Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates
and increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes’ goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

White

Asian/Pacific Islander

Hispanic

American Indian/Alaska Native

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
©2018 March of Dimes

  2018 PREMATURE BIRTH REPORT CARD

MARCH OFDIMES  

 

PRETERM BIRTH: DEFINITION AND SOURCE

Premature or preterm birth is birth less than 37 weeks gestation based on the obstetric estimate of gestational age. Data used in this report card
came from the National Center for Health Statistics (NCHS) natality files, as compiled from data provided by the 57 vital statistics jurisdictions
through the Vital Statistics Cooperative Program. This national data source was used so that data are comparable for each state and
jurisdiction-specific report card. Data provided on the report card may differ from data obtained directly from state or local health departments
and vital statistics agencies, due to timing of data submission and handling of missing data. The preterm birth rate shown at the top of the
report card was calculated from the NCHS 2017 final natality data. Preterm birth rates in the trend graph are from the NCHS 2007-2017 final
natality data. County preterm birth rates are from the NCHS 2016 final natality data. Preterm birth rates for bridged racial and ethnic categories
were calculated from NCHS 2014-2016 final natality data. Preterm birth rates were calculated as the number of preterm births divided by the
number of live births with known gestational age multiplied by 100.

GRADING METHODOLOGY PRETERM BIRTH RATE RANGE
Grade ranges were established in 2015 based on standard deviations SCORING CRITERIA
of final 2014 state and District of Columbia preterm birth rates away .
from the March of Dimes goal of 8.1 percent by 2020. Grades were A Preterm b'rth rate less than or equal to 8-1 percent-
determined using the following scoring formula: (preterm birth rate of Score leSS than or equal to 00.
each jurisdiction 8.1 percent)/ standard deviation of final 2014 state .
and District of Columbia preterm birth rates. The resulting scores Preterm rate 0f 8-2 percent to 9.2 percent-
were rounded to one decimal place and assigned a grade. See the Score greater than 00, but leSS than or equal to 1-0-
table for details.

Preterm birth rate of 9.3 percent to 10.3 percent.

BY COUNTY Score greater than 1.0, but less than or equal to 2.0.

Report cards for states and jurisdictions, except District of Columbia,
display up to 6 counties with the greatest number of live births.
Counties are not displayed if the number of preterm births is less than
20. Counties are ordered alphabetically. Grades were assigned based
on criteria described above. Change from previous year was assessed
by comparing the 2016 county preterm birth rate to the 2015 rate.

Preterm birth rate of 10.4 percent to 11.4 percent.
Score greater than 2.0, but less than or equal to 3.0.

Preterm birth rate greater than or equal to 11.5 percent.
Score greater than 3.0.

PRETERM BIRTH BY OF THE MOTHER

Mother?s race and Hispanic ethnicity are reported separately on birth certificates. Rates for Hispanic women include all bridged racial
categories (white, black, American Indian/Alaska Native, and Asian/Pacific Islander). Rates for non-Hispanic women are classified
according to race. The Asian/Pacific Islander category includes Native Hawaiian. In order to provide stable rates, racial and ethnic groups
are shown on the report card if the group had 20 or more preterm births in each year from 2010-2016. To calculate preterm birth rates on
the report card, three years of data were aggregated (2014-2016). Preterm birth rates for not stated/unknown race are not shown on the
report card.

PRETERM BIRTH DISPARITY MEASURES

The March of Dimes disparity ratio is based on Healthy People 2020 methodology and provides a measure of the differences, or disparities, in
preterm birth rates across racial/ethnic groups within a geographic area.1 The disparity ratio compares the racial/ethnic group with the lowest
preterm birth rate (comparison group) to the average of the preterm birth rate for all other groups.

To calculate the disparity ratio, the 2014-2016 preterm birth rates for all groups (excluding the comparison group) were averaged and divided
by the 2014-2016 comparison group preterm birth rate. The comparison group is the racial/ethnic group with the lowest six-year aggregate
preterm birth rate (2010-2015) among groups that had 20 or more preterm births in each year from 2010-2015. A disparity ratio was calculated
for US. states, the District of Columbia, and the total US. A disparity ratio was not calculated for New Hampshire, Maine, Puerto Rico, Vermont,
and West Virginia. A lower disparity ratio is better, with a disparity ratio of1 indicating no disparity.

Progress toward eliminating racial and ethnic disparities was evaluated by comparing the 2014-2016 disparity ratio to a baseline (2010-2012)
disparity ratio. Change between time periods was assessed for statistical significance at the 0.05 level using the approach recommended by
Healthy People 2020.1 If the disparity ratio significantly improved because the average preterm birth rate for all other groups got better, we
displayed ?Improved? on the report card. If the disparity ratio significantly worsened because the lowest group got better or the average of all
other groups got worse, we displayed "Worsened" on the report card. If the disparity ratio did not significantly change, we displayed "No
Improvement" on the report card.

The report card also provides the percent difference between the racial/ethnic group with the 2014-2016 highest preterm birth rate compared
to the combined 2014-2016 preterm birth rate among women in all other racial/ethnic groups. This percent difference was calculated using only
the racial/ethnic groups displayed on the state or jurisdiction-specific report card. This difference was calculated for each US. state with
adequate numbers and the District of Columbia.

CALCULATIONS

All calculations were conducted by the March of Dimes Perinatal Data Center.

1Talih M, Huang DT. Measuring progress toward target attainment and the elimination of health disparities in Healthy People 2020. Healthy
People Statistical Notes, no 27. Hyattsville, MD: National Center for Health Statistics. 2016.


