Despite advances in modern medicine, the US continues to have one of the worst infant and maternal mortality rates in the developed world.
In 2021, there were 32.9 maternal deaths for every 100,000 live births in the US, according to the Centers for Disease Control and Prevention (CDC).
Fast forward to 2022 and the maternal mortality rate is down to 22.3 deaths for every 100,000 live births, according to a new March of Dimes report.
The new rate marks a significant departure from the time of the pandemic when maternal mortality rates were at an all-time high.
However, not everything is back to pre-pandemic levels.
Here are the five key takeaways from the 2024 March of Dimes Report Card and what they mean for the health of mothers across the country.
1. Southern States Have Some of the Worst Preterm Birth Rates
In 2023, the preterm birth rate in the US was 10.4%, representing little to no change from 2022.
Several southern states, including Texas, Kansas, Oklahoma, and Tennessee, are on par with the rest of the country, standing at a preterm birth rate of 10.4% to 11.4%, according to the report.
Higher preterm birth rates continue into the southern region with many states to the east of Texas sharing a rate of 11.5% or greater.
This includes Arkansas, Louisiana, Mississippi, and Georgia.
While southern states have higher preterm birth rates, states to the north, such as Massachusetts, New Hampshire, and Vermont, and states on the west coast, like California, Oregon, and Washington have some of the lowest in the country.
Major cities in these states contribute to the high and low rates.
For instance, Detroit (14.8%), Cleveland (14.8%), and Mobile, Alabama (14.6%) had the worst preterm birth rates in the country, while cities like Irvine, California (7%) and Seattle (8.1%) have some of the best, according to the report.
2. Preterm Birth is Linked to Race/Ethnicity and Other Health Risks
Like many health conditions, preterm birth can affect people of color more often.
Black individuals are among the highest at risk for preterm birth at 14.7%, compared to those of other races and ethnicities, according to March of Dimes.
Pacific Islanders experience preterm birth at a rate of 12.4%, American Indian/Alaskan Native individuals experience it at 12.4%, and Latinos have preterm births at a rate of 10.1%, compared to 9.5% White individuals.
There are also certain health conditions that can play a role in someone’s risk for preterm birth.
Diabetes (28.8%), smoking (15.5%), hypertension (23.3%), and obesity (12.3%) can increase someone’s risk for preterm labor.
What’s more, all of these conditions disproportionately affect people of color.
The environment can also impact someone’s risk for preterm labor.
According to the report, 40.7% of birthing people are at risk for extreme heat exposure and 73.7% of birthing people are at risk for poor air quality exposure, which has been known to cause childhood obesity.
3. Infant Mortality is Higher in South and Midwest Regions
The infant mortality rate in the US is 5.6 for every 1,000 live births.
In 2022, over 20,000 babies died before their first birthday, with the greatest number of deaths coming out of the South and Midwest regions, according to the report.
Furthermore, only 16 states meet the target for infant mortality, which is 5 deaths per 1,000 births.
Some of those states include northern states, such as New York, New Hampshire, Rhode Island, and Connecticut, and states on the west coast, such as California, Oregon, and Washington.
Birth defects account for 20% of infant deaths, preterm birth and low birth weight 15%, SIDS at 7.3%, and accidents 6.4%.
When it comes to race and ethnicity, infant death is most prevalent in Black individuals (10.6%) followed by Pacific Islander (8.7%), American Indian/Alaskan Native (8.1%), and Latino individuals (4.8%).
4. Maternal Mortality is Higher Among People of Color
While maternal mortality has decreased over the last year, 800 maternal deaths occurred in 2022 — many of these individuals were people of color, according to the report.
By race and ethnicity, American Indian/Alaskan Native individuals have the highest rate of maternal mortality at 58.0 deaths for every 100,000 live births followed by Black individuals at 51.0, and Pacific Islander at 47.4.
White, Latino, and Asian individuals all have a rate lower than 20.0.
Several states are prone to worse maternal health outcomes, many of them being in the southern-most United States.
These states have low access to quality healthcare, many of them being in maternity care deserts, or have low access to insurance, leading to delayed maternity care.
The report indicates that 15.7% of pregnant people received care beginning in the fifth month or later.
Pregnant people living in these areas are also more prone to cesarean births, which can complicate the health of the mother and child.
In fact, 26.6% of cesarean births were done on first-time moms carrying a single baby, positioned head-first and performed at least 37 weeks pregnant.
5. States Have Begun Addressing Maternal and Infant Mortality
States where maternity mortality, preterm births, and infant mortality are low remain low because they’ve instituted important measures that ensure the health of expectant mothers and their babies, according to the report.
To improve access to healthcare, four states and DC have midwife policies in place, according to the report.
In response to low access to insurance, 37 states and DC have expanded and extended Medicaid coverage.
So far, 12 states have adopted policies that require, screening for postpartum depression , and another 17 states and DC require Medicaid reimburse for doula care.
To help families after birth, nine states and DC have implemented 12-week paid leave.
Assisting with the maternal mortality and infant mortality crisis in the US further, 24 states and Puerto Rico have a CDC-funded maternal mortality review committee. This committee also reviews fetal and infant deaths.
Factors Driving Maternal Mortality
One of the biggest driving factors driving the disparities in maternal and infant mortality stems from issues in healthcare, including provider implicit bias.
Implicit bias can occur in healthcare when a provider or clinician forms a conscious or unconscious opinion about a patient based on stereotypes.
This can greatly impact the type of care or treatment they receive, leading to worse health outcomes.
In a prenatal setting, implicit bias can have disastrous consequences, including increasing the risk for pregnancy complications, chance of giving birth via c-section, and maternal and infant mortality.
A recent survey cited by Salud America! found that “1 in 5 women (20%) experienced mistreatment by healthcare workers during pregnancy and delivery care.”
This was more profound among women of color, including 30% of Black women, 29% of Latinas, and 27% of multiracial women, compared to 19% of white women.
Health care workers combat implicit bias by downloading the free Salud America! Action Pack “Health Care Workers and Researchers: Find If You Have Implicit Bias and What to Do Next.”
“This Action Pack will help you see if you have implicit bias, learn from others who have overcome their own implicit bias, and encourage colleagues to learn about implicit bias, too,” said Dr. Amelie G. Ramirez, director of the Salud America! Latino health equity program, who created the Action Pack.
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