Reports
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Preterm Birth Grade
to 11.1 percent
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.
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
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
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).
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
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
Extreme Heat
This shows the average number of days in the year that birthing people were at risk for exposure to extreme heat.
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
Maternal Mortality
The maternal mortality rate cannot be shown due to unreliable estimates and concerns with confidentiality.
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.
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.
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
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
References
- National Center for Health Statistics, final natality data 2013–2023.
- Joinpoint Trend [computer software]. Version 5.0.2. Retrieved from https://surveillance.cancer.gov/joinpoint/.
- Ha S, Abatzoglou JT, Adebiyi A, et al. Impacts of heat and wildfire on preterm birth. Environ Res. 2024;252(Pt 4):119094.
- Dresser C, Mahalingaiah S, Nadeau KC. Preterm and Early-Term Birth, Heat Waves, and Our Changing Climate. JAMA Netw Open. 2024;7(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.
- 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.
- 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.
- Hoyert DL. Maternal Mortality Rates in the United States, 2022. NCHS Health E-Stats. 2024.
- 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.
- Surgo. Maternal Vulnerability Index. Accessed October 5, 2023. https://mvi.surgoventures.org.
- 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.
- 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.
- Kaiser Family Foundation. Medicaid Postpartum Coverage Extension Tracker. Published September 28, 2023. https://www.kff.org/medicaid/issue-brief/medicaid-postpartum-coverage-extension-tracker/.
- 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/.
- 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/.
- 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.
- 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/.
- DONA International. What is a Doula? Accessed October 4, 2023. https://www.dona.org/what-is-a-doula/.
- National Health Law Program. Doula Medicaid Project. Accessed September 22, 2022. https://healthlaw.org/doulamedicaidproject/.
- Guttmacher Institute. Maternal Mortality Review Committees. Accessed September 29, 2023. https://www.guttmacher.org/state-policy/explore/maternal-mortality-review-committees.
- 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.
- The National Center for Fatality Review and Prevention. Fetal & Infant Mortality Review. Accessed October 4, 2023. https://ncfrp.org/fimr/.
- The National Center for Fatality Review and Prevention. FIMR map. Accessed September 22, 2024. https://ncfrp.org/fimr-map/.
- 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.
- Vanderlaan J. Access to Midwifery Care National Chartbook. Published 2023. Accessed October 1, 2024. https://www.midwife.org/midwifery-workforce.