2018 March of Dimes

MO 2018 PREMATURE BIRTH

. REPORT CARD

MARCH OF DIMES

UNITED STATES

 

 

PREMATURITY IN THE UNITED STATES
Preterm birth rates and grades
Preterm birth rates in 100 largest cities
Preterm birth by maternal race/ethnicity
Technical notes

COMMUNITY PROFILES
STATE PREMATURE BIRTH REPORT CARDS

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates
and increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

 2018 PREMATURE BIRTH REPORT CARD

PRETERM BIRTH RATES IN U.S. CITIES

 

The 100 cities in the United States with the greatest number of births are graded based
on their 2016 preterm birth rates.

CITY RATE GRADE CITY RATE GRADE CITY RATE GRADE

 

Albuquerque, NM 10.7 Fresno, CA 9.4 Norfolk, VA 11.8 
Anaheim, CA 8.4 Glendale, AZ 9.1 Oakland, CA 8.3 
Anchorage, AK 9.2 Grand Rapids, MI 10.4 Oklahoma City, OK 10.9 
Arlington, TX 10.2 Greensboro, NC 10.4 Omaha, NE 10.5 
Atlanta, GA 11.4 Hempstead, NY 9.4 Orlando, FL 10.3 
Aurora, CO 9.9 Honolulu, HI 10.6 Philadelphia, PA 10.3 
Austin, TX 9.3 Houston, TX 11.1 Phoenix, AZ 10.0 
Bakersfield, CA 9.7 Indianapolis, IN 11.5 Portland, OR 8.0 A
Baltimore, MD 13.4 Irvine, CA 5.5 A Raleigh, NC 9.2 
Baton Rouge, LA 13.2 Irving, TX 7.6 A Ramapo, NY 6.0 A
Birmingham, AL 12.8 Islip, NY 10.4 Reno, NV 9.3 
Boston, MA 9.5 Jacksonville, FL 11.4 Riverside, CA 8.9 
Brookhaven, NY 8.9 Jersey City, NJ 11.1 Sacramento, CA 8.5 
Brownsville, TX 11.2 Kansas City, MO 10.8 Salt Lake City, UT 9.2 
Buffalo, NY 11.6 Knoxville, TN 10.4 San Antonio, TX 11.9 
Charlotte, NC 10.1 Laredo, TX 10.9 San Bernardino, CA 10.2 
Chicago, IL 10.7 Las Vegas, NV 10.5 San Diego, CA 8.3 
Chula Vista, CA 9.1 Lexington-Fayette, KY 11.2 San Francisco, CA 8.3 
Cincinnati, OH 11.4 Lincoln, NE 10.2 San Jose, CA 8.3 
Cleveland, OH 14.4 Long Beach, CA 8.7 Santa Ana, CA 9.2 
Colorado Springs, CO 10.1 Los Angeles, CA 9.5 Seattle, WA 7.5 A
Columbus, OH 11.2 Louisville, KY 10.9 Spokane, WA 9.8 
Corpus Christi, TX 9.4 Lubbock, TX 11.3 St. Louis, MO 12.6 
Dallas, TX 8.3 Memphis, TN 14.1 St. Paul, MN 8.3 
Denver, CO 8.8 Mesa, AZ 8.5 Stockton, CA 9.3 
Des Moines, IA 10.3 Miami, FL 10.7 Tacoma, WA 8.6 
Detroit, MI 14.5 Milwaukee, WI 11.9 Tampa, FL 10.5 
Durham, NC 8.9 Minneapolis, MN 9.3 Toledo, OH 10.9 
El Paso, TX 10.1 Modesto, CA 9.0 Tucson, AZ 8.1 A
Fayetteville, NC 12.7 Nashville-Davidson, TN 10.5 Tulsa, OK 11.5 
Fontana, CA 9.2 New Orleans, LA 12.5 Vancouver, WA 7.8 A
Fort Wayne, IN 9.3 New York, NY 8.8 Virginia Beach, VA 9.7 
Fort Worth, TX 9.7 Newark, NJ 12.9 Washington, DC 10.7 

Wichita, KS 9.7 



For details on data sources and calculations, see Technical Notes.
For more information on how we are working to reduce premature birth, visit @2018 March of Dimes

 2018 PREMATURE BIRTH REPORT CARD

MARcHorm?Es RACE ETHNICITY IN THE U.S.

 

Aggregate 2014-2016
preterm birth rates
are shown for each of

Asian/Pacific Islander 8.6

 
 

In United States, the

 

primal :3 8'9 preterm birth rate
The racial/ethnic ttmorgg bgaCk women
group with the 1549/0 hzgher than
highest rate is the rate among all

 

combined rate for all
other racial/ethnic
groups.

13.4

  

 

5 1O 15
Percentage of live births in 2014-2016 (average) born preterm



 

RACE ETHNICITY DISPARITY BY STATE

The March of Dimes disparity ratio measures and tracks progress towards the elimination of racial/ethnic disparities
in preterm birth. It is based on Healthy People 2020 methodology and compares the group with the lowest preterm
birth rate to the average for all other groups. Progress is evaluated by comparing the current disparity ratio to a
baseline disparity ratio. A lower disparity ratio is better, with a disparity ratio ofl indicating no disparity.

