Seven years ago, at 30 weeks into a seemingly low-risk pregnancy, I unexpectedly began to bleed. Doctors diagnosed me with . Then, while on bed rest at 32 weeks, my , leading to an immediate emergency cesarean section.
I became one of about to , which means before 37 weeks of pregnancy.
Now, as a maternal and child health researcher in the U.S., I’m struck by the stubbornly high preterm birth rate here. According to the most recent March of Dimes Report Card on maternal and infant health, released on Nov. 17, 2025, 10.4% of babies in the U.S. .
Preterm birth is the , contributing to over each year. Some who survive are at increased , with substantial emotional and financial tolls.
That rate has not budged for three years, according to the report – and it is consistently higher than in many other countries, particularly . That’s also true for other crucial aspects of maternal and infant health, such as .
One key factor underlying the problem of preterm birth in the U.S. is extensive disparities in health care access for expectant mothers. In Texas, where I conduct my research and where I managed the state’s in 2023 and 2024, this .
Revealing disparities that drive preterm birth rates
The March of Dimes report scored the U.S. overall a D+ grade on preterm birth rate at 10.4%, but states differ dramatically in their scores. New Hampshire, for example, scored an A- with 7.9% of infants born prematurely, while Mississippi, where , scored an F.
Texas’ rates aren’t the worst in the country, but it scores notably worse than the national rate of 10.4%, with 11.1% of babies – 43,344 in total – born prematurely in 2024. And Texas has an especially large effect on the low national score because 10 of the 46 cities that receive a D or F grade – defined in the report as a rate higher than the national rate of 10.4% – are located there. In 2023, Texas had the .
That may be in part because access to maternal care in Texas is so limited. Close to half of all counties across the state completely lack , compared with one-third of counties across the U.S. Moreover, more counties in Texas are designated as , meaning they lack enough doctors for the number of people living in these areas. Shortages exist in 257 areas in Texas , 149 for dentists and 251 for mental health providers.
But even against the backdrop of geographic differences in health care access, the starkest contribution to the state’s preterm birth rates comes from ethnic and racial disparities. Mothers of non-Hispanic Black (14.7%), American Indian/Alaskan Native (12.5%), Pacific Islander (12.3%) and Hispanic (10.1%) descent have babies prematurely much more often than do mothers who are non-Hispanic white (9.5%) or Asian (9.1%).
These numbers reflect the broader landscape of maternal health in the U.S. Although nationwide maternal mortality rates decreased from 22.3 to 18.6 deaths per 100,000 live births from 2022 to 2023, Black women at almost three times the rate (50.3%) of white (14.5%), Hispanic (12.4%) and Asian (10.7%) women.
Preterm birth in context
Having a baby early is not the normal or expected outcome during pregnancy. It occurs due to , which are . According to the World Health Organization, women should have during their pregnancy. Without adequate and quality prenatal care, the chances of reversing the preterm birth trends are slim.
Yet in Texas, unequal access to prenatal care remains a huge cause for concern. As the March of Dimes report documents, women of color in Texas receive than do white women – a fact that holds true in several other states as well. In addition, Texas has the , with 17% of women uninsured for health coverage, compared with a national average of 8%.
Nationwide, public health experts, community advocates and families are calling for comprehensive health insurance to help cover the costs of prenatal care, particularly for low-income families that primarily for childbirth. Cuts to funding for the Affordable Care Act and Medicaid outlined in the make it likely that more or see their health care costs balloon.
But state-level action may help reduce access barriers. In Texas, for example, a set of improve access to care before, during and after pregnancy. Texas legislators funded initiatives targeted at workforce development in rural areas – particularly for obstetrician-gynecologists, emergency physicians and nurses, women’s preventive safety net programs, and maternal safety and quality improvement initiatives.
, such as hypertension, obesity and diabetes, also contribute to . While working with the state maternal mortality and morbidity review committee, my team and I found that cardiovascular conditions contributed to the .
An upward trend in before pregnancy are pressing issues in the state, posing a serious threat to fetal and maternal health.
Learning from other countries
These statistics are grim.
But proven strategies to reduce these and other causes of maternal mortality and morbidity are available. In Australia, for instance, from 12.7 per 100,000 live births in the early 1970s to . The reduction can be linked to that are based on equitable, safe, woman-centered and .
In Texas, some of my colleagues at Texas A&M University use an to develop centered on educational health promotion, .
Utilizing nurses and nonmedical support roles such as community health workers and , my colleagues’ and close critical gaps in .
Across the country, researchers are , including , to address the Black maternal health crisis.
Research shows the use of doulas can , particularly for women of color.
It’s all hands on deck
There isn’t one, single risk factor that leads to a preterm birth, nor is there a universal approach to its prevention.
Results from my aligns with what other experts are saying: Addressing the requires . It involves the dismantling of that lead to high rates of preterm births and negative pregnancy and childbirth outcomes, , through funding, research, policy changes and community voices.
Although I had my preterm birth in Nigeria, my story and I have worked with in the U.S. show eerily similar underlying challenges across different settings.
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