to 9.6 percent
The 2022 March of Dimes Report Card highlights the latest key indicators to describe and improve maternal and infant health. We continue to provide updated measures on preterm birth, infant mortality, low-risk Cesarean births and inadequate prenatal care. New this year is the inclusion of the Maternal Vulnerability Index (MVI), which provides county-level indicators of where women are most vulnerable to poor outcomes. We continue to monitor disparities in maternal and infant health. Comprehensive data collection and analysis of these measures inform the development of policies and programs that move us closer to health equity. The Report Card presents policies like Medicaid expansion and programs like Maternal Mortality Review Committees, that can help improve equitable maternal and infant health for families across the country. Our Supplemental Report Card, which can be downloaded above, summarizes state-level progress towards selected Healthy People 2030 pregnancy and childbirth health objectives, outcomes by race/ethnicity and describes March of Dimes programmatic initiatives.
Percentage of live births born preterm
Purple (darker) color shows a significant trend (p <= .05)
Infant Mortality Rate
Infant mortality rates are an indication of overall health. Leading causes of infant death include birth defects, preterm birth, low birth weight, maternal complications and sudden infant death syndrome (SIDS).
Rate per 1,000 live births
Purple (darker) color shows a significant trend (p <= .05)
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. *See technical notes for details.
Percentage of live births in 2019-2021 (average) born preterm
Preterm Birth Rates By Counties And City
Preterm Birth Rate
Change in rate from last year
Preterm Birth Rate
Change in rate from last year
There is a critical connection between infant health, maternal health and the health of a family. All are dependent on their lived social context, the quality and accessibility of healthcare and the policies within a state. Each factor can provide insight into how a state serves its population, among other factors.
Maternal Vulnerability Index
Where you live matters.
March of Dimes, in partnership with Surgo Ventures, examines determinants of maternal health using the Maternal Vulnerability Index (MVI)*. The MVI is the first county-level, national-scale tool to identify where and why moms in the U.S. are vulnerable to poor pregnancy outcomes and pregnancy-related deaths. The MVI includes not only widely known clinical risk factors, but also key social, contextual, and environmental factors that are essential influencers of health outcomes.
Differences in counties are measured using numerous factors broken into six themes: reproductive healthcare, physical health, mental health and substance abuse, general healthcare, socioeconomic determinants and physical environment. The MVI assigns a score of 0-100 to each geography, where a higher score indicates greater vulnerability to adverse maternal outcomes.
*Visit https://mvi.surgoventures.org for more information.
Where in North Dakota are mothers most vulnerable?
Your healthcare matters.
Access to and quality of healthcare before, during and after pregnancy can affect health outcomes in the future. An unnecessary Cesarean birth can lead to medical complications and inadequate prenatal care can miss important milestones in pregnancy.
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. These births are frequently considered low-risk.
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.
The policies in your state matter.
Adoption of the following policies and organizations can help improve maternal and infant healthcare.
State has adopted this policy to allow women greater access to preventative care during pregnancy.
State has recent action to extend coverage for women beyond 60 days postpartum.
State allows for Medicaid reimbursement at 90% and above for certified nurse midwives.
Maternal Mortality Review Committee (MMRC)
State has a MMRC, which is recognized as essential to understanding and addressing the causes of maternal death.
Perinatal Quality Collaborative (PQC)
State has a PQC to identify and improve quality care issues in maternal and infant healthcare.
Doula Policy or Legislation
State has allowed for the passage of Medicaid coverage for doula care.
- State has the indicated organization/policy
- State does not have the indicated organization/policy
- Waiver pending or planning is occurring
- Has an MMRC but does not review deaths up to a year after pregnancy ends
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.
