click the section titles in the map legend to hide or reveal sections and filter your view. Hover (on desktop) or tap (on mobile) on each county on the map for more specific information.

Preterm Birth

The preterm birth rate in District of Columbia was 10.8% in 2023, higher than the rate in 2022

Preterm birth rate by year, 2013 to 2023

The presence of purple (darker color) indicates a significant trend (p <= 0.05)

Source: National Center for Health Statistics, Natality data, 2013-2023.

Preterm Birth Rates By And City

Source: National Center for Health Statistics, 2022 natality data.

City
Grade
Preterm Birth Rate
Change in rate from last year
Washington, DC
D
10.8%
Worsened

The preterm birth rate among babies born to Black birthing people is 1.8x higher than the rate among all other babies

This data is intended to highlight disparities in outcomes related to race/ethnicity and should serve as a starting point for discussions about addressing systemic racism and inequality.

Preterm birth rate

Rate per 100 births by maternal race/ethnicity, 2021-2023

Disparity
Ratio

1.81

Note: The disparity ratio is a summary measure of the gap between the racial/ethnic group with the lowest rate of preterm birth compared to all others. A value closer to 1 is most desirable, with 1 indicating no disparity. See calculations for the preterm birth disparity ratio here

Chronic health conditions make people more likely to have a preterm birth

The tiles display the 2023 preterm birth rate for babies born to birthing people with each chronic condition (in blue) and percentage of all births exposed to each condition (in parentheses).

24.2%
Smoking
(1.3% of all births)
18.4%
Hypertension
(3.3% of all births)
13.0%
Unhealthy weight
(27.9% of all births)
21.5%
Diabetes
(1.5% of all births)

Note: More than one condition can occur at the same time. All conditions occur prior to pregnancy. US preterm birth rates for birthing people with each condition are as follows: smoking: 15.5%; hypertension: 23.3%; unhealthy weight: 12.3%; and diabetes: 28.8%.

Source: National Center for Health Statistics, Natality data, 2021-2023.

Infant Mortality

Infant
Mortality
Rate

5.5
US Rate
5.6
DC Rank
19

The infant mortality rate decreased in the last decade; In 2022, 44 babies died before their first birthday

Rate per 1,000 live births

Purple (darker) color shows a significant trend (p <= .05)

Source: National Center for Health Statistics Period Linked Birth/Infant Death data, 2012-2022.

The infant mortality rate among babies born to Black birthing people is 1.7x the state rate

Infant mortality rate

Rate per 1,000 live births by maternal race/ethnicity, 2020-2022

Leading causes of infant death

Percentage of total deaths by underlying cause, 2020-2022

Notes: PI = Pacific Islander; AIAN = American Indian/Alaska Native; PTB/LBW = preterm birth and low birth weight; SIDS = sudden infant death syndrome. Other causes account for 50.7% of infant deaths.

Source: National Center for Health Statistics, Period Linked Birth/Infant Death data, 2012-2022.

Maternal Health

The Maternal Vulnerability Index is used to understand where and why birthing people may be more likely to have poor health outcomes

Maternal Vulnerability Index by County

Birthing people in District of Columbia are most vulnerable to poor outcomes due to the following factors:

Physical health

Physical environment

Source: Surgo Health, Maternal Vulnerability Index (MVI), 2024. https://mvi.surgoventures.org

Exposure to extreme heat or air pollution can increase the risk of poor maternal and infant health outcomes, including preterm birth

Community and individual risk mitigation efforts can help reduce the risk of exposure to extreme heat and poor air quality. Birthing people can check their local heat risk and air quality at: http://www.cdc.gov/heatrisk

24
Days

Extreme Heat

This shows the average number of days in the year that birthing people were at risk for exposure to extreme heat.

12
Days

Poor Air Quality

This shows the average number of days in the year that birthing people were at risk for exposure to poor air quality.

Source: Centers for Disease Control and Prevention National Environmental Public Health Tracking Network, Historical Temperature and Heat Index, 2023; Environmental Protection Agency, Air Quality Statistics by County, 2023. See technical notes for more details.

Clinical Measures

The measures below are important indicators for how District of Columbia is supporting the health of birthing people

N/A
23.2

Maternal Mortality

The maternal mortality rate cannot be shown due to unreliable estimates and concerns with confidentiality.

29.7
Percent
26.6

Low-Risk Cesarean Birth

Percent of women who had Cesarean births and were first-time moms, carrying a single baby, positioned head-first and at least 37 weeks pregnant.

21.0
Percent
15.7

Inadequate Prenatal Care

Percent of women who received care beginning in the fifth month or later or less than 50% of the appropriate number of visits for the infant's gestational age.

Source: National Center for Health Statistics, Mortality data, 2018-2022. National Center for Health Statistics, Natality data, 2023.

Policy Measures

Adoption of the following policies and sufficient funding in District of Columbia is critical to improve and sustain maternal and infant healthcare

Midwife Policy

State has adopted 4 of 4 supportive midwifery policies.

State has adopted policies that support the growth and sustainability of the midwifery workforce.

Independent Practice

Pay Parity

Prescriptive Authority

Licensure For Certified Midwives

Medicaid Extension

State has extended coverage for women to one year postpartum.

Medicaid Expansion

State has adopted this policy, which allows birthing people greater access to preventative care during pregnancy.

Mental Health

State Medicaid program requires and reimburses for postpartum mental health screening.

Doula Reimbursement Policy

State Medicaid agency is actively reimbursing doula care.

Paid Family Leave

State has required employers to provide a paid option while out on parental leave.

Commitment To Prevention

State has a CDC funded maternal mortality review committee and reviews fetal and infant deaths.

