Premature Birth Rate in the US 2026 – Which States See the Highest Numbers

In the United States, a baby born alive before 37 completed weeks of gestation is considered preterm or premature. Preterm birth is a leading contributor to infant mortality and lifelong disability. The nation’s overall preterm‑birth rate has remained stubbornly high for several years.

According to the 2025 March of Dimes Report Card, which uses final 2024 natality data from the National Center for Health Statistics, 10.4 % of U.S. babies in 2024 were born preterm,a rate unchanged since 2022 and the third‑highest in the industrialised world.

The report assigns letter grades to each state based on its preterm‑birth rate; grades of F correspond to rates ≥ 11.5 %.

National Trends and Grading Methodology

The March of Dimes uses a colour‑coded grading system (A through F) linked to defined preterm‑birth-rate ranges. The grades correspond to the proportion of live births occurring before 37 weeks:

Nationally, more states saw their preterm‑birth rates worsen between 2023 and 2024 than improve; 19 states improved, 21 states worsened and 12 states showed no change. Only 11 states met the Healthy People 2030 goal of ≤ 9.4 % preterm births.

States With the Highest Preterm‑Birth Rates

The table below lists U.S. jurisdictions that received an F grade in the 2025 March of Dimes Report Card and therefore had preterm‑birth rates ≥ 11.5 % in 2024. For each state/territory, the table includes the 2024 preterm‑birth rate, the number of preterm births and the rank among 52 jurisdictions (50 states plus the District of Columbia and Puerto Rico).

Observations

• Mississippi remains the highest at 15%, well above the national average, and continues to struggle with poverty, inadequate prenatal care and high rates of hypertension and diabetes.
• Louisiana (14%) and West Virginia (13.4%) follow closely.
• Several southeastern states, Alabama, Georgia, Kentucky and South Carolina, also exceed 11.5%. This mirrors broader regional disparities in maternal health.
• Puerto Rico (12.2%) shows that territories face similar or worse challenges.

States With the Lowest Preterm‑Birth Rates

Only one jurisdiction earned a grade in the “A” range. New Hampshire received an A‑ because its preterm‑birth rate fell to 7.9% in 2024. The state recorded 932 preterm births and ranked first. Other high‑performing states (not listed in the table) received grades of B or B‑ and had rates between 8.6% and 9.2%.

These include Oregon, Vermont, Massachusetts, Washington and California. Such states generally have greater access to prenatal and maternity care, lower rates of chronic health conditions and broader adoption of evidence‑based maternal‑health initiatives.

Factors Associated with Preterm-Birth

The March of Dimes report card emphasises that premature birth is influenced by complex medical and social factors. National data show that:

• Medical risk factors: In 2024, 3.4% of births involved hypertension, 10.4% included hypertension during pregnancy, 3.0% of mothers smoked during pregnancy, 1.3% had diabetes and 34.8% were of unhealthy pre‑pregnancy weight. Each of these conditions increases the likelihood of preterm birth.
• Insurance and socioeconomic status: Preterm‑birth rates differ by insurance type. Nationally in 2024, the rate among births covered by Medicaid (10.5%) or “other” insurance types (self‑pay 7.9%, Indian Health Service 10.5%) exceeded that among births covered by private insurance (9.6%). These differences highlight socioeconomic inequities.
• Race/ethnicity: Preterm‑birth rates vary by maternal race. In 2024, babies born to Black mothers had a preterm‑birth rate around 10.5% compared with 9.6% for White mothers and 9.8% for Hispanic mothers. Structural racism, chronic stress and differential access to care contribute to these disparities.

Regional patterns show that southern states tend to have higher rates of smoking, hypertension and diabetes during pregnancy than northern states. They also experience higher poverty rates and more limited access to obstetric providers, creating “maternity‑care deserts”.

March of Dimes reports that maternity care deserts disproportionately affect rural and low‑income communities, forcing pregnant women to travel long distances for prenatal visits or give birth in facilities without neonatal intensive care units.

Preterm birth can also intersect with broader medical and legal challenges for families. In some situations, complications during pregnancy or delivery may be linked to delayed interventions, improper monitoring, or other preventable medical mistakes.

When that happens, families sometimes look for guidance on what steps they can take after a traumatic birth. Resources such as childbirthinjuries.com provide information about birth injury cases and explain how specialised attorneys investigate whether medical negligence during labour or delivery contributed to a child’s condition.

These legal resources are often used by parents who are trying to understand their options while managing the long-term care needs that can follow complicated or premature births.

Implications and Recommendations

High premature‑birth rates have significant public‑health and economic consequences. Preterm birth is the leading cause of newborn death, and surviving infants often require prolonged neonatal intensive care.

The 2024 analysis notes that premature birth and its complications cost the U.S. health‑care system billions of dollars annually and contribute to long‑term disability and special‑education needs. The March of Dimes recommends several evidence‑based strategies for reducing preterm births:

1. Improving access to comprehensive prenatal care. States with the lowest rates invest heavily in prenatal services and nurse‑midwifery programs. Medicaid expansion and community health centres help ensure early and regular prenatal care.
2. Addressing chronic health conditions. Screening and managing hypertension, diabetes and unhealthy weight before and during pregnancy can lower the risk of preterm birth.
3. Combating racial and socioeconomic disparities. Policies that expand paid family leave, reduce structural racism, improve transportation to prenatal services and increase support for pregnant people of colour are critical.
4. Expanding maternal‑health initiatives. The report tracks states’ adoption of six supportive initiatives (such as doula coverage, perinatal quality collaboratives and Medicaid extension postpartum). States with more initiatives tend to have better outcomes.
5. Community engagement and education. Programs that educate families about the signs of preterm labour and encourage healthy behaviours (e.g., smoking cessation, nutrition) can help reduce risk.

Methodology

This overview relies on the March of Dimes 2025 Report Card, which uses final 2024 natality data from the National Center for Health Statistics for all states and U.S. territories.

Using that dataset, the report assigns letter grades based on preterm‑birth rates and lists each jurisdiction’s rate, number of preterm births and rank among 52 jurisdictions.

We extracted these metrics from the PDF reports for the nation and for individual states, focusing on those graded F (≥ 11.5%). We also reviewed sections of the national report card that explain the grading scale, risk factors and socioeconomic disparities.

The data quoted in the report reflects the most recent complete annual statistics available as of March 2026.

Conclusion

As of March 2026, the most recent published data on premature births in the United States comes from the final 2024 natality records. The national preterm‑birth rate remains high at 10.4%, and the March of Dimes gave the United States a D+ grade for the fourth consecutive year.

Several states, particularly in the South, continue to experience alarming preterm‑birth rates. Mississippi (15.0%), Louisiana (14.0%) and West Virginia (13.4%) top the list of worst performers. At the other end of the spectrum, New Hampshire achieved the lowest rate at 7.9% and earned the only A‑ grade.