LEVEL OF OVERALL
DISPARITY

I Highest disparity

 

Lowest disparity

Disparity ratio
not available

U.S. DISPARITY
RATIO

1.24

The U.S. disparity ratio has

Worsened
from baseline

 

 

MORE INFORMATION


For details on data sources and calculations, see Technical Notes.
For more information on how we are working to reduce premature birth, visit @2018 March of Dimes

MARCH OF DIMES

 

 

 

 

 

 

 

 

 

COMMUNITY PROFILEK
COMMUNITY
PROFILE
MM

RHODE ISLAND

STATEWIDE EFFORTS LEAD TO 23% DROP IN
PRETERM BIRTH RATE IN RHODE ISLAND
Over the past ten years, Rhode Island has been on a steady march to reduce its preterm birth rate from 10.8 percent in
2007 to 8.3 percent in 2017.1 Rhode Island is the smallest state in the United States. It has 1 million residents, making it
the 43rd most populated state. While its small size may be advantageous when organizing and implementing public health
solutions, its success in reducing the preterm birth rate should not be diminished. Lessons learned in Rhode Island are
assessable for potential implementation in other locations.
While Rhode Island can boast some serious progress in reducing the preterm birth rate since 2007, its leaders are the
first to say they still have work to do to address the stubborn racial and ethnic disparities in premature birth as well as
factors beyond the health care system that contribute to these disparities. This awareness and commitment to achieving
more equitable outcomes underlies state-level decision-making in Rhode Island.
Successful strategies stem from strong, cooperative leadership emanating from the Rhode Island Task Force on
Premature Births. This group of state leaders, initially brought together by the Rhode Island Department of Health
(RIDOH) and March of Dimes, takes on the challenge of identifying and addressing system-level opportunities for
stronger integration of services and improved processes to ensure that all mothers receive the care, education, support
and services they need, where and when they need them most.

CHALLENGES IN RHODE ISLAND
Even with a declining state preterm birth rate, health experts in Rhode Island identify several
challenges to continued success:
Poverty. "What's the key issue for preterm birth in Rhode Island? Social determinants of health,
including poverty," says Maureen G. Phipps, MD, MPH, Chief of Obstetrics and Gynecology,
Women & Infants Hospital and Care New England Health System and founding Co-Chair of the
Rhode Island Task Force on Premature Births. Social determinants of health are the conditions
in which people live, learn, work, play and pray that affect their health risks and outcomes. Dr.
Phipps and other health leaders recognize that poverty is a key determinant at the core of many
critical health issues facing women in the state.
Institutional racism. Rhode Island health leaders now see the impact of institutionalized racism on societal systems and
dynamics, ultimately leading to disparities in poor birth outcomes. This recognition leads state leaders to deliberately focus
on eliminating inequities through raising awareness about implicit bias and discrimination; identifying and breaking down
systems and policies that contribute to these inequities; and investing in interventions that help accelerate improvements
for all. "Moving forward, we need to narrow our focus even more on preterm birth disparities, including those based on
race, ethnicity, city or town of residence and insurance status," says Nicole Alexander-Scott, MD, MPH, Director of the
Rhode Island Department of Health.2
Delivery of reproductive health care. With almost half of all pregnancies being unplanned, opportunities exist to improve
how, where and when reproductive health care is delivered in Rhode Island.3 Many mothers may be unaware that optimal
birth spacing (at least 18 months from the birth of one child to the beginning of the next pregnancy) may reduce their risk of
having a premature birth. One Task Force work group has been charged with analyzing this issue to make
recommendations on integration of person-centered pregnancy intention screening and related care as well as education
into routine care across the state.
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Successes in Rhode Island are the result of how health leaders
implemented changes as well as what they changed or expanded.
Securing buy-in and support from top state health leadership has
been crucial and has led to intense collaboration among providers and
stakeholders. Successful initiatives include:
Rhode Island Task Force on Premature Births. Anchored by RIDOH,
Women and Infants Hospital and March of Dimes, the Task Force is a
diverse coalition of community-based organizations, government agencies
and health care providers. Launched 12 years ago, the Task Force adopted
shared measures of success to reduce the rate of preterm birth in the state.
By collectively analyzing existing practices, the Task Force emphasizes
learning from patient and provider experiences. Annual data-driven plans
have led to evidence-informed strategies that take social determinants into
consideration. Over the years, the Task Force has looked for ways to
collaboratively improve maternal/child care in Rhode Island's health system.
For example, insurance companies simplified their policies and processes;
state agencies provided free curbside transportation for clients; providers
completed professional education to better serve pregnant women and new
mothers; and new evidence-based strategies were implemented and
supported across key communities in the state (e.g. Nurse Family
Partnership). Specific areas of Task Force focus include:
o

o

Access to 17P. After completing a statewide provider survey, the Task
Force identified several opportunities to address barriers to access to
17P, a medication that can help reduce the risk of subsequent premature
birth for certain women. Working closely with physicians, hospitals,
community health centers, managed care organizations, insurers, and
pharmacies, the Task Force analyzed the current pre-authorization and
ordering process to access this medication. It then developed a toolkit to
provide guidance from the state's four largest health insurers on ordering
17P in a timely fashion; the toolkit is being disseminated to provider
practices statewide.
Preconception and interconception care. Perinatal health research
emphasizes the importance of integrating pre-/interconception care
within the continuum of women's health care. This care includes family
planning guidance; nutrition education; infectious, chronic disease and
immunization screening; review of medication use; and behavioral health
assessment. Best practice guidelines encourage providers to base a
woman's care on previous pregnancy outcomes, genetic history, mental
health and history of intimate partner violence. Additionally, RIDOH trains
providers to integrate pregnancy intention screening and patientcentered contraceptive counseling into routine care.

