For the fourth consecutive year, the United States earned a D+ grade for maternal and infant health from March of Dimes, marking the longest stretch of the organization’s lowest grade in its 17-year report card history. The grade reflects a 10.4% preterm birth rate that has barely moved since 2021, when it hit a decade-long high of 10.5%.
Behind that static letter lies a health care system stuck in reverse. The nation’s best grade—a C+ in 2014—now seems impossibly distant. The preterm birth rate that year was 9.8%. A decade later, despite increased awareness, advocacy and proposed legislation, more than 370,000 babies are born too early each year in the wealthiest nation in the world.
Two viral videos from November 2025 brought the crisis into sharp focus. In Dallas, Karrie Jones screamed in a wheelchair at Dallas Regional Medical Center, a 172-bed acute care hospital in Mesquite, Texas. Doubled over in agony as a nurse methodically conducted intake paperwork, Jones screams out that her baby is coming “right now” while the nurse asks routine questions. Her mother asks the nurse directly: “Y’all treat all your patients like this or just the Black ones?” Jones remained in the waiting area for more than 30 minutes. Twelve minutes after the video was recorded, she gave birth. Her mother said the baby was born with his eyes open due to stress and had meconium in the amniotic fluid, both signs of fetal distress.
Less than a week later, in Crown Point, Indiana, Mercedes Wells was wheeled out of Franciscan Health Crown Point hospital in tears, discharged despite contractions one minute apart. The hospital is a 199-bed facility in suburban Indiana with a Level III certified Family Birth Center equipped to handle complex maternal medical conditions. Wells, an experienced mother who had given birth three times before at the same facility, said she spent six hours there without seeing a doctor. Wells’s sister-in-law, Cherise Thompson, told ABC News Wells repeatedly begged the nurse, saying, “I’m really in active labor. I can feel it, contractions as I walk. I mean my pain. I’m telling you, I can feel it.” Eight minutes after leaving the hospital parking lot, Wells gave birth on the side of a road. Her husband Leon, with no medical training, delivered their daughter in their truck.
Both hospitals took personnel action. Franciscan Health Crown Point fired the doctor and nurse involved in Wells’s care. Dallas Regional Medical Center said the employee involved with Jones is no longer employed at the facility. But the incidents reflect deeper systemic failures that March of Dimes has documented year after year—failures that help explain why the grade has not improved.
For the fourth consecutive year, the United States earned a D+ grade for maternal and infant health from March of Dimes, marking the longest stretch of the organization’s lowest grade in its 17-year report card history.
What the Grade Actually Measures
The D+ reflects the national preterm birth rate, defined as babies born before 37 weeks of pregnancy. Preterm birth is the leading cause of infant death in the United States and contributes to long-term health complications. March of Dimes set a goal of an 8.1% preterm birth rate. The current 10.4% rate means the country is falling nearly 30% short of that target.
One in 10 babies born in America is born too early. That translates to more than 370,000 preterm births in 2023. The infant mortality rate rose to 5.6 deaths per 1,000 live births in 2023, up from 5.4 the previous year, representing the largest jump in more than two decades. More than 20,000 babies died before their first birthday.
The maternal mortality picture shows similar stagnation. While the overall rate decreased to 18.6 deaths per 100,000 live births in 2023, down from a pandemic high of 32.9 in 2021, the rate remains higher than it was in 2018. According to the Centers for Disease Control and Prevention (CDC), more than 60% of pregnancy-related deaths are preventable.
The Drivers That Won’t Change
March of Dimes identifies consistent factors driving poor outcomes, and those factors have worsened rather than improved over the past four years.
Inadequate prenatal care reached its highest level in a decade in 2023. The rate rose to 15.7%, meaning nearly one in six pregnant women either received care starting after their fifth month of pregnancy or had less than half of the recommended visits. The rate was even higher among Black and American Indian/Alaska Native communities. Research shows that lack of adequate prenatal care is linked to a 9% increase in the rate of preterm birth compared to those who receive adequate care.
Chronic health conditions continue to rise. Prepregnancy hypertension increased by more than 10% in just one year between 2023 and 2024. Diabetes among pregnant women rose 8%. Women with prepregnancy diabetes experience a 28.8% rate of preterm birth. Women with prepregnancy hypertension experience a 23.4% rate. These conditions are leading causes of preeclampsia, which can dangerously elevate blood pressure and lead to preterm birth.
More than one-third of pregnant women—34.8%—have an unhealthy weight, which increases preterm birth risk to 12.3%. About 3% of pregnant women smoke, which raises preterm birth to 15.2%. Women with a previous preterm birth face a 30% risk of another preterm birth.
