The rate of preterm births in the United States dropped to a 15-year low of 11.5 percent in 2012, according to a report released on Friday, but the country still came in dead last among industrialized nations on this measure of infant health.
The rate reflects six straight years of declines, possibly due to factors such as a drop in smoking among women of childbearing age, said the March of Dimes, the nonprofit group that produced the report.
The improvement comes during an acrimonious, partisan debate in Congress about health insurance centered on President Barack Obama's healthcare reform law.
The Affordable Care Act requires all insurance plans to cover maternity care, spreading the cost of healthy pregnancies across society.
That provision led to a testy exchange on Wednesday when Kathleen Sebelius, secretary of the Department of Health and Human Services, testified before a congressional panel and defended the provision. Republican Representative Renee Ellmers retorted that the maternity requirement "is why healthcare premiums are increasing, because we are forcing (people) to buy things that they will never need."
The requirement increases premiums for a typical policy about 3 percent, calculated James O'Connor of Milliman, an actuarial firm, in an April report for the health insurance industry.
"We are the only high-income country in the world not to have everyone covered for maternity care," said Dr Edward McCabe, medical director of the March of Dimes.
Before the ACA, "only 16 percent of plans in the individual market covered women for maternity care," McCabe said. "Requiring that coverage is a statement about our values as a society."
$26 BILLION COST
The rate of preterm births peaked in 2006 at 12.8 percent, as women gave birth at older ages and were more likely to carry twins, triplets and higher multiples.
The reasons for the declines are unclear, but several factors likely played a role. The percentage of women of childbearing age who smoke, a risk factor for early labor, fell from 22.5 percent in 2011 to 20.8 percent last year, said McCabe.
The percentage of women in that age group who are uninsured also dipped, from 21.9 percent to 21.3 percent, government data show.
The decrease in preterm births should make a dent in healthcare spending: preemies cost the United States more than $26 billion annually, according to the Institute of Medicine, or $51,600 per preterm baby in 2005.
In the first year of life, medical costs for a baby born before 37 weeks gestation are 12 times those of one born at 40 weeks, a full-term pregnancy.
Those costs continue for years. Preemies can suffer developmental delays, vision loss and cerebral palsy, leading to higher educational costs and lost wages, said McCabe.
The drop in preterm births in the United States since 2006 means that about 176,000 fewer babies were born too soon, calculates the March of Dimes, for an estimated $9 billion savings in health and societal costs.
VERMONT FIRST, MISSISSIPPI LAST
The variation in rates of preterm births among U.S. states is almost as great as that among countries.
Vermont led the nation with just 8.7 percent of births coming before 37 weeks gestation. Alaska, California, Maine, New Hampshire and Oregon had rates of 9.6 percent or lower, the target recommended by the March of Dimes.
At least 80 countries have rates of preterm births below 9.6 percent, according to a U.N. report, "Born Too Soon," released last year. They include China, Romania, Cuba and Latvia. And every developed country has a rate of preterm births lower than that of the United States, the U.N. report showed.
"I think it's wonderful what the March of Dimes is doing with this report," said Dr Wanda Barfield, director of reproductive health at the U.S. Centers for Disease Control and Prevention. "It's taking us to school in terms of how the U.S. is doing on preterm births: we rank 130th out of 184 countries."
The states with the highest rates of preterm birth are Mississippi (17.1 percent), Louisiana (15.3 percent) and Alabama (14.6 percent). If they were countries, they would be among the 14 worst of the 184 for which data are available, according to the U.N. report. The global average is 11.1 percent.
Rates also varied by race. Among non-Hispanic blacks, 16.5 percent of births were preterm last year, down from 18.5 percent in 2006 and the lowest in more than 20 years. Among whites, the rate was 10.5 percent.
The high U.S. rate for preterm births is often blamed on the nation's racial, ethnic and economic diversity, said McCabe, "but the California example refutes that."
California, with half a million births each year, "has an incredibly diverse population, but it set up policies and procedures to make reducing preterm births a priority," he said.
The full report is available at marchofdimes.com/reportcard