Statewide programs. The work spearheaded by the Task Force provides a
steady focus on improving the health of all moms and babies across the
state. Its activities are further amplified and supported by state and local
leaders, as well as by partner-led activities that aim to improve the health
and wellbeing of the population at large. A significant state change that
impacts health services provided to pregnant and parenting women is
Medicaid expansion. Almost all women in Rhode Island currently have

2

PRETERM BIRTH IN
RHODE ISLAND,
2007-2017
Percentage of live
births born preterm

WHAT'S WORKING IN RHODE ISLAND:
SUCCESSFUL STRATEGIES

2007

2017

Source: National Center for Health Statistics, final natality data

RHODE ISLAND BY
THE NUMBERS
o

Women ages 15-44 in Rhode
Island: 18.1% Hispanic, 68.2 %
white, 7.8 % black, 5.4 %
Asian/Pacific Islander, and <1%
American Indian/Alaska Native.4

o

Nearly 13% of the population live
below the federal poverty level.5

o

About 1 in 20 women ages 15-44
(5.1%) were uninsured in Rhode
Island, compared to 11.7%
nationwide in 2016.6

o

In Rhode Island, 48.9% of births in
2016 were covered by Medicaid.7

o

The preterm birth rate among nonHispanic black women was 12.2% in
2016, 42% higher than the rate of
8.6% among non-Hispanic white
women.8

MARCH OF DIMES LEADS THE FIGHT FOR
THE HEALTH OF ALL MOMS AND BABIES.

SUCCESSFUL STRATEGIES

(continued)

access to prenatal care. Additionally, an awareness campaign resulted in mothers using a free, curbside
transportation service (a previously unknown benefit to most) to get to medical care they need. Extensive statewide
education efforts focus on teen health; reducing tobacco use (access to Quitlines); increasing use of contraception
to reduce unintended pregnancies; and preventing and treating substance use disorders.
Community programs. In 2015, RIDOH initiated the Health Equity Zones (HEZ) Initiative, developing ten Health
Equity Zones throughout Rhode Island to implement community-driven work plans over a three- or four-year period.
Innovative approaches implemented by HEZ programs aim to reduce the burden of chronic diseases, improve birth
outcomes and ameliorate the social and environmental conditions of communities across the state. Local
communities choose certain initiatives based on local need. The structure of HEZ programs emphasizes
coordination between state agencies and community-based organizations, keeping the residents' experiences front
and center. As part of this effort, RIDOH's Family Home Visiting Program coordinates closely with the HEZ projects
and activities. As a result of this coordination, providers are now able to more readily refer high-risk patients to
appropriate health care specialists and community resources.

LESSONS LEARNED
o

o

o

o
o

Intense collaboration and shared responsibility by
leaders, diverse stakeholders and providers are
critical for success. Sarah Coutu, Maternal Child
Health Program Coordinator, UnitedHealthcare(R)
Community Plan, Rhode Island says it best: "We all
leave our egos and titles at the door. When we
work together, we don't represent our various
segments or silos. We represent the mothers and
babies of Rhode Island."
Using evidence-based strategies, such as
increasing access to effective medications to
reduce the risk of premature birth among eligible
mothers and safely reducing early elective
deliveries, can help further reduce the incidence of
premature birth in the state.
Programs and services need to be integrated in the
continuum of women's health care and be inclusive
of efforts that seek to mitigate societal stress
factors.
Education programs and materials for patients and
providers should be disseminated effectively
through diverse channels.
Health leaders can use community data to identify
what works and how service providers can best
replicate positive results. Every initiative should set
goals and track progress.

MARCH OF DIMES IN THE
COMMUNITY
In support of continued success in Rhode Island to
reduce the incidence of premature birth and associated
health outcomes, March of Dimes commits to:
o Continue support of and collaboration with the
Rhode Island Task Force on Premature Births.
o Co-organize and support the annual March of Dimes
Prematurity Summit. The Summit provides a
welcome opportunity for the Task Force and RIDOH
to report on progress and activities; brings visibility
to the issue of premature birth; and educates clinical
and community-based providers on promising
interventions.
o Convene stakeholders across sectors to collaborate
on system-wide improvement opportunities
o Educate women and providers about current
research and best practices to prevent premature
birth.
o Support the NICU Family Support(R) program at
Women and Infants Hospital
o Advocate to advance maternal/child health issues,
including access to care and tobacco- and opioidrelated interventions.
References
1. National Center for Health Statistics
2. https://www.ri.gov/press/view/30274
3. Rhode Island Department of Health, Pregnancy Risk Assessment
Monitoring System 2012-2015
4. U.S. Census Bureau
5. U.S. Census Bureau
6. US Census Bureau
7. National Center for Health Statistics
8. National Center for Health Statistics
For information on how communities were chosen, please
contact perinataldatacenter@marchofdimes.org.

3

MARCH OF DIMES LEADS THE FIGHT FOR
THE HEALTH OF ALL MOMS AND BABIES.

COMMUNITY PROFILE

KNOX COUNTY,
TENNESSEE

PRETERM BIRTH RATE IN KNOX COUNTY
IMPROVES MORE THAN 20% SINCE 2007
Knox County, Tennessee has demonstrated an ability to turn the corner on certain metrics associated with premature
birth. Local health leaders in Knox County face many stubborn problems that affect the health of pregnant women, young
mothers and their babies, including chronic substance abuse, high tobacco use and mental health challenges.
Complicating these issues is a poverty rate in Knox County of 15 percent and 24 percent in Knoxville, the county's largest
city.1 The median household income for these areas is significantly below the national average. Despite these obstacles,
and rising preterm birth rates across the United States in recent years, the preterm birth rate in Knox has fallen to 9.8
percent in 2016 from 12.5 percent in 2007, an improvement of more than 20 percent over the past decade.2
Strong, local, collaborative efforts by hospitals, county and state public health departments and March of Dimes have
driven change within the health care system in Knox County. These changes have led to improvements in birth outcomes.
For example, the county's Power to Quit Knox program has produced positive results, including a reduction in the number
of pregnant women who smoke. Another local initiative, Healthy Babies Are Worth the Wait, has helped reduce the high
rate of early elective deliveries (EEDs) locally and statewide. And implementation of March of Dimes Supportive
Pregnancy Care (SPC) in Knox County has the potential to reduce the risk of premature birth for program participants.

