For the month of November, we honor Prematurity Awareness and uplift families impacted by the global prematurity crisis. Today, prematurity rates continue to climb in the US, and the COVID-19 pandemic has only further exposed the ever-present health equity gap that fuels crises in maternal and infant health. Throughout Prematurity Awareness Month (and especially on November 17’s World Prematurity Day), March of Dimes is leading the charge in educating and raising funds that will prove life-saving for expectant and new families in need.
We spoke to Stacey D. Stewart, President and CEO of March of Dimes, about what global and national prematurity says about the future of maternal and infant health, what present-day statistics say about inequity without the healthcare system, and how we can all push the movement forward together.
Prematurity Awareness Month, allows us to reflect on the nearly 400,000 babies born preterm each year in the United States and what we can do to prevent it. We know that premature birth disproportionately affects Black women and their babies. Can you speak to the systemic inequities that create this disparity?
As the leading nonprofit fighting for the health of all moms and babies, we are alarmed that each year in the U.S. 22,000 babies die —that is two babies every hour; and approximately 1 in 10 babies is born preterm. Premature birth and complications resulting from birth defects are the largest contributors to infant death in the U.S. and globally.
Women of color reading this won’t be surprised to learn this problem doesn’t affect all American women equally. For Black women who are 30 years or older, the number of pregnancy-related deaths per 100,000 live births is approximately four times that of White women. Black women also have a preterm birth rate that’s 50 percent higher than that of White women. The racial disparity in birth outcomes in this country is staggering and is an issue that should concern all of us.
These statistics are eye opening and really demonstrate the state of maternal and infant health in this country, but it’s also important to look at the root causes. African American women have long been blamed for our own poor health, but in fact we’re still dealing with the legacy of slavery and segregation. Modern researchers such as Dr. Fleda Mask Jackson have shed light on this, showing how stress and the social determinants of health — housing, health care access, employment, transportation, education — influence Black women’s maternity outcomes. We urgently need to address these inequities head on in order to reverse these troubling trends.
About 15 million babies around the world are born premature every year, and around 1 million do not survive. Where does the USA fall in the stats for the developed world? And, what can we do to improve?
Moms and babies are facing higher risks than ever before. The U.S. earned a C grade in the 2019 March of Dimes Report Card, which grades the nation, all states, the District of Columbia and Puerto Rico based on the latest data on preterm birth rates. Since then, the rate has continued to climb and we plan to release an updated report next month that will provide a comprehensive view of the state of maternal and infant health. Compared to European countries and Canada, the U.S. has the second highest preterm rate, just behind Cyprus.
We know that early delivery impacts both moms and babies. A preterm birth can lead to long-term health and developmental disabilities for babies. Sometimes women also face long-term health complications, for example, preeclampsia is linked to the development of heart disease and stroke in women after reproductive age. This is only compounded by the stress experienced by the entire family unit—which can have lasting impact.
There are solutions that have improved preterm birth rates for specific populations and we can expand them to change the course of this maternal and infant health crisis. We should improve access to quality prenatal care and expand programs that work like group prenatal care, which matches pregnant women with similar due dates together in small groups for prenatal care. We must ensure that women have access to public health insurance programs and close gaps in coverage. It’s also critical that we eliminate racial and ethnic health disparities and support economic, social and health equity by focusing on prevention, treatment and social determinants of health.
How has Covid-19 impacted premature birth, does the research show a spike in infants being born prematurely?
Research shows that pregnant people may have some higher risks related to COVID-19 such as blood clots, injury to the placenta (the placenta grows in the uterus and supplies the baby with food and oxygen through the umbilical cord), preterm birth, preeclampsia, emergency cesarean (C-section) delivery or pregnancy loss. It’s not certain if the risk of preterm labor and premature birth increases with COVID-19 like it does with the flu. Based on limited reports, there have been some premature births among moms with COVID-19, but it is not clear if that is related to the mother being infected.
The COVID-19 pandemic has further magnified disparities in accessing and receiving quality care, including maternity care, and we know that quality care contributes to birth outcomes. Recent studies suggest that pregnant women are more likely to get sicker from COVID-19 than non-pregnant women, and that pregnant women with COVID-19 are at an increased risk of needing to be admitted to the hospital or intensive care unit (ICU). Pregnant women with COVID-19 may also be more likely to need a ventilator to breath compared with non-pregnant women.
