Morbidity and mortality for mothers and infants continues to be far too high. Elizabeth Cherot, March of Dimes CEO, talks about the new report and what can be done to improve outcomes.
America is failing too many of its babies and their mothers.
That’s the assessment of the March of Dimes, which released its 2023 report card on infant and maternal health Thursday morning. Overall, the nation gets a “D+” in preterm birth weight.
There was a slight improvement in the rate of preterm births, as they dropped from 10.5% to 10.4% of all births in 2022, but the rate remains too high, according to the report. Preterm birth remains one of the leading causes of infant death.
The Centers for Disease Control and Prevention reports that the infant mortality rate has risen for the first time in two decades. The U.S. infant mortality rate in 2022 was 5.60 infant deaths per 1,000 live births, 3% higher than in 2021, according to preliminary data from the CDC. It’s the first increase since the infant mortality rate rose from 2001 to 2002
Elizabeth Cherot, president and CEO of the March of Dimes, tells Chief Healthcare Executive® that the new report card shows that far too many babies and mothers are dealing with health complications.
“When you think about morbidity, mortality, for both moms and babies, we know the data is all going in the wrong direction,” Cherot says.
The report also illustrates sharp disparities in the mortality among Black babies. It also comes as maternal mortality has nearly doubled since 2018, according to federal data.
Problems in southern states
The report found that even with a slim improvement in preterm births, 14 states saw increases in their preterm birth rate. Nationwide, 380,548 babies were born before 37 weeks.
Eight states, along with Puerto Rico, earned an “F” in the March of Dimes report card: Alabama, Arkansas, Georgia, Kentucky, Louisiana, Mississippi, South Carolina and West Virginia.
States in the south generally fared worse in the report, with Texas and Oklahoma earning a “D-”, Tennessee getting a “D”, and Florida and North Carolina earning a “D+”.
In the low-performing states, many struggle with chronic conditions, such as hypertension and diabetes, and many also find it difficult to obtain obstetric care, Cherot says.
Many Americans live in “maternity care deserts,” according to the March of Dimes. One in three counties have no obstetric services, and it’s a problem beyond small, remote communities, Cherot says. Those in cities face problems in getting care.
“Everyone thinks this is a rural issue,” Cherot says.
“When we look at maternity care deserts across the country, 60% are rural and 40% are inner city,” she adds. “So if you think about that, you may have a county where there is no provider. They have to take three buses to get to a provider.”
The report card also looked at the preterm birth rate in America’s biggest cities. One-third of the 100 cities with the most live births received an “F” in the report card, including Houston, Detroit, Baltimore, St. Louis, New Orleans, Memphis, and San Antonio.
Even with greater attention on preterm births, Cherot finds it frustrating to see such little progress in recent years.
“This is some place we should be moving the needle, and we're not,” Cherot says.
The report also finds troubling disparities along racial lines.
Black women and American Indian/Alaskan Native women are 54% more likely to have a preterm birth as compared to white women, the report states.
The preterm birth rate among Black babies is 1.5 times higher than all other babies. And the infant mortality rate among babies born to Black patients is 1.9 times higher than the national average. The mortality rate refers to babies who die in their first year.
“I get really saddened by that, when you think that Black babies are two times more likely not to reach their first birthday compared to their white counterparts,” Cherot says. “That kind of hangs there for a little bit. And to me, I start thinking if we could solve for that, we can lift everyone.”
Maternal complications also play a role and Black mothers are more likely to have complications. “Moms and babies are certainly intertwined,” Cherot says.
“This is the time for us to really be focusing on moms and babies,” she says.
She also views it through the lens of health equity, particularly with such disparities among Black and American Indian patients.
“You realize that moms and babies are from the window into the health of a society and we're going in the wrong direction,” Cherot says.
The March of Dimes report card also offers new statistics on risk factors that could affect pregnant patients and lead to preterm births. More than one in three patients (37%) have at least one preexisting health condition before pregnancy that is associated with preterm birth.
The report notes that 28.8% of patients with pre-pregnancy diabetes had preterm births, while 23.4% of women with hypertension had babies before their full term.
Smoking, unhealthy weight and having a previous preterm birth are factors that can lead to preterm births.
Patients need to understand that information, and health systems and hospitals must do a better job of educating their patients, Cherot says. She points to a federal study that found more than 80% of maternal deaths are preventable.
Some simple steps involve making sure patients are aware that headaches can be a sign of preeclampsia. And in some cases, preeclampsia leads to eclampsia, “where you can seize and die,” Cherot says.
“The presumption that everyone knows about preeclampsia is a problem,” Cherot says. “We need to make sure that every patient knows about preeclampsia, especially our black moms, and especially in the postpartum period.”
Patients also would benefit from learning more about other potential signs of complications in pregnancy, such as abnormal swelling or a blind spot in their vision.
Physicians and health systems need to also work on building more trust with patients, in order to help them see the importance of watching out for warning signs and potentially screening for conditions such as diabetes, which can lead to complications.
“It's not just getting access, but it's actually trusting the system which has been failing Moms,” Cherot says.
The March of Dimes is pushing for policy changes to improve the health of babies and mothers.
The organization continues to push for the expansion of Medicaid coverage in all states, allowing coverage for up to one year after birth. Currently, 37 states and Washington, D.C. have approved such extensions.
Cherot also touts the benefits of expanding access to doulas, who support patients during and after pregnancy. Across the nation, only 11 states, along with Washington, D.C., offer reimbursement for services from doulas.
She also called for more consistent policies on telehealth at the state level, noting that some states make it more difficult to access virtual care.
Health systems should also look at expanding mobile units to make it easier for patients to get access to obstetric services, Cherot says.
“I think the solutions are really focusing on moms and babies where they are, whether we bring mobile units to them to get the right solutions, community workers and doulas,” Cherot says. “I mean there's so many things to try to solve the problem because it is so complex.”