KNOX COUNTY
BY THE NUMBERS
o

Women ages 15-44: 4.5%
Hispanic, 81.9% white, 10.3%
black, 3% Asian/Pacific Islander,
and <1% American Indian/Alaska
Native.7

o

14.8% of the total population has
a household income below the
federal poverty level, compared
to 15.8% in Tennessee.8

o

9.7% of women ages 18 to 64
were uninsured, compared to
11.6% in Tennessee.9

o

Black women have a preterm
birth rate of 13.4%, compared to
9.2% of births to Hispanic
women and 8.9% of births to
white women.10

o

79.2% of women in Knox County
began prenatal care in their first
trimester compared to 74.2% of
women in Tennessee.11

CHALLENGES IN KNOX COUNTY
A core problem facing health leaders in Knox County is that many public
decision makers are not aware of problems related to premature birth and
neonatal care. "There was no urgency related to this issue," says Dr. Mark
Gaylord, Director of Neonatology at the University of Tennessee Medical
Center.
When leaders examined the data for Knox County, they found that 16 percent
of pregnant women smoke and that a significant proportion of births were
EEDs. In addition, similar to the rest of the country, they found that preterm
birth rates among black women were higher than for other women -- 13.5
percent compared to 9.4 percent.5
For many women, health- and societal-related factors that can affect
premature birth are evident before pregnancy. For example, in 2015, one
third of those living in Knox were experiencing some form of housing stress
(for example, lack of complete plumbing or kitchen facilities).6 By the time a
woman gets pregnant, these issues may have already critically impacted her
health and her baby's health.

(C) 2018 March of Dimes 11/18

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WHAT'S WORKING IN KNOX: SUCCESSFUL STRATEGIES
Strong and creative leadership in Knox County has produced effective, local programs that offer
providers, community organizations and the public needed information, services and education to
address premature birth. Successful initiatives include:

PRETERM BIRTH RATE:
KNOX COUNTY 2007-2016

StrongBabyKnox. Developed by the Knox County Health
Department, this online program is an easy-to-follow
resource for pregnant women and new mothers. It includes
information on prenatal care, smoking cessation, healthy
eating, breastfeeding, safe sleep and immunizations. The
program was promoted via digital ads as well as billboards
and posters in community organizations and churches.
Tennessee Healthy Babies are Worth the Wait. Based
on a March of Dimes quality improvement initiative, this
program encourages providers and health care systems to
implement policies and procedures to reduce the incidence
of non-medically indicated EEDs between 37 and 39
weeks. The program educates the public about the
importance of full-term deliveries via a website, billboards,
radio and TV. Hospitals that achieved a sustained EED rate
of <5 percent are recognized for success. "We changed the
culture," said Jackie Moreland, RN and Clinical Quality
Specialist, Tennessee Center for Patient Safety. The Knox
County Health Department set a goal to reduce EEDs from
16 percent to <5 percent. When the rate hit 7 percent, the
Tennessee Hospital Association's Board of Directors
adopted the program statewide. March of Dimes, the
Tennessee Hospital Association, the Tennessee
Department of Health and the Tennessee Initiative for
Perinatal Quality Care collaborate on statewide efforts.
Each year since 2013, the program has helped the state
achieve an EED rate <2 percent.12
Power to Quit Knox County. This smoking cessation
program implemented 190 group and individual counselling
sessions with gift card incentives and referrals to the
Tennessee QUITLINE. The self-reported quit rate for
pregnant women at delivery is 30 percent, and 33 percent
of pregnant women reported quitting by the first postpartum
visit.13
Addiction clinics. These clinics are a major partner in the
Knox County health care network. At opioid addiction
recovery centers, Knox County Health Department
provides birth control and family planning services and
women's health classes. Paige Huggler from the Regional
Perinatal Program at the University of Tennessee Medical
Center in Knoxville states, "We facilitate helping pregnant
women with opioid use disorder by getting them into
programs that will wean them down and potentially off of
opiates by the time of delivery - but they need ongoing
behavioral health management during this process (and
after, especially if they are fully detoxed). We now have
fully detoxed more than 600 patients."

2

Source: National Center for Health Statistics, final natality data

Provider education. The University of Tennessee Medical
Center and other providers, in collaboration with state and
local health departments, have ramped up their
professional education programs, especially around the
use of 17P to help reduce the risk of subsequent premature
birth for certain at-risk women. The number of OB
outpatient high-risk consultations, OB education hours and
neonatal education hours have more than tripled from 2013
to 2017.14
Supportive Pregnancy Care. Knox County is one of
several sites in the state implementing the March of Dimes
SPC model of group prenatal care. With funding and
partnership from the Tennessee Department of Health and
UnitedHealth Group, the program launched in six sites in
November 2016. Group prenatal care is an evidence-based
intervention that has been shown to reduce the risk of
premature birth for African-American women by 41
percent.15 In group care, pregnant women with similar due
dates meet together for prenatal care and education with
their obstetric provider. At sessions, women learn how to
take and record their own vital signs; receive a private
physical assessment with their provider; become part of a
support network for each other; and gain knowledge and
skills related to pregnancy, birth and infant care. SPC is
available at UT Knoxville; Cherokee Health Center in Knox
County is implementing the program at two locations that
serve all patients with or without insurance. The Center
provides wrap-around medical care that includes mental
health and addiction services and other specialized health
programs. "If we've made progress, it's because we have
integrated medical and other critical services in a 'safety
net program' for pregnant women and young mothers,"
says Dr. Michael Caudle, an OB/GYN at Cherokee.

