he preterm birth rate in the U.S. has increased for the second consecutive year, according to a new report, and minorities are suffering a disproportionate share of those births. The increases, which follow nearly a decade of declines, raise concerns that gains made in women’s health care are now slipping, experts say.
The annual report on preterm births by the March of Dimes, released Wednesday, found that 9.8 percent of U.S. infants were born preterm in 2016, up from 9.6 percent in 2015. And rates found in some parts of the U.S. are on par with those found in undeveloped countries in Africa and the Middle East.
Preterm birth is the largest contributor to infant death in the United States and is linked to a range of lifelong disabilities and chronic conditions.
The report shows that preterm birth rates grew in 43 states, plus Puerto Rico and Washington, D.C., and among all racial groups.
But not all racial groups saw the same impacts. In 2016, black women were 49 percent more likely to deliver preterm than white women; American Indian and Native Alaskan women were 18 percent more likely than whites to give birth prematurely.
“In many communities of color, there are inequities with respect to health care, housing, jobs, food security — lots of things that put enormous stress on families and especially on pregnant moms,” said Stacey Stewart, president of the March of Dimes.
“One of the things we have to be very clear on is that race itself is not a cause of preterm birth,” she said. “What we see, though, is that different racial and ethnic groups face different challenges that could impact their ability to have healthy babies.”
Earlier this year, the March of Dimes convened a partnership of hundreds of organizations to examine how environmental, economic, and social factors are impacting the rate of premature birth in particular communities.
The organization’s report, known as the Premature Birth Report Card, is compiled using data from the National Center for Health Statistics. It gives the United States a “C” overall for its performance in 2016. Some cities and states, however, are doing worse than others. The report found the highest rates of preterm birth in the Deep South, Appalachia, and the Rust Belt states of the Midwest.
Of 100 cities examined in its report, Cleveland had the highest preterm birth rate, at 14.9 percent; the lowest was in Irvine, Calif., which had a rate of 5.8 percent.
Preterm birth rates by state in 2016, %
Although the precise reasons for these disparities are unknown, researchers are examining a wide array of factors suspected to contribute to the problem, including unequal access to health care, jobs, and education, as well as inequities in housing and a greater prevalence of violence, discrimination, and negative encounters with police in minority communities.
Rachel Hardeman, a professor at the University of Minnesota who has studied preterm birth rates in the U.S., and who was not involved in the new report, said the health of minority women and their babies is undermined by structural racism — in the past and present — that bleeds into many aspects of their lives.
“If you look at the history of redlining in the U.S,” she said, “it’s not by accident that there are certain neighborhoods with higher concentrations of poverty and that those neighborhoods have higher concentrations of people of color. Those are the folks that are suffering from these adverse birth outcomes.”
Hardeman pointed to a study showing that infant mortality rates improved following the abolition of Jim Crow laws. “That suggests there’s something bigger going on than the personal lifestyle, behavior piece we so often rely on,” she said.
The breadth and magnitude of those inequities also make them harder to reverse. No state has demonstrated success in reducing disparities in preterm births over the last several years, according to the March of Dimes.
The organization is now examining how environmental factors are modifying gene expression among women and how those modifications are impacting birth outcomes, among other lines of inquiry. It is unclear when that work will be completed. It is being pursued at five research centers the March of Dimes has established across the country. Stewart said the hope is to devise new ways to attack a problem that has proved resistant to traditional methods.
“We spend a lot of money in this country on health care, and we don’t see outcomes commensurate with what we invest,” Stewart said. “That just seems to be unacceptable for a lot of folks.”