Preterm Birth Rates Are Not Falling for Black and Indigenous People—Heres What Needs To Change

March of Dimes, a nonprofit organization that aims to improve the health of birthing people and babies, released its annual preterm birth report card, giving the United States a C- rating. According to the report, 33 states, Washington D.C. and Puerto Rico experienced a decline in preterm birth rates, but 13 states saw an increase, and four remained the same. Additionally, the organization found that even though the overall rate decreased, Black and American Indian/Alaska Native women are 60 percent more likely to give birth preterm than white women.

"Prior to the 2020 rates, we had five years of increases in the preterm birth rate, and this is the first year in the past six that we've seen an actual decrease with a slight decrease from 10.2 percent to 10.1," says Zsakeba Henderson, MD, deputy chief medical and health officer at March of Dimes.

Still, Dr. Henderson calls the slight decrease "mediocre" and says it's not enough to raise the overall grade. Preterm births occur 37 weeks before the due date, according to the Centers for Disease Control and Prevention (CDC), and it's the primary cause of birth complications, including vision impairment, breathing issues, and developmental delays.

"There are so many factors that contribute to preterm birth," she says. "[Including] factors around healthcare access and quality; issues around various social determinants of health, and resources that are available." 

That is why the full report card includes a detailed action plan that would decrease the number of preterm births and potentially fight against maternal mortality. Below, you'll find three preterm birth factors that need to change.

1. Address racial disparities

The preterm birth and mortality rates cut across racial lines, but certain groups—Native American and Black birthing people—are more susceptible to the troublesome birth outcomes. According to Dr. Henderson, "For Asian and white mothers, there was a decline, but for Black and American Indian and Alaskan Native women, there was an increase." Dr. Henderson explains that for Black women, it went from a rate of 14.2 to 14.36, and for Native women, it went from 11.55 to 11.61.

March of Dimes identifies the role that social determinants of health, as well as racism, play in these outcomes. These include economic, environmental, and social factors that could shift with access to doula care.

2. Increase access to midwifery and doula services

Thirteen states, including New Jersey, Minnesota, Oregon, and Indiana, now offer access to doula care covered by insurance. A 2013 study published in the Journal of Perinatal Education suggests birthing people who used doulas are less likely to have preterm births or require a cesarean section. This could be because doulas help birthing people feel more empowered during their pregnancy and labor, which might contribute to more positive outcomes. 

Also, while a certified nurse-midwife or other midwife attends to 1 in 10 births, the American College of Obstetricians and Gynecologists (ACOG) and the American College of Nurse-Midwives state that the best birth outcomes occur when physicians and certified midwives work together.

3. Protect and expand healthcare coverage

Quite a few action items address the unequal healthcare in the U.S. and health insurance before, during, and after pregnancy, which gives birthing people and babies a better chance at survival and positive outcomes. While 39 states have adopted some sort of Medicaid expansion program, many states with the worst birth outcomes in the U.S. have not. March of Dimes recommendations on expansion could hopefully alter the trajectory for those remaining states with high preterm births that haven't expanded Medicaid.

This expansion ensures that more people qualify for health insurance, and therefore helps them get the necessary prenatal care.  The organization also wants Medicaid coverage to extend beyond delivery and to include babies since the latest data shows that one-third of all pregnancy-related deaths happen one week to one year after delivery.

Another significant aspect of the healthcare initiative is access to prenatal telehealth services. March of Dimes says that it's a cost-effective way to help birthing people, but it also will help those in maternal health deserts, like women in rural areas and those where major health systems are closing.

For Dr. Henderson, a mother of three daughters, the report card results hit close to home. "I frequently encounter people who have fears around childbirth, including my children. My daughters are very aware of what Mommy does for a living and how invested I am in improving outcomes, particularly for the backbones in this country because we have consistently been at the bottom in terms of outcomes."

Despite the report card results, Dr. Henderson is pleased that birth outcomes are finally receiving attention, including legislation to create health equity and fix maternal mortality. She says, "There is much work to be done to improve outcomes for some of the most vulnerable in our country, our moms and our babies."

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