1067: A Nation at Risk: What a D+ in Birth Outcomes Means for Public Health

JOHN SHEEHAN: 

This is Public Health Review Morning Edition for Wednesday, February 11, 2026. I'm John Sheehan, with news for the Association of State and Territorial Health Officials.

Today, we hear about the latest March of Dimes Report Card on birth outcomes. And the headline is hard to ignore. The nation earns a D+ for preterm birth. Dr. Michael Warren, chief medical and health officer at March of Dimes, joins us to explain the report: what's driving poor outcomes and what public health leaders can actually do about it.

MICHAEL WARREN: 

The United States is not faring very well when it comes to maternal and infant health outcomes. Every year, March of Dimes releases our Report Card. States are very accustomed to getting a grade on preterm birth, and we continued to have this grade of D+ for the nation when it comes to preterm birth. When you look at how the states fared, certainly there were some states that did better than others, but what we saw is that half of all states got a D or an F. And I don't know about your listeners, but if I had brought home that report card, we would have had a corrective action plan, we would have had some work to do. And so, I think it really is an important reminder of just how much work we've got left to do when it comes to improving birth outcomes in this country.

SHEEHAN: 

Yeah, and for the fourth straight year, that is dire. What should public health leaders focus on first? What is, how do you, how do you eat this elephant?

WARREN: 

Well, I think one thing that I always emphasize when I'm talking to state health officials is they all know these numbers take time to move, particularly when we're talking about things like preterm birth, one of the leading drivers that we saw in this year's report card were high rates of chronic conditions like high blood pressure and diabetes and unhealthy weight, and it takes a while to change those things. And so, the first takeaway is to recognize that we're not going to fix this in one year, but that you do hope to see some progress in some of those areas that lead up to these outcomes. And one of the places to look for that is where you may be able to make some progress on the policy front. And so, looking at where there may be gaps between what your state is doing and where there may be policy options to be able to improve birth outcomes.

SHEEHAN: 

And do you think it's important to make that distinction, to make that, sort of, that narrative link between chronic disease and higher infant mortality?

WARREN: 

So, we absolutely know there's a link. And so, for example, in women who have these chronic conditions, whether it's high blood pressure, or diabetes, or unhealthy weight, their rates of preterm birth are higher. The rates of infant mortality are largely driven in this country by preterm birth. We also know this is not just about the baby when we think about maternal health outcomes, moms who go into pregnancy with diabetes or high blood pressure, unhealthy weight, are more likely to have worse outcomes for themselves, and so we know these are important indicators, and these are not new challenges for state and territorial health officials. These are perennial challenges. And I would point out that some of our colleagues are doing better than others. And so we did see, for example, that 19 states improved their grades when it comes to the report card and improved their preterm birth rates, including in some states where there are baseline high rates of chronic disease, where folks have really doubled down and said, 'What can we do to make improvements so change is possible?'

SHEEHAN: 

Yeah, that's very heartening, that it's not an intractable problem, that things can be done, right?

WARREN: 

And we talk a lot about chronic disease, but that's one piece of the puzzle. The other thing that really jumped out here relates to access to care. And so, a couple of statistics that jumped out: one was when we look at women who started prenatal care early, those percentages got worse, so now only about three-quarters of women got prenatal care that started in the first trimester. So, the goal is that women start prenatal care early. That number has continued to dip down and right now we're at about 75% of women across the country getting prenatal care early. The other statistic that's in the report card looks at the adequacy of prenatal care. So, not only when did prenatal care start, but did women get the recommended number of visits? And what we saw is that the percentage of women who are getting inadequate prenatal care is also getting worse. That number is creeping up. And so, that and these are inextricably linked, right? So, when you think about a high proportion of women who have chronic diseases, like we talked about either starting prenatal care late or not getting all the prenatal care they need, then you've got women who are coming into pregnancy with a higher risk of bad outcomes for themselves and their baby, and less of a runway to be able to identify those conditions early on, properly manage those so that we get the best outcome for mom and baby. So, this access issue is one that we've really got to think about how we tackle as well. Absolutely.

SHEEHAN: 

And on the policy front, could you prioritize other policy initiatives that have, that lead to better outcomes?

