Full-Term Crisis

No caption David Lidbetter/Gallery Stock

It could be an old-style good-news/bad-news joke if not for one detail: There's nothing funny about it. According to a "report card" just issued by the March of Dimes, the rate of premature births in the United States has fallen for the past six years straight. Even after such a dramatic improvement, however, the number remains shockingly high. As the group's president, Dr. Jennifer L. Howse, pointed out in announcing the report, "The U.S. still has the highest rate of preterm birth of any industrialized country."

In fact, America ranks among the world's worst in sheer numbers of premature births, alongside countries like Bangladesh and the Democratic Republic of Congo. Every year in the United States, more than 450,000 babies are born before completing the 37th full week of gestation. That is, nearly one out of nine U.S. births is premature. Overall, the March of Dimes gives the country a C, hardly a grade to brag about.

But shame is the least of America's worries. Doctors say premature infants tend to be more susceptible to any number of health complications associated with low birth weight and, in some cases, underdeveloped organs. Their ailments can include breathing difficulties, low blood pressure, brain bleeding or infections resulting from underdeveloped immune systems. Worldwide, premature birth runs second only to pneumonia as a cause of death among children under the age of 5, according to the World Health Organization. In the longer term, children born prematurely are at higher risk for a whole range of medical problems, including cerebral palsy, vision, and dental problems, behavioral problems and other chronic health issues.

And those medical complications reach far beyond the afflicted newborns and their immediate families. According to Howse, premature births drive up everyone's insurance rates and cost American employers about 10 times more than healthy, full-term deliveries. (To illustrate the report card, the March of Dimes issued a state-by-state map reflecting how the problem thrives in the poorest parts of the country. Alabama, Louisiana, and Mississippi get an F, and so does Puerto Rico.)

Why is the U.S. rate so much worse than those of other industrialized nations? Many public-health specialists blame the country's lack of universal health-care coverage. Regular doctor visits before and during pregnancy can help to identify and manage medical conditions that could raise the risk of preterm birth in mothers-to-be. But the cost of those doctor visits gives most uninsured women little choice but to take their chances.

This means that if more American women of childbearing age begin receiving proper medical coverage, the number of premature births is likely to drop further, and one major goal of the Affordable Care Act is to provide health insurance to women who were previously unable to afford it. In fact, some insurers were setting premiums higher for female policyholders than for men on the grounds that the ability to get pregnant could be viewed as a "pre-existing condition." Under the new law, that kind of sex discrimination will be illegal.

The report card also criticizes the American health-care system's massive social imbalances. "The March of Dimes is concerned about the inequities in health and health care that contribute to higher rates of preterm birth among different racial and ethnic groups," the group warns, and it calls for state and federal governments to invest in remedying those problems - a proposal that sounds all but hopeless in these budget-cutting times.

Nevertheless, the group has declared its ambition to cut America's rate of premature births to 9.6 percent or less by 2020. This year only six states made the grade: Alaska, California, Oregon, Maine, New Hampshire, and Vermont. According to Howse, however, the goal can be achieved. "We must continue to invest in premature birth prevention," she said. "Every baby deserves a healthy start in life."