Maternal and Infant Health in the United States: A Continuing Crisis

It was on November 14, 2024, that the 17th annual March of Dimes (MOD) Report Card was released. ¹ This report, one generated annually since 2008, seeks to highlight “the collective factors that contribute to maternal and infant mortality and morbidity.” ¹ Regrettably, when compared with last year’s MOD Report Card, it is apparent that little progress has been made in the realms of preterm birth, infant mortality, and racial/ethnic disparities in both maternal mortality and preterm birth.^1–2 It is the purpose of this commentary to review the findings of the 2024 MOD Report Card and its recommendations of policy approaches to improving maternal and neonatal outcomes in the United States.

The overall preterm birth grade for the United States in 2024 was D+ in recognition of the fact that 10.4% of births occurred prior to 37 completed weeks of gestation. This preterm birth rate is unchanged as compared to the preterm birth rate noted in the 2023 MOD Report Card. Geographically, rates of preterm birth varied widely across the United States, with the lowest rate being noted in Vermont (7.7%) and the highest rate prevailing in Mississippi (15%). The infant mortality rate in the 2024 MOD Report was noted to be 5.6 deaths per 1,000 live births, as compared with 5.4 per 1,000 live births in the year prior. The maternal mortality rate in the latest MOD Report was 22.3 per 100,000 live births. Notably, the latter rate represents a return to pre-pandemic rates after a spike in maternal mortality was seen in last year’s report. Overall, the highest rates of preterm birth, infant mortality, and maternal mortality are reported for Southern and Midwestern states. Throughout, higher rates of maternal mortality and preterm birth were observed for Black, Pacific Islander, and American Indian/Alaska Native individuals as compared with Hispanic, White and Asian counterparts.^1–2

In a key recommendation to improve maternal mortality, the 2024 MOD Report Card again recommends Medicaid Expansion/Extension, including the provision of care for birthing individuals for up to 1 year postpartum. ³ By the time that the 2024 MOD report card was generated, 37 states and DC had implemented policies intent on improving access to care. It should be noted that since the option for states to enact expanded postpartum Medicaid coverage was rendered permanent, 49 states have expanded Medicaid coverage by the time that this Commentary was written. ⁴ If this postpartum Medicaid coverage is sustained, this measure should aid in decreasing the maternal mortality rate in the coming years.

Last year’s MOD Report Card called for “paid family leave systems” that require at least 12 weeks of paid family leave following childbirth or the adoption of an infant. ² Little meaningful work has been accomplished on this issue, a reality that is highlighted in the most recent 2024 MOD Report Card wherein only nine states and DC were included among those providing 12 weeks of paid leave. ¹ This reality represents a decrease in the count from the year before, when 10 states and DC were offering this benefit. ² Congressional legislative actions continue to fall short. The Caring for All Families Act, introduced by Sen. Richard J. Durbin [D-IL] in 2023, was referred to the Committee of Health, Education, Labor, and Pensions in 2023, and most recently, in February of 2025, it was read twice and referred again to the same committee. The New Parents Act of 2023, introduced by Sen. Marco A. Rubio [R-Fl] to allow parents to use a portion of their social security benefits for parental leave, was referred to the Committee on Finance in 2023 with no further action having been taken.

The 2024 MOD Report Card additionally identifies other key areas to focus current policy in the interest of improving outcomes. State policies to support Midwifery—including targeting payment parity, allowance of independent practice, and licensing—are limited to four states and DC. ¹ Further expansion of these policies will improve access to Obstetrical care by expanding the breadth of able providers at a time when more patients than ever live in maternity care deserts. Perinatal mental health conditions are a leading cause of maternal mortality in the United States as well. Still, at present, mental health screening is required and reimbursed in just 12 states. ¹ Expansion of policies requiring screening and support of reimbursement for these services is essential if one is to target this preventable cause of mortality. The 2024 MOD Report Card additionally emphasizes the importance of Doula care in improving outcomes for patients in that research has demonstrated that Doula support programs decrease the rate of preterm birth and Cesarean delivery. ⁵ At the time of the 2024 MOD report, just 17 states and DC have implemented reimbursement for Doula care. ¹ And finally, only 24 states and Puerto Rico underwent a Centers for Disease Control and Prevention-funded review of maternal mortality and fetal and infant deaths. ¹ These latter review programs are integral to identifying the contributing factors to perinatal mortality. Without such data, our ability to target interventions will remain severely limited.

Finally, the 2024 MOD Report Card describes the prevalence of environmental factors that impact pregnancy-related complications. Notably, 40.7% of birthing people were at risk of exposure to extreme heat, and 73.7% were at risk of exposure to poor air quality. Heat waves have been associated with an increased risk of preterm delivery in both U.S.-based and global populations. ⁶ The physiological changes of both pregnancy and the neonatal periods create increased exposure to inhaled pollutants. These compounds have been linked to hypertensive disorders in pregnancy, placental abruption, low birth weight, preterm birth, and infant mortality. ⁷ It follows that policies that impact climate change—including the regulated use of fossil fuels and the promotion of sustainable energy sources—are deserving of focus given their broad implications for maternal and child health.

In summary, the 2024 MOD Report Card demonstrates little improvement in the state of maternal, fetal, and infant health in the United States as compared with the year prior. The United States continues to feature the highest maternal mortality rate of any high-income nation, a finding that persists when examining the rate overall, as well as when broken down by race/ethnicity. ⁸ These maternal deaths are largely preventable, and the above evidence-based recommendations for structural changes are imperative to improving outcomes for all. Pregnancy, birth, and the postpartum and neonatal periods are critical, high-risk times in the lives of parents and their children. As noted by the World Health Organization, “each stage should be a positive experience, ensuring women and their babies reach their full potential for health and well-being.” ⁹ In this regard, the United States has fallen short—there is still much to be done before the United States is known as a safe or supportive place to have a family.