Insurance disparities remain stark. Medicaid beneficiaries experience preterm birth rates 1.2 times higher than those with private insurance—11.7% compared to 9.6%. The infant mortality rate for babies born to parents with Medicaid is 1.8 times higher than the rate for babies born to parents with private health insurance—7.4 deaths per 1,000 live births compared to 4.1.
Low-risk cesarean births occur at rates higher than recommended. About 26.6% of low-risk deliveries for first-time mothers carrying a single baby correctly positioned for delivery are done by cesarean section, despite evidence that cesarean deliveries lead to more negative health outcomes for both mother and baby and are associated with three of the six leading causes of maternal mortality: hemorrhage, complications of anesthesia, and infection.
Environmental exposures emerged as a new focus in the 2024 report. Nearly 40% of pregnant people face the risk of exposure to extreme heat at some point in pregnancy, while almost three in four face the risk of exposure to poor air quality. Research shows pregnant people exposed to extreme heat and air pollution are more likely to give birth preterm, have underweight or stillborn babies, and suffer from preeclampsia.
Maternity care deserts affect more than 6 million women who live in counties with no or limited access to maternity care services. Recent hospital closures and reductions in obstetric services have worsened access, particularly in rural areas and the South.
Black infants die at nearly twice the rate of the national average. The disparities persist across income levels and educational attainment, pointing to systemic failures rather than individual factors. (Photo source: Adobe Stock Photo)
Disparities That Define the Crisis
The D+ grade masks profound inequities. Black women face a preterm birth rate of 14.7%, nearly 1.5 times higher than the national average. Pacific Islander and American Indian/Alaska Native women both experience preterm birth rates of 12.4%. Hispanic women experience a rate of 10.1%, white women 9.5%, and Asian women 9.2%.
Black women died from pregnancy-related causes at a rate of 50.3 per 100,000 live births in 2023—nearly 3.5 times higher than white women at 14.5. Hispanic women experienced a maternal mortality rate of 12.4 per 100,000, though research shows significant disparities exist within Hispanic populations, with Puerto Rican women facing elevated risks. While rates for white and Hispanic women improved between 2022 and 2023, the rate for Black women remained essentially flat.
Black infants die at nearly twice the rate of the national average. The disparities persist across income levels and educational attainment, pointing to systemic failures rather than individual factors.
Both Karrie Jones and Mercedes Wells are Black women. Their experiences reflect well-documented patterns of pain dismissal and inadequate care that particularly affect women of color. But the systemic problems they encountered—inadequate staffing, administrative barriers prioritized over clinical need, lack of physician oversight—affect pregnant women across demographics.
U.S. Rep. Robin Kelly, an Illinois Democrat and chair of the Congressional Black Caucus Health Braintrust, introduced the Women Expansion for Learning and Labor Safety Act in December, legislation named after Mercedes Wells. The WELLS Act would require hospitals to develop Safe Discharge Labor Plans before discharging any patient showing signs of labor, including clinical justification, travel distance assessment, and physician approval. Franciscan Health Crown Point CEO Raymond Grady issued a formal apology and announced mandatory cultural competency training and a requirement that all pregnant patients must be examined by a physician before discharge.
Why the Grade Stays Stuck
The videos provided visceral evidence of what maternal health data has documented for years. But individual hospital failures and subsequent firings do not address the systemic factors driving the D+ grade.
According to a November 2025 analysis by KFF, recent federal policy changes may further widen existing disparities. The Trump administration eliminated key programs affecting maternal health, including laying off most staff in the CDC’s Division of Reproductive Health, halting community-based maternal health grants and eliminating the Pregnancy Risk Assessment Monitoring System, which for decades provided data to track maternal experiences and inform evidence-based policies.
March of Dimes calls for expanding and extending Medicaid coverage, increasing access to quality prenatal care and establishing environmental safeguards to protect at-risk communities. The organization advocates for licensing midwives, providing doula reimbursement through Medicaid, implementing paid family leave, and extending Medicaid postpartum coverage beyond 60 days.
But four years at a D+ grade shows that awareness alone does not drive change. Inadequate prenatal care worsened. Chronic conditions increased. Environmental risks grew. Maternity care deserts expanded. The systems, policies, and environments that put families at risk remain largely unchanged.
When Mercedes Wells was asked what her message is to medical professionals, she said: “Listen to the patient.” Jones and Wells both told health care providers what was happening to their bodies. They were correct. They were ignored.
Their experiences illustrate what the D+ grade represents: not just individual failures of care, but a health care system that has proven unable or unwilling to address the documented, preventable factors driving poor maternal and infant health outcomes in the United States.