This summer a report made headlines and it said that Black infants in the care of White physicians were 3 times more likely to die in their care. We know racial bias in the medical system is real and has lethal consequences. What does this mean for preemies who are even more vulnerable at birth?
Based on current research, we know the maternal and infant health crisis is particularly devastating for underserved families of color. Deeply entrenched structural racism is directly and negatively impacting the health of moms and babies of color. For Black and Brown women who are 30 years or older, the number of pregnancy-related deaths per 100,000 live births is approximately 4 to 5 times that of White women. Black women also have a preterm birth rate that’s 50% higher than their White counterparts.
The George Mason University study on infant mortality is interesting; however it’s difficult to draw conclusions on premature babies even though we recognize bias does exist. More generally, however, we know that race/ethnic concordance of patients and physicians have some known benefits including more consistent preventative care and greater patient satisfaction with care. This is true for all patients, not just pregnant women and their infants. We also know that non-Hispanic Black women had the highest mortality and neonatal mortality rates in the U.S. in 2018 compared to the overall rate.
March of Dimes has been at the forefront of the fight for health equity for decades by championing policies, building awareness of the issues, funding research, and providing programs and resources to help achieve parity in maternal and child health. As part of our efforts to address racial bias in our healthcare system, we launched an implicit bias training for healthcare providers with the goal of training providers not to perpetuate the cycles of discrimination in their workplace. We have seen strong demand for the training, which covers an understanding of the origins of implicit bias, an overview of structural racism in this country, strategies to mitigate racial bias in maternity care and a commitment to creating a culture of equity.
What does this month teach us in terms of education, awareness and advocacy? What are some of the policy aims we should know about?
Prematurity Awareness Month, which kicks off November 1, and World Prematurity Day on November 17 are important in raising greater awareness of the 15 million babies born too sick and too soon around the world each year and what we need to do address this crisis. As we do each November, we will be releasing our March of Dimes Report Card, which provides a comprehensive view of the current state of maternal and infant health. The report grades each state the nation, all states, the District of Columbia and Puerto Rico based on the latest data on preterm birth rates. This year, we’re also including data on severe maternal morbidity and low risk C-section rates, as well as information on COVID-19.
But, this report and Prematurity Awareness Month are not just about highlighting the problems we face. It’s also about the policies and actions we need to create positive change for moms and babies. We are planning a special Congressional Briefing following the release of the Report Card to highlight the findings and to advocate for the policy solutions we need to drive positive change. Moms and babies need comprehensive health care coverage. We need Medicaid expansion to cover individuals up to 138 percent of the federal poverty level and we need to expand group prenatal care, which studies show can benefit both moms and babies. Its critical that we eliminate racial disparities by increasing access to and coverage for doula services for example.
The March of Dimes has lead the charge when it comes to addressing this issue head on, what insights make you hopeful for the future?
Promising interventions from a range of organizations, including March of Dimes, are already helping to lower preterm birth rates in some states, counties and cities. We need to expand these programs and solutions across the country to ensure that women have the support the need before, during and after pregnancy. Through our six March of Dimes Prematurity Research Centers we are also studying the unknown causes of premature birth, knowing that the answers are going to involve a combination of interventions to prevent and solve this urgent health crisis.
These are challenging times, and unfortunately, the COVID-19 pandemic is only compounding the current maternal and infant health crisis facing our nation. We are concerned about pregnant women and babies who may be at greater risk of becoming sick and not receiving the care they need. Now more than ever, we must come together to support moms, babies and families who need us the most right now.
I think we have a once in a century opportunity to remake the U.S. healthcare system and built it around pregnant women, rather than asking women to adapt to a broken system that consistently leads to inequitable health outcomes. I’m encouraged to see how ubiquitous telehealth is becoming, while recognizing we there’s much more we can do to reach women in greatest need. If we’re going to stop these troubling trends in their tracks, we need to reach women where they are and with the right programs and policies. I’m confident we can get there.