(NEW YORK) — The United States continues to be one of the “most dangerous developed nations” for childbirth, according to a new report released Thursday by March of Dimes, a nonprofit organization focused on improving the health of pregnant people and babies.

The U.S. earned a D+ grade on its preterm birth rate for the second straight year in March of Dimes’ annual report looking at the state of maternal and infant health.

The preterm birth rate was 10.4%. The report also notes that the U.S. saw a 3% increase in infant mortality over the past year and a maternal death rate that doubled from 2018 to 2021.

When it comes to preterm births, one of the leading causes of infant deaths in the U.S., more than 380,000 babies were born before 37 weeks over the past year, according to March of Dimes. There are also large racial disparities when it comes to preterm births, according to the report, with Black and American Indian/Alaskan Native women 54% more likely to have a preterm birth compared to white women.

Racial disparities also exist when it comes to maternal health, with non-Hispanic Black women dying due to pregnancy-related complications at a rate 2.6 times that of non-Hispanic white women, according to data from the U.S. Centers for Disease Control and Prevention.

In addition, a separate March of Dimes report released earlier this year found that more than 5.6 million women in the U.S. live in counties with limited or no access to maternity care services. Since 2018, there has been a 4% increase in maternity care deserts, defined by March of Dimes as “any county in the United States without a hospital or birth center offering obstetric care and without any obstetric providers.”

“This year’s report shows the state of infant and maternal health in the United States remains at crisis-level, with grave disparities that continue to widen the health equity gap,” Dr. Elizabeth Cherot, president and CEO of March of Dimes, said in a statement about Thursday’s report. “We have long known that many of the factors impacting poor outcomes for moms and babies can and must be addressed if we are to reverse these trends.”

She continued, “The fact is, we are not prioritizing the health of moms and babies in this country, and our systems, policies, and environments, as they stand today, continue to put families at great risk.”

States where infant, maternal outcomes are the worst

The South and Midwest regions of the U.S. continue to have the worst outcomes when it comes to infant and maternal health, according to the March of Dimes report.

Louisiana, Arkansas, South Carolina, Oklahoma, Ohio, Mississippi and Alabama are among the states with the highest infant mortality rate. Those states each had an infant mortality rate of at least 7 deaths per 1,000 live births, compared to the national average of 5.4 deaths per 1,000 live births.

Infant mortality is defined by the CDC as “the death of an infant before his or her first birthday.”

The primary causes of infant mortality include birth defects, preterm birth and low birth weight, sudden infant death syndrome, accidents and injuries, and maternal pregnancy complications, according to both the CDC and March of Dimes.

States including Oklahoma, Alabama, Arkansas, Louisiana, Texas and Mississippi also had the worst maternal health outcomes, according to the March of Dimes report.

Among all states, birthing people living in Louisiana are the most vulnerable to “poor maternal health outcomes,” according to the report, with 39 deaths per 100,000 live births.

The report did not go into specific causes for poor maternal health, but cited “clinical risk factors and other social, contextual, and environmental factors.”

Previous research has shown that birthing women, and people of color specifically, often face discrimination or other gaps in care when receiving health care, and that is linked to poorer treatment.

Lack of proper health care and existing health complications — like diabetes, obesity and hypertension — are among the factors that can make pregnant women more likely to have a preterm birth, according to the March of Dimes.

The report found, again, that states in the South — including Alabama, Georgia, South Carolina, Mississippi, Arkansas and Louisiana — had the highest rates of preterm birth.

To improve the state of maternal and infant health care in the U.S., the March of Dimes, in its report, called for several policy changes, including extending Medicaid health care benefits to one year after the birth of a child, the expansion of mandatory paid parental leave, Medicaid coverage of doula care for birthing women and federally funded maternal mortality and fetal and infant mortality review committees in every state.

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