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.
Infant Health
The preterm birth grade was D+ in 2023; the worst grades occurred in the southern region of the US
Preterm Birth
The preterm birth rate was 10.4% in 2023, no change from 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; National Center for Health Statistics, US Territories Natality data, 2023.
One third of the 100 US cities with the greatest number of live births had a preterm birth grade of F in 2023
Notes: 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; *Data for Honolulu represent the combined city and county of Honolulu.
Source: National Center for Health Statistics, Natality data, 2023.
In the US, the preterm birth rate among babies born to Black birthing people is 1.4x 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
Many factors make birthing people more likely to have a preterm birth
Addressing chronic health conditions before pregnancy, educating people about the risks and management of environmental exposures, and advocating for policies that offer solutions can mitigate the risks of preterm birth and other adverse outcomes.
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. Hypertension, diabetes, smoking and unhealthy weight occur pre-pregnancy.
Source: National Center for Health Statistics, Natality data, 2021-2023.
Infant Mortality
Infant
Mortality
Rate
Over 20,000 babies died before their first birthday; the greatest rates occurred in the South and Midwest regions
Infant mortality rate (deaths per 1,000 live births) by state, 2022
Source: National Center for Health Statistics Period Linked Birth/Infant Death File, 2022.
The infant mortality rate increased for the first time in two decades in 2022 and babies born to Black birthing people have a rate 1.9x the national rate
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.
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: AIAN = American Indian/Alaska Native, PI = Pacific Islander; PTB/LBW = preterm birth and low birth weight; SIDS = sudden infant death syndrome.
Source: National Center for Health Statistics Period Linked Birth/Infant Death data, 2020-2022.
Maternal Health
Maternal mortality has returned to pre-pandemic rates. Still, over 800 maternal deaths occurred in 2022 and disparities by race/ethnicity persist
Maternal
Mortality
Rate
Maternal mortality is a death from complications of pregnancy or childbirth that occur during the pregnancy or within six weeks after the pregnancy ends.
Maternal mortality rate (deaths per 100,000 live births) by year, 2018-2022
Maternal mortality rate (deaths per 100,000 live births) by race/ethnicity, 2018-2022
Source: National Center for Health Statistics, Mortality data, 2018-2022.
Note: AIAN = American Indian/Alaska Native, PI = Pacific Islander.
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 (MVI) by state, 2024
Source: Surgo Health, Maternal Vulnerability Index, 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
40.7% of birthing people were at risk of exposure to extreme heat.
Poor Air Quality
73.7% of birthing people were at risk of exposure to poor air quality.
Note: Extreme heat is defined by ≥ 30 days above the 90th percentile of the heat index. Poor air quality is defined by Air Quality Index over 100 for ≥ 1 day.
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 the US is supporting the health of birthing people
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, Natality data, 2023.
Policy Measures
Adoption of the following policies and sufficient funding for all states is critical to improve and sustain maternal and infant health
- Midwifery Policy
4 states & DC have all policies in place to support midwives
Adoption of these polices support the growth and sustainability of the midwifery workforce.
Policies include the following: independent practice, prescriptive authority, payment parity at 100% and licensing for Certified Midwives (CMs).
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.