CLEVELAND, Ohio — The state of Ohio, along with the country as a whole, received nearly failing grades on the recently released March of Dimes report measuring how well pregnant women and babies are protected from preterm birth.
The United States as a whole received a D-plus preterm birth grade, while Ohio was a notch below at D and Cleveland was given an F grade on the 2023 March of Dimes Report Card: The State of Maternal and Infant Health for American Families.
The highest grade went New Hampshire with a B-plus, and seven other states scored B or B-minus.
The March of Dimes report card assigned grades to states and cities by evaluating the rates at which babies are born prematurely, along with the prevalence of factors making a premature birth more likely, such as smoking, hypertension, obesity and diabetes, previous preterm birth, and carrying multiples.
Preterm birth and low birth weight were leading causes of infant deaths between 2019 and 2021, the report said. Birth defects and accidents were also leading causes of babies dying.
Overall across the country, the likelihood of a woman dying from pregnancy complications or childbirth has nearly doubled since 2018, the report said.
The report, which reflected 2022 data, was released in late November.
When looking at the 100 U.S. cities with the greatest number of live births, one-third of the cities — including Cleveland — had a preterm birth grade of F, according to the report card.
Columbus, Toledo and Cincinnati also were given F grades. Dayton received a D-minus grade.
Nationally, only two cities — Ramapo, New York; and Irvine, California — earned A grades.
A high number of premature births is an indicator, like a canary in a coal mine, that Ohio residents need to be healthier, said Dr. David Hackney, division chief of maternal and fetal medicine at University Hospitals.
Hackney said he has spent a decade trying ways to decrease Ohio’s infant mortality — including statewide initiatives — with little progress to show for it. A dearth of research into the reasons for premature birth, and effective drugs to prevent it, are among the factors keeping preterm birth rates high, he said.
“This has been a very difficult issue, over time, to move the needle on,” Hackney said. “It’s not just a line on a chart. These are people’s lives; these are babies that die. These are tragedies that parents face.”
Lita Wills, Commissioner of Health Equity and Social Justice at the Cleveland Department of Public Health, wasn’t surprised by Ohio’s bad grade.
“When you look at the factors that influence healthy pregnancies for moms and babies, access to healthcare isn’t enough,” Wills said. “Ohio struggles with filling basic needs and improving social determinants of health such as healthy food, stable housing and affordable health services.”
Another recent report, this one from the U.S. Centers for Disease Control and Prevention, looked at the U.S. infant mortality rate and found it may be rising again.
The CDC’s provisional infant mortality rate for the United States in 2022 was 5.6 infant deaths per 1,000 live births, 3% higher than in 2021, the CDC said in November. It was the first year-to-year increase since 2002.
The March of Dimes, which advocates for healthy mothers and babies, compiled its grades from data pulled from various federal sources, including the National Center for Health Statistics. Find out more about how the report was compiled here.
Preterm birth rate was defined as birth before 37 weeks’ gestation.
More research, better drugs, doulas possible ways to save babies
The March of Dimes report did not discuss reasons why so many states and cities failed to protect the health of pregnant women. But state policies can help improve maternal and infant healthcare, the report said.
These policies include extension of Medicaid healthcare benefits to one year after childbirth, greater access to preventative pregnancy care; paid family leave; doula reimbursement and reviews into the causes of fetal and infant mortality.
“We know that having the additional support of doulas works to have healthy pregnancies and deliveries, but it is not reimbursed by Medicaid,” the city of Cleveland’s Wills said. “We know reducing toxic stress during pregnancies works for healthy pregnancies and deliveries, yet we still do not have paid family leave across the state.”
The healthier that women are when they conceive, and the more they have positive social determinates for health, the better their chances for a healthy pregnancy, UH’s Hackney said.
Hackney pointed to the need for research into why women’s bodies sometimes start labor too early.
This research doesn’t have enough support from the pharmaceutical industry, he said. Drug companies are wary of including pregnant women in many types of drug trials because of the threat of lawsuits.
“There’s a very problematic belief that trials are dangerous for pregnant patients” Hackney said. “We need more pharmaceutical companies and other researchers being willing to at least not exclude pregnant patients from trials.”
Ohio’s D puts it above Kentucky, West Virginia
Here is how Ohio compared to surrounding states in terms of March of Dimes report card grades, along with preterm birth rates:
Pennsylvania: C-plus (9.6 preterm birth rate per 1,000)
Michigan: D-plus (10.4)
Ohio: D (10.8)
Indiana: D (10.9)
Kentucky: F (11.7)
West Virginia: F ( 13.0)
When the March of Dimes report card graded every U.S. state, none earned an A grade for preterm births, but eight were given F grades.
After New Hampshire with a B-plus, Idaho, Oregon, Vermont and Washington received Bs, and California, Massachusetts and Rhode Island receive B-minus grades.
States that earned an F preterm birth grade were West Virginia, Kentucky, Arkansas, Louisiana, Mississippi, Alabama, Georgia and South Carolina.
Maternity Vulnerability Index for Cuyahoga, surrounding counties
The March of Dimes report included data from the 2023 Maternity Vulnerability Index, a national tool showing where and why mothers are likely to experience poor maternal health outcomes. It is compiled by Surgo Ventures, a data-driven global health firm.
The Maternity Vulnerability Index, which includes 2021 data, reinforced the troubling statistics in the March of Dimes report when looking at Northern Ohio pregnancy outcomes.
Cuyahoga County scored high on the Maternity Vulnerability Index, meaning that pregnant women in this county are at high risk for poor outcomes. Ashtabula County received a worse “very high” vulnerability index score.
Lorain, Portage and Medina counties earned “moderate” index scores. Lake and Geauga counties were given “low” scores, while Medina county earned the best ranking with a “very low” score on the on the Maternity Vulnerability Index.
Ohio’s preterm birth rate higher than U.S.
The March of Dimes report also included information about preterm birth rates and infant mortality rates — separate from the report’s grades — for the United States and Ohio.
The preterm birth rate (percentage of live births born preterm) in Ohio was 10.8% in 2022, up from 10.5% in 2012.
However, Ohio’s infant mortality rate per 1,000 live births decreased in the last decade, falling from 8.0 per 1,000 live births in 2011 to 7.1 in 2021, the report said.
Nationally, the U.S. preterm birth rate was 10.4% in 2022, only a 1% dip from 2021, which saw the highest rate in 10 years.
The infant mortality rate per 1,000 live births, from 2019-2021, was 10.5 for Black pregnant women, as compared to 4.4 for white pregnant women.
Julie Washington covers healthcare for cleveland.com. Read previous stories at this link.