(CNN) — The rate of premature birth in the United States remains high, especially in the southern region of the country, according to the infant and maternal health nonprofit March of Dimes.

The group’s annual “report card” on US maternal and infant health, released Thursday, says that the nation’s preterm birth rate – the rate of babies born before 37 weeks gestation – was 10.4% in 2022, down only 1% from 2021’s rate, which was the highest in more than a decade.

“We went from 10.5% to 10.4%. It’s flat,” said Dr. Elizabeth Cherot, president and chief executive officer of March of Dimes. “A slight change is just not big enough in that direction.”

March of Dimes gave the United States a D+ for its rate of preterm births, which are the leading cause of infant deaths in the country. It’s the second year in a row that the nation has earned that grade.

The national preterm birth rate peaked at 12.8% in 2006 after rising steadily for more than two decades, according to data from the National Center for Health Statistics. According to the new report, the rate fell to 9.8% in 2012 before climbing back to 10.4% last year.

Among the many factors that can raise a mother’s risk of delivering preterm are smoking, having high blood pressure, being at an unhealthy weight, having diabetes, having previous preterm births or carrying multiple babies, such as twins or triplets.

“I look at this as a window into the lens for the health of the country, and we are failing our moms and our babies, and we need to prioritize them,” Cherot said.

“We should have better outcomes, and we don’t. So I think there’s so much work to be done,” she said. “This is the time to be amplifying this for our country.”

Where preterm birth rates are highest

In the new report, March of Dimes gave grades to the 100 US cities with the highest number of live births last year. About a third of them got Fs.

The cities with the highest rates of preterm birth included 14.8% in Birmingham, Alabama; 14.5% in Detroit; 14.1% in Cleveland; 13.5% in New Orleans; and 13.3% in Memphis.

Among the cities with the lowest rates of preterm birth last year were Ramapo, New York, at 5.3%; Irvine, California, at 7.1%; Seattle at 8.1%; San Diego at 8.6%; and Long Beach, California, at 8.8%.

On the state level, eight states and Puerto Rico earned an F grade for preterm birth rates in the new report: Alabama, Arkansas, Georgia, Kentucky, Louisiana, Mississippi, South Carolina and West Virginia. No states earned an A grade.

The new report also showed that infants born to Black mothers were more likely to be born preterm. The preterm birth rate among these babies was 1.5 times higher than the rate among all other babies. The rate was 14.6% among Black babies; 12.2% among American Indian, Alaska Native and Pacific Islander babies; 10.1% among Hispanic babies; 9.4% among White babies; and 9% among Asian babies.

“This data really dives into how preterm birth is increased for Black moms, for Native American and Alaskan moms, and Hispanic moms,” Cherot said.

“We know those rates are so much higher – that is where we should be focusing to solve for this, and that’s what’s clear in this data,” she said. “We hope that people are using this data to really look at what we could be doing to make a difference.”

Black infants also were most likely to die before their first birthday. The US infant mortality rate declined 10% in the last decade, according to the report, but the rate among babies born to Black mothers was still 1.9 times higher than the national rate and two times higher than the rate among White babies.

Overall last year, according to the report, a total of 19,868 babies died nationwide before turning 1 year old, with the highest infant death rates in the South and Midwest. Similar regional trends were seen in maternal health outcomes.

The new report also showed that maternal deaths have almost doubled in the United States since 2018. The rate of people dying from complications of pregnancy or childbirth in the United States increased from 17.4 deaths per 100,000 people in 2018 to 32.9 per 100,000 in 2021.

The data in the new March of Dimes report is “tragic” but not surprising, said Dr. Georges Benjamin, executive director of the American Public Health Association, who was not involved in the report. This month, he noted, the US Centers for Disease Control and Prevention’s National Center for Health Statistics released findings that the nation’s infant mortality rate rose by 3% from 2021 to last year.

“This aligns with the fact that we’ve still got some real challenges,” Benjamin said. “We need to pay a lot more attention and focus like a laser on making sure that women who have high-risk pregnancies are getting the prenatal care that they really need and are being cared for in good systems of care, designed to take care of people with complicated pregnancies.”

‘You can’t only treat the symptoms; you have to treat the root causes’

To address these maternal and infant health crises, March of Dimes called for several actions for states to take to improve and sustain maternal and infant health care.

March of Dimes has called for more states to provide 12 weeks of paid family leave, to require Medicaid to reimburse for doula care and to develop committees to review and study maternal and infant deaths, among other actions.

The group also urged for more states to extend Medicaid benefits, in which new moms can qualify for Medicaid insurance after giving birth, offering coverage beyond the required 60 days postpartum to 12 months.

The expansion of Medicaid is a major part of the Affordable Care Act, and research suggests that the expansion of Medicaid is associated with lower rates of maternal death.

As of last week, according to data from the National Academy for State Health Policy, only three states have not extended Medicaid postpartum coverage, have not proposed plans to do so or don’t have pending legislation that passed at least one chamber: Arkansas, Idaho and Iowa.

The National League of Cities has long encouraged cities to consider similar actions to improve maternal and infant health and reduce health disparities, said Lourdes Aceves, health and wellness director at the National League of Cities, who was not involved in the new March of Dimes report.

“You have to have a whole-system approach. You can’t only treat the symptoms; you have to treat the root causes. For maternal health, for instance, that’s understanding what the root causes are, like diabetes and hypertension, that’s leading to early deaths,” Aceves said, adding that social determinants of health – the conditions in which people are born and live – play a role in high rates of maternal and infant mortality.

On the city level, Aceves said, some regions may have seen correlations between the opioid epidemic and preterm births, as opioid exposure during pregnancy has been linked with preterm birth. The National League of Cities has an initiative called Cities of Opportunity in which leaders and communities are provided support to help identify and address health-equity issues specific to their communities, including opioid abuse.

“One of the principal ways that Cities of Opportunity has engaged with issues that directly impact pregnant women, tragically, has been addressing opioids,” Aceves said.

On the federal level, the Biden administration announced on Monday new efforts to study women’s health, establishing the White House Initiative on Women’s Health Research. Within 45 days, according to a memorandum, members of this Initiative will recommend actions that the Biden-Harris administration can take to improve how women’s health research is conducted, including addressing health disparities and inequities.

“Every woman I know has a story about leaving her doctor’s office with more questions than answers. Not because our doctors are withholding information, but because there’s just not enough research yet on how to best manage and treat even common women’s health conditions. In 2023, that is unacceptable,” first lady Jill Biden said in a statement.

“Our new White House Initiative on Women’s Health Research will help change that by identifying bold solutions to uncover the answers that every woman and her family deserves,” she said. “We also are calling on congressional leaders, the private sector, research institutions, and philanthropy to join us in taking urgent action to improve the health and lives of women throughout the nation.”

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