MARCH OF DIMES LEADS THE FIGHT FOR
THE HEALTH OF ALL MOMS AND BABIES.

LESSONS LEARNED
o

Partnership between statewide organizations, like the Tennessee Department of Health, county and local
organizations and March of Dimes is critical to maximize resources and impact.

o

Locally developed programs with strong leadership, comprehensive dissemination tactics and sustained funding
can lead to improvements in prevention efforts, prenatal care and outcomes.

o

Peer support programs encourage ongoing participation and accountability.

o

Collaboration among health and social service providers leads to better results by helping meet critical needs of
women.

o

Specialized clinics, like opioid treatment facilities, are important in reaching women at high risk and can improve
health in pregnancy and childbirth.

o

Regional perinatal programs that offer provider/patient consults and provider training help the community reach
its perinatal goals.

MARCH OF DIMES IN THE COMMUNITY
In support of continued success in Knox County, Tennessee, to reduce the incidence of premature birth and associated
health outcomes, March of Dimes commits to:
o

Work collaboratively with agencies in Knox County to improve outcomes for moms and babies

o

Provide assistance for March of Dimes Supportive Pregnancy Care programs being implemented with local partners

o

Collaborate with providers and payers to ensure that all eligible women who have had a premature birth have access
to progesterone therapy to prevent a subsequent early delivery

o

Provide nationally produced, easy-to-use provider and consumer resources and education tools on topics that address
prematurity prevention, including the impact of smoking during pregnancy and educating women on the warning signs
of preterm labor

o

Offer professional education opportunities for providers to enhance care and prevent premature birth on topics such
as best practices in smoking cessation and treating opioid addiction

o

Advocate for state laws that include tobacco prevention program funding; opioid prevention and treatment measures;
and perinatal centers that provide education and treatment of high risks moms and babies

References:
1.
U.S. Census Bureau, 2010
2.
National Center for Health Statistics
3.
U.S. Census Bureau, 2010
4.
Tennessee Department of Health, Reducing Pregnancy Smoking and Associated Low Birth Weight Births, Tobacco Settlement Program 2014-2016
5.
National Center for Health Statistics
6.
Centers for Disease Control and Prevention. (2015). Housing stress.
7.
National Center for Health Statistics
8.
U.S. Census Bureau
9.
U.S. Census Bureau
10. National Center for Health Statistics
11. National Center for Health Statistics
12. Association of State and Territorial Health Officials. (2013). Tennessee Healthy Babies are Worth the Wait.
13. Tennessee Department of Health, Reducing Pregnancy Smoking and Associated Low Birth Weight Births, Tobacco Settlement Program 2014-2016
14. Kettrey, HH et al; Piloting the March of Dimes Supportive Pregnancy Care Model in Tennessee: Addressing Providers Perceived Barriers to Group Prenatal Care
Implementation. Early results presented at CityMatch 2018.
15. Ickovics JRet al. (2007). Group prenatal care and perinatal outcomes: A randomized controlled trial. Obstetrics and Gynecology, 110(2 Pt 1), 330-339.
For information on how communities were chosen, please contact perinataldatacenter@marchofdimes.org.

3

MARCH OF DIMES LEADS THE FIGHT FOR
THE HEALTH OF ALL MOMS AND BABIES.

COMMUNITY PROFILEK
COMMUNITY
PROFILE
MM

RALEIGH,
NORTH CAROLINA

RALEIGH DRIVES IMPROVEMENT IN PRETERM
BIRTH: CITY'S GRADE MOVES FROM "D" TO "B"
Premature birth is the number one cause of infant mortality in North Carolina. Health leaders cite several issues that
affect health care and prenatal care in their state. Economic inequalities, the education gap, racism and stress contribute
to racial/ethnic disparities. The infant mortality rate for black infants in North Carolina is more than twice the rate for white
babies. Medical conditions, such as obesity, diabetes and cardiovascular disease, as well as tobacco and opioid
addiction, impede the ability to combat high prematurity and mortality rates.
In the midst of this reality, the city of Raleigh and the larger Wake County have demonstrated an ability to turn the corner
on certain metrics associated with premature birth. Raleigh is the state capital and the second largest city in North
Carolina. It is part of Wake County whose population is just over 1 million people. Of Raleigh's 404,000 residents, 57
percent are white, 29 percent are black and 11 percent are Hispanic.1
Various state and local programs help women in Raleigh have healthy pregnancies and healthy babies. For example, the
state's Pregnancy Medical Home program provides medical support for high-risk women; most maternity care providers
across North Carolina participate in the program. Through the North Carolina Preconception Health Campaign, local
leadership has implemented effective state programs to address prematurity and postpartum issues. In Raleigh,
Community Care of North Carolina screens and provides care for the pregnant Medicaid population. And ongoing group
prenatal medical visits offer trained help and peer support for at-risk pregnant women. The results of these efforts are
promising. In Raleigh, preterm birth rates declined from 10.6 percent in 2007 to 9.2 percent in 2016.2