Legend
State has the indicated funding/policy
State reimburses up to $1,500
State does not have the indicated funding/policy

This table is a summary of report card measures.
Refer to each individual section for more info on each measure.

Preterm birth
Preterm disparity ratio
Infant mortality
Maternal mortality
Low-risk Cesarean
Adequate PNC
Measure
10.8%
1.81
5.5 deaths per 10K births
N/A
29.7%
64.8%
Rank
34th of 52
47th of 47
19th of 52
N/A
46th of 52
51st of 52
Direction from prior year
Worsened
Worsened
Improved
N/A
Worsened
Improved
HP2030 Target
9.4%
1.00
5.0 deaths per 10k births
15.7 deaths per 100k births
23.6%
80.5%

Note: All policies were assessed on October 15, 2024. Adequate PNC measure differs from inadequate PNC. Adequate is presented here to align with Healthy People 2030 target. Ranks are determined for all states with available data with 1 being the best.

Infographic

Infographic

The March of Dimes Report Card indicates the maternal and infant health crisis is worsening. You can make a difference. Share your state's grade on your social channels, by email or by text and encourage others to take action by advocating for change.

Technical Notes

  1. Preterm Birth
  2. Infant Mortality
  3. Additional Factors
  4. State Level Policies
  5. Appendix A: Cause Of Death Categories And Corresponding Codes

References

  1. National Center for Health Statistics, final natality data 2013–2023.
  2. Joinpoint Trend [computer software]. Version 5.0.2. Retrieved from https://surveillance.cancer.gov/joinpoint/.
  3. Ha S, Abatzoglou JT, Adebiyi A, et al. Impacts of heat and wildfire on preterm birth. Environ Res. 2024;252(Pt 4):119094.
  4. Dresser C, Mahalingaiah S, Nadeau KC. Preterm and Early-Term Birth, Heat Waves, and Our Changing Climate. JAMA Netw Open. 2024;7(5).
  5. Jiang P, Li Y, Tong MK, et al. Wildfire particulate exposure and risks of preterm birth and low birth weight in the Southwestern United States. Public Health. 2024;230:81-88.
  6. Research Data Assistance Center. 130 ICD-10 Cause of Infant Death Recodes. Accessed October 5, 2024. https://resdac.org/cms-data/variables/130-icd-10-cause-death-recodes.
  7. National Institute of Child Health and Human Development (NICHD). Maternal Morbidity and Mortality. Accessed October 5th, 2023. https://www.nichd.nih.gov/health/topics/maternal-morbidity-mortality.
  8. Hoyert DL. Maternal Mortality Rates in the United States, 2022. NCHS Health E-Stats. 2024.
  9. Hoyert DL, Miniño AM. Maternal Mortality in the United States: Changes in Coding, Publication, and Data Release, 2018. National Vital Statistics Reports; vol 69 no 2. Hyattsville, MD: National Center for Health Statistics. 2020.
  10. Surgo. Maternal Vulnerability Index. Accessed October 5, 2023. https://mvi.surgoventures.org.
  11. Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: Final Data for 2018. Natl Vital Stat Rep 2019;68(13):1- Retrieved from: https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_13-508.pdf.
  12. 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(9):1414-1420.
  13. Kaiser Family Foundation. Medicaid Postpartum Coverage Extension Tracker. Published September 28, 2023. https://www.kff.org/medicaid/issue-brief/medicaid-postpartum-coverage-extension-tracker/.
  14. Kaiser Family Foundation. Status of State Medicaid Expansion Decisions: Interactive Map. Accessed September 22, 2023. https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/.
  15. Kaiser Family Foundation. Status of State Action on the Medicaid Expansion Decision. Accessed September 29, 2023. https://www.kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/.
  16. U.S. Department of Labor- Women’s Bureau. Paid family and medical leave fact sheet. Accessed October 4, 2023. https://www.dol.gov/sites/dolgov/files/WB/paid-leave/PaidLeavefactsheet.pdf.
  17. A Better Balance. Overview of Paid Family and Medical Leave Laws in the United States. Updated March 15, 2024. Accessed October 1, 2024. https://www.abetterbalance.org/resources/paid-family-medical-leave-laws/.
  18. DONA International. What is a Doula? Accessed October 4, 2023. https://www.dona.org/what-is-a-doula/.
  19. National Health Law Program. Doula Medicaid Project. Accessed September 22, 2022. https://healthlaw.org/doulamedicaidproject/.
  20. Guttmacher Institute. Maternal Mortality Review Committees. Accessed September 29, 2023. https://www.guttmacher.org/state-policy/explore/maternal-mortality-review-committees.
  21. Centers for Disease Control and Prevention. Enhancing Reviews and Surveillance to Eliminate Maternal Mortality. Accessed September 22. 2024. https://www.cdc.gov/maternal-mortality/php/erase-mm/index.html#cdc_generic_section_2-erase-mm-participants-across-the-nation.
  22. The National Center for Fatality Review and Prevention. Fetal & Infant Mortality Review. Accessed October 4, 2023. https://ncfrp.org/fimr/.
  23. The National Center for Fatality Review and Prevention. FIMR map. Accessed September 22, 2024. https://ncfrp.org/fimr-map/.
  24. Commonwealth Fund. State policies to improve perinatal health outcomes. Published 2023. Accessed October 15th, 2024. https://www.commonwealthfund.org/publications/maps-and-interactives/state-policies-improve-perinatal-health-outcomes.
  25. Vanderlaan J. Access to Midwifery Care National Chartbook. Published 2023. Accessed October 1, 2024. https://www.midwife.org/midwifery-workforce.