- Preterm Birth Rate
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 2021 final natality data for all U.S. States and Washington D.C. Preterm birth rates in the trend graph are from the NCHS 2011-2021 final natality data. County and city preterm birth rates are from the NCHS 2021 final natality data for U.S. states and Washington D.C. Preterm birth rates for bridged racial and ethnic categories were calculated from NCHS 2019-2021 final natality data. All provided measures for Puerto Rico are calculated from the NCHS 2021 Territory final natality data, unless otherwise noted. 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. Joinpoint Trend Analysis Software2 was utilized to assess significant trends in preterm birth.
- Infant Mortality Rate
- Preterm Birth Grading Methodology
- Preterm Birth by Race/Ethnicity of the Mother
- Preterm Birth by City
- Preterm Birth Disparity Measures
- Maternal Vulnerability Index
- Low-Risk Cesarean Birth Rates
- Inadequate Prenatal Care
- Medicaid Expansion
- Medicaid Extension
- Maternal Mortality Review Committee (MMRC)
- Perinatal Quality Collaborative (PQC)
- Doula Policy on Medicaid Coverage
- Midwifery State Laws
- Healthy People 2030
- Unhealthy Weight Before Pregnancy
- Preterm Birth By County
- Live Births and Preterm Birth by Race and Ethnicity of the Mother—Expanded
- Advocates Who Raised Their Voice
- Implicit Bias Training Seats Contracted
- People Supported Through Our NICU Initiatives
- Pieces of State Legislation Supported
- National Center for Health Statistics, final natality data 2017-2021.
- Joinpoint Trend [computer software]. (2022). Retrieved from Joinpoint Regression Program (cancer.gov).
- 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.
- Surgo Maternal Vulnerability Index. Available at: Surgo Ventures - The US Maternal Vulnerability Index (MVI).
- 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):141 4-1420.
- Kaiser Family Foundation. Status of State Medicaid Expansion Decisions: Interactive Map. Accessed September 9, 2022. 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 | KFF or https://www.kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/.
- American College of Obstetricians and Gynecologists. Status of State Actions to Extend Postpartum Medicaid Coverage. Accessed September 9, 2022. https://www.acog.org/advocacy/policy-priorities/extend-postpartum-medicaid-coverage/status-of-state-actions.
- Equitable Maternal Health Coalition. Accessed October 4, 2022. https://static1.squarespace.com/static/5ed4f5c9127dab51d7a53f8e/t/5ee12b312ecd4864f647fe67/1591814991589/State+White+Paper+06 1020-V6.pdf.
- Center for Disease Control (CDC), Pregnancy-Related Deaths: Data from 14 U.S. Maternal Mortality Review Committees, 2008- 2017. Accessed October 4, 2022. https://www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/mmr-data-brief.html.
- Guttmacher Institute. Maternal Mortality Review Committees. Accessed September 9, 2022. https://www.guttmacher.org/state-policy/explore/maternal-mortality-review-committees.
- Vermont Department of Health. Maternal Mortality Review Panel Annual Report (2012). Accessed October 3, 2022. https://legislature.vermont.gov/Documents/2022/WorkGroups/House%20Human%20Services/Reports%20and%20Resources/W~Vermont%20Department%20of%20Health~Maternal%20Mortality%20Review%20Panel%20Annual%20Report~1-11-2021.pdf.
- Centers for Disease Control and Prevention, Perinatal Quality Collaboratives. Accessed October 4, 2022. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pqc.htm.
- National Institute for Children's Health Quality. (NICHQ). National Network of Perinatal Quality Collaboratives (NNPQC) Coordinating Center (nichq.org) or https://www.nichq.org/project/national-network-perinatal-quality-collaboratives.
- DONA International. What is a doula? Accessed October 4, 2022. https://www.dona.org/what-is-a-doula/.
- National Health Law Program. Doula Medicaid Project. Accessed October 17th, 2022. https://healthlaw.org/doulamedicaidproject/.
- American College of Nurse-Midwives (ACNM). Reimbursement Equity. Accessed September 9, 2022. https://www.midwife.org/reimbursement-equity.
- U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion. Healthy People 2030. Assessed October 17, 2022. Healthy People 2030 | health.gov.