San Antonio receives "F" grade for preterm births, healthcare access, report shows

New March of Dimes report shines light on current maternal, infant health crisis

SAN ANTONIO – The March of Dimes 2019 report said the U.S. is facing an urgent maternal and infant health crisis that it is intertwined.

March of Dimes is a nonprofit that works to improve the lives of mothers and babies, specifically focused on premature births. 

The organization's report grades cities and states based on premature birth, but also things like health insurance, available healthcare for mothers, smoking, environmental factors, etc. 

The state of Texas received a "D" grade, while San Antonio received an "F." 

"It's sobering," said San Antonio mother and March of Dimes ambassador Katie McCleary.

McCleary had her son, Tyler, at 25-and-a-half weeks, and he weighed one pound, 13 ounces.

"When you give birth, he goes right through the window through the NICU. Not being able to hold your baby for the first time and not knowing what's going on on the other side of that window, it's scary," McCleary said through tears. 

Tyler is about to turn 10 and has had over a dozen surgeries. Katie is amazed at how far he has come, but is stunned by the new March of Dimes report, showing situations like hers are still on the rise a decade later.  

"For many women, it's that they have no money or insurance they can't get into healthcare. A lot of times we see them without that healthcare that could have kept them from having a premature sick baby," said Dr. Alice Gong, a neonatologist who works with UT Health San Antonio and University Hospital.

Dr. Gong said many women here in San Antonio already have underlying health issues when they get pregnant. 

"How is she going to get help with her blood pressure? Or with her diabetes? How is she going to get help with postpartum depression which is much higher if you’ve given birth to a preemie?" she said.

Postpartum care must be mandatory, up to a year for both baby and mother, McCleary said.

"I think that would be incredible for moms because it is a very hard situation to go through," McCleary said. "There is a lot of guilt involved. 'What could I have done better? I can't help my baby.'"

Both women said this must be a community-wide effort in order for things to change. 

"The community has to say, 'It is not right for women to not have healthcare when they're pregnant,'" Dr. Gong said. 


A specific state and local breakdown of the March of Dimes report shows:

  • Texas Statistics:

    • Texas earned a grade of D in 2019 for its preterm birth rate, which is a key indicator of maternal and infant health.

    • Texas’ preterm birth rate of 10.8 percent, increased .02 percent compared to last year.

    • Austin’s rate actually improved slightly since last year, earning the city a B-.

  • U.S. Statistics:

    • The U.S. is among the most dangerous developed nations in which to give birth.

    • Each year in the U.S., 22,000 babies die. That is two babies an hour. Preterm birth rates increased for the fourth year in a row, earning the U.S. a “C” grade. One in 10 babies are born preterm, which can lead to life-long health problems.

    • The rates of maternal death and severe pregnancy complications also are unacceptably high. Approximately every 12 hours a woman dies as a result of complications from pregnancy and over 50,000 suffer life-threatening health challenges. While 700 women die from causes related to pregnancy each year in the U.S., more than 60 percent of these deaths are preventable.


In Texas, March of Dimes recommends the following policies and actions:

  • Expanding Medicaid to cover individuals with incomes up to 138 percent of the federal poverty level to improve maternal and infant health .

    • A growing number of studies indicate that Medicaid expansion has reduced the rate of women of childbearing age who are uninsured, improved health outcomes and helped to reduce disparities, including lower rates of premature birth and low birthweight for Black infants in expansion states.

  • Extending Medicaid coverage at least one year postpartum.

    • In Texas, full Medicaid coverage ends 60 days after giving birth, ending access to care at a time when risks of maternal complications and death persist.

  • Allow Children’s Medicaid coverage to cover a child for a full year. Alternatively, reduce red tape that is causing kids to be erroneously denied Medicaid coverage throughout the year.

  • Addressing chronic inequities and unequal access to quality health care , which contribute to higher rates of maternal and infant health complications, particularly for communities of color.

    • A recent CDC Report describes the factors that may be contributing to higher rates of pregnancy-related death in the U.S., particularly for Black and American Indian/Alaska Native women. It points to the importance of quality of care, including the need to identify and address implicit bias and structural racism in health care and in communities.

    • Inequitable conditions, such as unequal access to housing, transportation, health care and neighborhood safety, also affect a person’s ability to achieve good health starting at birth. Chronic and severe adversity, including the experience of racism, floods the body with dangerous levels of stress hormones, a condition known as toxic stress.

  • Implementing implicit bias training and eliminating structural racism in health care and community settings .

    • March of Dimes is leading the way with a new, compelling implicit bias training for maternal care providers and health systems that became available in October 2019.

    • We’re collaborating with Quality Interactions, a firm that provides cultural competency and implicit bias training for health care providers.

    • Together our unique learning opportunity will stimulate providers to address bias and improve the health of moms of color.

  • Increasing programs that work, like group prenatal care. Studies demonstrate that group prenatal care reduces premature birth among Black women by 41 percent, and among women of all races/ethnicities by 33 percent, in addition to other health benefits for both moms and babies.

    • March of Dimes is expanding its flexible group prenatal care program, called Supportive Pregnancy Care, so that more families can get the best possible start.

    • Evidence shows that group prenatal care fosters several positive outcomes, including an increase in breastfeeding and a decrease in preterm birth, particularly among Black women when compared to traditional prenatal care. ( AAP, ACOG, American Journal of Obstetrics & Gynecology, 2012)


  • Currently, March of Dimes works on multiple fronts to improve the health of moms and babies in Texas that can be found on the website .

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