CHALLENGES IN RALEIGH
Racial/Ethnic disparities. While the preterm birth rate in
Raleigh has declined, racial disparities are a serious
problem. Black babies are almost twice as likely to be
born early as whites.3 Whitney Tucker, research director
at NC Child notes that the challenge largely comes down
to improving the health of black children and black
families. The state infant mortality rate for white children
is 6 deaths for every 1,000 live births. But the black infant mortality rate in North Carolina is 12.4 deaths, above the
national average of 11.3 deaths for every 1,000 live births. "It's really a black-white disparity or a black and everyone
else disparity," Tucker says. "It's not just whether or not we move the needle but whether we close the gap."
Access to care, smoking and opioid use. A community needs assessment by hospitals and other health care
agencies in 2013 stated that the top health challenges in Wake County were poverty and unemployment, health care
access and utilization, and mental health and substance use. These issues can have a negative impact on pregnant
and postpartum women. For example, access to health services and limited public transportation in Wake County can
be barriers for low-income pregnant women who need quality care. Tobacco use during pregnancy is associated with
infertility, miscarriage and premature birth.4 Alarmingly, 10 percent of North Carolina's pregnant women smoke.5
Women who use opioids are likely to use tobacco as well: nearly 95 percent of women with opioid use disorder
continue to smoke cigarettes during pregnancy.6 Risks from opioid exposure also include premature birth and low
birthweight, in addition to neonatal abstinence syndrome (NAS).7

(C) 2018 March of Dimes 11/18

FOLLOW US ON

MARCHOFDIMES.ORG/REPORT CARD

WHAT'S WORKING IN RALEIGH:
SUCCESSFUL STRATEGIES
Strong planning at the state and local levels is part of the good news
in the Raleigh area. Local leaders report a total buy-in from local
health care providers and community organizations that have taken
ownership for improving outcomes for moms and babies through
various state-funded initiatives. Successful initiatives include:

PRETERM BIRTH
RATE: RALEIGH
2007 & 2016

Health education for women. The March of Dimes North Carolina
Preconception Health Campaign provides health education to all women of
childbearing age with the message that health now matters for future
families.
Addressing health equity. The North Carolina Department of Public
Health is taking a proactive stance to reverse the results of long-term
racism. Ensuring health equity for all requires changing policies, systems
and practices to address health inequities and reduce longstanding
disparities. The North Carolina Health Equity Impact Assessment (HEIA),
developed by NC Child in partnership with the NC Division of Public Health
Women's Health Branch and the NC Office of Minority Health and Health
Disparities, is a tool that enables decision makers to intentionally focus and
align strategies to reduce disparities and promote health equity.8
Access to and quality of care. To improve access to quality care and to
coordinate services, Community Care of North Carolina partnered with state
Medicaid to develop the Pregnancy Medical Home (PMH) program in 2011.
As part of the program, if a woman is screened and determined high risk,
she is assigned a medical professional to educate and support her. She can
now qualify for 17P treatment, a progesterone shot that can help prevent
premature birth in certain women. Most maternity care providers across
North Carolina (1,600 individual providers from more than 350 practices)
participate in PMH. Each Community Care Network, such as Community
Care of Wake and Johnston Counties, provides an OB team with one or
more physician champions and at least one nurse coordinator to recruit,
educate and support PMH practices. The Raleigh area now has a lower
percentage of women who do not receive prenatal care than does the state
as a whole.9
Early elective deliveries. Elective delivery before 39 weeks of pregnancy
carries significant risks for a baby with no known benefits to the mother.10
The Perinatal Quality Collaborative of North Carolina is working to reduce
the incidence of early elective deliveries across the state. In conjunction with
March of Dimes, the Collaborative educates women and their partners
about the importance of avoiding early elective deliveries by caesarean birth
or labor induction. Partly as a result of these efforts, the rate for early
elective births statewide has dropped to 3 percent.10
Smoking cessation. The statewide You Quit, Two Quit (YQ2Q) campaign
funds tobacco cessation services and quitlines for women. YQ2Q offers
free, on-site training and technical assistance to clinics that serve women of
reproductive age. With March of Dimes support and advocacy, the program
provides 98 percent of women ready to quit with a brief, evidence-based
counseling intervention.

2

RALEIGH BY THE
NUMBERS
o

Women ages 15-44 in Wake
County: 10.9% Hispanic, 57.3%
white, 23.3% black, 8.2%
Asian/Pacific Islander, and <1%
American Indian/Alaska Native.11

o

Nearly 11% of the population in
Wake County live below the
federal poverty level.12

o

About 1 in 10 women ages 18-64
(9.8%) were uninsured in Wake
County, compared to 14.9%
overall in North Carolina.13

o

In Raleigh, 30.5% of births in
2016 were covered by
Medicaid.14

o

The preterm birth rate among
non-Hispanic black women in
Raleigh was 12.7% in 2016, 49%
higher than the rate of 7.7
percent among non-Hispanic
white women.15

MARCH OF DIMES LEADS THE FIGHT FOR
THE HEALTH OF ALL MOMS AND BABIES.

LESSONS LEARNED
o

Programs to improve the health of moms and babies and decrease the incidence of premature birth need statesecured funding for sustainability.

o

Health and community leaders can raise awareness and urgency around premature birth with robust planning
and sustained, visible commitment to improving outcomes.

o

Statewide programs should be customizable to accommodate the needs of local stakeholders.

o

Pregnant women can benefit from long-term maternal health counseling programs facilitated by trained providers.

o

Providers need education on evidence-based solutions to reduce premature birth and improve postpartum health,
including timely screenings and services.