WARREN: 

Well, one of the things that we know is vital is insurance coverage. And so right now, lots of folks are talking about Medicaid. Medicaid particularly important here, because Medicaid covers four in 10 births in the United States. And so, if we think about improving birth outcomes, we can't have a serious conversation about that without thinking about how we address insurance access, particularly through Medicaid. Many states have extended Medicaid coverage to 12 months postpartum. That is a really good thing. Let's take maternal health for starters. We know from the good work that states are doing through maternal mortality review committees that many pregnancy-related deaths actually happen in that postpartum period. And so, extending that coverage is really important to be able to take good care of mom that we always talk about with infant mortality. The goal is to get the baby to their first birthday. We also want mom to be there to celebrate with them. And so that coverage over that first year is so important, a smaller number of states have actually done Medicaid expansion, so extending Medicaid to non-pregnant adults, for example. And that becomes particularly important when we think about the burden of chronic disease in the population. The best prenatal care can't erase years or even decades of chronic disease that has gone unmanaged. And so the goal would be to make sure that people have insurance throughout their life course, particularly throughout their adulthood, so that should they choose to become pregnant. Once they become pregnant, they're in an optimal state of health, or at least chronic diseases have been identified and managed, so that we're lowering the risk for those bad outcomes. And that's where that Medicaid expansion piece becomes really key. There are other policy indicators that we report on in the report card, for example, maternal mental health screening. We know that maternal mental health conditions are a leading cause of pregnancy related deaths, and so we want to think about how we make sure that women are screened, particularly in that postpartum period, and connected to care. What we saw in the report card is that 11 states have actually adopted policy through their state Medicaid programs that require postpartum screening and will pay for it in the context of a well child visit. So mom may not go to her own follow up visit, but she's often going to bring baby in for baby's visit. And so if we can screen mom in the pediatrician or family physician's office while baby is there, we really take advantage of an important window. And 11 states have implemented that important policy to make that even easier to do.

SHEEHAN: 

How do you think about how states should use the report card? I mean, it's, I think, designed to be sort of a red flag, right? It's a stark indicator of like, 'Hey, pay attention to this.' How should public health officials be using the report when they make their cases to, you know, state officials?

WARREN: 

You know John, prior to coming to March of Dimes, I was in federal service, and prior to that, I spent about a decade in state public health down in Tennessee. The last couple of years, I was the deputy state health commissioner, and I have joked since getting here to March of Dimes that I used to have a love/hate relationship with the March of Dimes Report Card, because it would come out every year. And I was in Tennessee, we didn't get the best grade, and so we got a lot of heat for that, from our governor's office, from our legislators, from constituents across the state, and yet we used that as an opportunity to tell the story about the good work we were doing and to help underscore the urgency of the work that we were doing. And so, I absolutely understand that our state public health colleagues across the country can be frustrated by these reports, and I hope, at the same time, they will channel that frustration into a positive energy to think about working with their stakeholders to see what can be done about this. I think, particularly, my background is in maternal and child health, this is a fantastic opportunity for state health officials to be able to lift up the great work that's happening in your Title V MCH Block Grant programs. The timing of that is really good. All the states have just done their five-year needs assessment. They've got a brand new five-year action plan. This is a real opportunity to say we may have these problems, but here's what we're doing about it, and here's how you can join the public health enterprise in moving this work forward. I also think, you know, there's that saying, 'Never waste a perfectly good crisis.' And so, if you're a D or an F state, and there is this burning platform you've got around a particular policy item or a programmatic agenda that you're trying to push, maybe you're trying to get funding in your governor's budget proposal, or get your general assembly to push forward a piece of legislation. This may be another tool in your toolkit as you're helping to move that forward.

SHEEHAN: 

Yeah, if you're hearing alarm bells and the report inspires strong feelings, well, good.

WARREN: 

That's right. That's right. Don't, don't let this go to waste.

SHEEHAN: 

Michael, are there any next steps for anyone who wants to either see the Report Card or for officials who want to learn more?

WARREN: 

Well, first, I want to thank all the state and territorial health officials for the work they did during the launch of the Report Card. We were able to get embargoed copies out to the officials, so they had a copy in advance, so they could be prepared for media inquiries, and inquiries from governor's offices, or legislatures, or those sorts of things. Now the work comes of actually putting the Report Card to use. So again, I would say this is an opportunity. Lean in with your maternal and child health teams. Think about where there are opportunities to lift up the work they're doing. Think about the opportunities to work across your department. So often the funding that comes from the federal level is categorical, and so you've got a silo for maternal and child health here, and a silo for chronic disease over here, but this Report Card points out so clearly these are linked. And so, this is a great opportunity internally to bring your folks together, and also to think about reaching out to your Medicaid partners. We know in some states Medicaid is in the same 'superagency' as the public health agency, sometimes not. Regardless of how you're organized, this is an important opportunity to be able to reach out to those partners and say, we've got to lock arms and do this work together. And so, would encourage folks to do that. If for some reason, folks don't have the Report Card, they can find it at marchofdimes.org/report card. They can find not only the national level Report Card, but also their state-specific Report Cards there.

SHEEHAN: 

Dr. Michael Warren, chief medical and health officer at March of Dimes.

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This has been Public Health Review Morning Edition. I'm John Sheehan for the Association of State and Territorial Health Officials.