The South leads the nation in babies born too early, according to a new report from the March of Dimes, a national organization that funds research and advocates for healthy mothers and babies. 

The only states to earn F ratings for their high rates of preterm birth were Alabama, Georgia, Mississippi, Louisiana, Arkansas, Oklahoma, South Carolina and West Virginia. A baby is considered preterm if born before 37 weeks’ gestation; 40 weeks is considered full term.  

This trend is alarming, as the health of moms and babies is considered one of the best proxy measures for the health of a population,” said Britta Cedergren, associate director for postpartum care with the Alabama March of Dimes, in a statement. 

We have long recognized that social and economic factors, including healthcare coverage, the ability to take time off of work to attend prenatal and postpartum appointments, and access to healthy food, and accessible transportation, all play a huge role in creating healthy environments for moms and their families to thrive,” she said. 

Preterm birth is a leading cause of infant death and drastically increases a baby’s chances of developing health problems and disabilities. It’s also costly: The report estimates the additional cost of a preterm birth, over the child’s lifetime, is about $65,000. 

In Alabamaone in eight babies are born too early, a rate that has changed little over the past 10 years, according to the report. The numbers reflect 2018 data, the most recent year for which data were available. 

Mississippi has the highest preterm birth rate in the nation, at 14.6% of live births, followed by Louisiana at 13.1. The rest of the Southern states that didn’t score an F received a D rating. 

A few report highlights: 

1. Fewer babies are dying.

Across the country, the infant mortality rate is slowly declining, including in Alabama. 

Alabama’s rate of infant death, 6.9 babies per 1,000 live birthswas at an all-time low in 2018. Even so, 401 Alabama babies died before their first birthday that year. 

Mississippi led the nation with the highest infant mortality rate, at 8.4 deaths per 1,000 live births. The nation’s highest infant mortality rates are concentrated in Southern states. 

2. The nation’s declining infant mortality rate masks significant racial disparities. 

Babies born to women of color have higher death rates than their white counterparts, according to the report. Nationally, Black babies are also 50% more likely than all other babies to be born too early. 

And Black women in Alabama more than twice as likely to die in childbirth as white women. 

Progress in improving maternal and infant health care has been hampered by increasing racial and ethnic health care disparities, said Stacey Stewart, president and CEO of March of Dimes.  

“At a time of racial awakening in our nation, we must amplify our efforts to decrease deaths and health challenges facing our nations moms and babies, and enact new policies that support health equity,” said Stewart in a statement. 

3. Birmingham, Ala. has one of the highest rates of preterm birth in the nation. 

Nearly 1 in 7 babies born to Birmingham mothers are born prematurely, setting them up for potential health complications throughout their lives. 

The report looked at preterm birth rates in the 100 U.S. cities with the greatest number of live births; Birmingham had the third-highest, behind Cleveland and Detroit. Just behind Birmingham were New Orleans, Baton Rouge and Memphis. 

4. Insurance coverage isn’t equal.

In Alabama, Medicaid pays for about half of all births. But Alabama women who are eligible for Medicaid while they’re pregnant lose their coverage six weeks after the birth, meaning they may not have insurance to pay for followup appointments to address physical or mental health issues resulting from the birth. 

This isn’t the case for most women nationally; Alabama is one of 14 states that did not expand Medicaid. In states that expanded Medicaid, full coverage is available to women who meet certain income requirements.  

Alabama women are more likely than women nationally to be uninsured, to have inadequate prenatal care and to live in poverty, according to the report.  

Some states that did not expand Medicaid have sought to improve Medicaid coverage for people who have given birth. In Georgia, the governor signed a law earlier this year that effectively extends Medicaid coverage for six months after birth.  

Last year, Alabama State Rep. Laura Hall, D-Huntsville, sponsored a bill that would have extended Medicaid coverage for women to one year after birth. It died in committee before reaching the House floor.