MARCH OF DIMES IN THE COMMUNITY
In support of continued success in Raleigh and Wake County, North Carolina to reduce the incidence of premature
birth and associated health outcomes, March of Dimes commits to:
o
o

Educate legislators and help secure state funds
Promote a focus on preconception health as a strategy to
improve preterm birth
Serve in collaborative leadership roles to promote health equity
Engage community organizations, colleges/universities, and
other non-traditional partners to raise awareness of preterm
birth as a public health issue; engage stakeholders regularly
Provide professional education to healthcare providers serving
women of childbearing age; support advancement of key
strategies such as tobacco cessation and eliminating early
elective deliveries

o
o
o

References:
1. U.S. Census Bureau
2. National Center for Health Statistics
3. National Center for Health Statistics
4. Center for Disease Control and Prevention, Tobacco Use and Pregnancy
5. National Center for Health Statistics
6. Center for Disease Control and Prevention, Tobacco Use and Pregnancy
7. Ram, A et al, Cigarette Smoking Reduction in Pregnant Women with Opioid Use Disorder, Journal of Addiction Medicine. 2016 Feb: 10(1).
8. https://www.ncchild.org/promoting-health-equity/
9. NC State Center for Health Statistics
10. https://www.marchofdimes.org/mission/39-weeks-quality-improvement.aspx
11. Berrien, K et al, The Perinatal Quality Collaborative of North Carolina's 39 Weeks Project, NC Medical Journal. 2014 May-June 75(3).
12. U.S. Census Bureau
13. U.S. Census Bureau
14. U.S. Census Bureau
15. National Center for Health Statistics
For information on how communities were chosen, please contact perinataldatacenter@marchofdimes.org.

3

MARCH OF DIMES LEADS THE FIGHT FOR
THE HEALTH OF ALL MOMS AND BABIES.

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Hispanic

Asian/Pacific Islander

White

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates
and increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

White

Hispanic

Black

Asian/Pacific Islander

American Indian/Alaska Native

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Asian/Pacific Islander

White

Hispanic

American Indian/Alaska Native

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Hispanic

White

American Indian/Alaska Native

Asian/Pacific Islander

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates
and increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

White

Asian/Pacific Islander

Hispanic

American Indian/Alaska Native

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

White

Hispanic

Asian/Pacific Islander

American Indian/Alaska Native

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Asian/Pacific Islander

White

Hispanic

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Asian/Pacific Islander

Hispanic

White

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

White

Asian/Pacific Islander

Hispanic

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Asian/Pacific Islander

Hispanic

White

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Asian/Pacific Islander

Hispanic

White

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Asian/Pacific Islander

Hispanic

White

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

White

Hispanic

Asian/Pacific Islander

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Hispanic

White

Asian/Pacific Islander

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Asian/Pacific Islander

White

Hispanic

American Indian/Alaska Native

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Asian/Pacific Islander

White

Hispanic

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Hispanic

White

Asian/Pacific Islander

American Indian/Alaska Native

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Asian/Pacific Islander

Hispanic

White

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates
and increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Hispanic

White

Asian/Pacific Islander

American Indian/Alaska Native

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Asian/Pacific Islander

Hispanic

White

Black

American Indian/Alaska Native

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Black

White

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Asian/Pacific Islander

White

Hispanic

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Hispanic

Asian/Pacific Islander

White

American Indian/Alaska Native

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Asian/Pacific Islander

White

Hispanic

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Asian/Pacific Islander

White

Hispanic

American Indian/Alaska Native

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Asian/Pacific Islander

Hispanic

White

American Indian/Alaska Native

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Asian/Pacific Islander

Hispanic

White

American Indian/Alaska Native

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

White

Hispanic

American Indian/Alaska Native

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates
and increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

White

Asian/Pacific Islander

Hispanic

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

White

Asian/Pacific Islander

Hispanic

American Indian/Alaska Native

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

American Indian/Alaska Native

Hispanic

White

Asian/Pacific Islander

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

White

Asian/Pacific Islander

Hispanic

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

White

Hispanic

American Indian/Alaska Native

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Asian/Pacific Islander

American Indian/Alaska Native

White

Hispanic

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

White

Asian/Pacific Islander

Hispanic

American Indian/Alaska Native

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Asian/Pacific Islander

White

Hispanic

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Asian/Pacific Islander

Hispanic

White

American Indian/Alaska Native

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

White

Asian/Pacific Islander

Hispanic

American Indian/Alaska Native

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Asian/Pacific Islander

White

Hispanic

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates
and increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Asian/Pacific Islander

White

Hispanic

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Hispanic

White

Asian/Pacific Islander

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

White

Black

Hispanic

American Indian/Alaska Native

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates
and increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Asian/Pacific Islander

Hispanic

White

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Asian/Pacific Islander

White

Hispanic

American Indian/Alaska Native

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

White

Hispanic

Black

Asian/Pacific Islander

American Indian/Alaska Native

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Asian/Pacific Islander

White

Hispanic

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

White

Hispanic

Asian/Pacific Islander

Black

American Indian/Alaska Native

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

White

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

Asian/Pacific Islander

Hispanic

White

American Indian/Alaska Native

Black

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes

Premature birth and its complications are the largest contributors to infant
death in the U.S., and a major cause of long-term health problems in
children who survive. March of Dimes aims to reduce preterm birth rates and
increase equity, and monitors progress through Premature Birth Report
Cards. Report Card grades are assigned by comparing the 2017 preterm
birth rate in a state or locality to March of Dimes' goal of 8.1 percent by
2020. Report Cards provide county and race/ethnicity data to highlight the
importance of addressing equity in areas and populations with elevated risk
of prematurity. March of Dimes is working to expand solutions to help all
mothers and babies have healthy, full-term births.

White

Hispanic

American Indian/Alaska Native

For details on data sources and calculations, see Technical Notes. For more information on how we are working to reduce premature birth, visit www.marchofdimes.org.
(C)2018 March of Dimes