How Did Vermont Get the Best Maternal Health Score in the US?

Vermont emerged as a leader in maternal and infant health in the latest March of Dimes report card, achieving the best scores—and the only A—in the country.¹

The March of Dimes 2024 report card included all 50 states; Washington, DC; and Puerto Rico in the report and gave the country overall a D+ for its 2023 preterm birth rate.² Vermont was the only state to receive an A grade for its low preterm rate, with just 6 other states falling close behind with B ratings.¹ Meanwhile, 20 states landed in the C category and 16 in the D category, while 8 states and Puerto Rico received Fs.

How Did Vermont Jump From a B Rating to an A in 1 Year?

The state reported a preterm birth rate of 7.7% in 2023, which improved from the prior year when it was 8.8%—the highest it was since 2013—and is notably lower than the national average of 10.4%. Breaking it down by county, Chittenden, Franklin, Rutland, Windham, and Windsor all saw improvements, while the rate in Washington county worsened compared with last year’s report. Additionally, half these counties got Bs, with Rutland county having the highest rate of 9.1%.

There are a few factors that play into Vermont’s low preterm birth rate. First, the percentage of women having low-risk cesarean births in Vermont was 23.7%, comparable to the country-wide rate of 26.6%. Additionally, only 6.2% of birthing people were receiving inadequate prenatal care, much lower than the 15.7% rate across the US. These factors underline the importance of improving nationwide access to comprehensive maternal care.

Vermont had the lowest preterm birth rate in the US in 2023 | Image credit: rabbit75_fot – stock.adobe.com

Vermont is also one of the few top-performing states in terms of women’s overall health.³ According to the 2024 State Scorecard on Women’s Health and Reproductive Care, Vermont has the lowest all-cause mortality rate among women of reproductive age (15 to 44 years) and the lowest maternal mortality.

According to The Commonwealth Fund, this is largely due to the state increasing its number of maternity care providers and reducing the number of women lacking prenatal care, postpartum checkups, and insurance.³ Expanding Medicaid to include more individuals with lower household incomes is linked to reduced maternal mortality rates, improved infant health outcomes, and increased access to reproductive health services, and Vermont is among the states that have adopted Medicaid expansion.

However, the maternal mortality rate nearly doubled between 2018 and 2022, increasing the most for Black and American Indian and Alaska Native women, though the role of the COVID-19 pandemic during this timeframe should be examined closer as there was a clear spike in 2021 that has since dropped.¹

Despite progress in reducing preterm births, Vermont has also seen a slight increase in infant mortality over the past decade, with 26 babies dying before their first birthday in 2022. Interestingly, the infant mortality rate among Black babies was 20% lower than the state average, highlighting nuanced trends in outcomes.

Racial Gaps in Preterm Birth Rates

Disparities remain as the preterm birth rate varied by race and ethnicity. The preterm birth rate among babies born to Hispanic birthing people was 1.3 times higher than among all other groups in 2023, similar to the gap between Black birthing people and other groups across the country as a whole.

According to the report, Hispanic people in Vermont have a 52% higher preterm birth rate relative to Asian people, with rates of 10% and 6.6%, respectively. Meanwhile, Black and White parents have rates of 8% and 8.1%, respectively. Hispanic and Latino individuals make up less than 3% of Vermont’s predominantly non-Hispanic White population.⁴ However, the Hispanic population has grown the most of any racial group in Vermont over the past decade, growing from 9291 in 2010, to 14,857 in 2022.⁵ As the state’s population slowly grows more diverse, it’s important that health care policies in the state focus on protecting those at higher risk of having a preterm birth.

Chronic Health Conditions Increase Risk

The report card also highlights the compounding risks faced by certain demographic groups when preexisting chronic health conditions intersect with systemic inequities. In Vermont, the influence of chronic conditions such as smoking, hypertension, unhealthy weight, and diabetes becomes more concerning.¹

State-level data showed that preterm birth rates rise to 13.8% for those with smoking-related conditions, 17.3% with hypertension, 8.3% with unhealthy weight, and 22.6% with diabetes. With 13% of the state’s population smoking, 32% having hypertension, 35% having overweight, 27% having obesity, and 8% having diabetes in 2022, it’s important to focus on preventive strategies to mitigate the risk of these conditions and, in turn, preterm birth.⁶

The report card credited mental health, substance use, and general health care as the primary factors that make Vermont patients more vulnerable to poor maternal outcomes.¹ In 2019, Vermont was one of few states to have a lower maternal mortality ratio for all racial and ethnic groups, “suggesting that either underlying risk factors that drive maternal deaths are lower in these states or that prevention efforts have had some success in these locations,” according to researchers.⁷

Ways Vermont Could Still Improve

Despite having the lowest preterm birth rate in the country, there are a few policies Vermont does not have in place that could improve outcomes.¹ March of Dimes reported the state has only adopted 1 of 4 midwife policies that “support the growth and sustainability of the midwifery workforce.”

As previously mentioned, Vermont expanded Medicaid to allow birthing people more access to preventive care during pregnancy, in addition to extending coverage for women to 1 year postpartum. However, the state Medicaid program does not require nor reimburse for postpartum mental health screening, nor does it reimburse doula care. Vermont also does not require employers to provide a paid parental leave option according to the report card, and does not have a CDC-funded maternal mortality review committee that reviews fetal and infant deaths.

These state-level findings show how effective policies and investments can improve outcomes for birthing people and their infants. While the state sets an example with its low preterm birth rate and strong overall health rankings, addressing gaps in midwifery support, postpartum mental health care, and parental leave could further enhance Vermont’s standing as a national leader in maternal health.

References

1. 2024 March of Dimes report card for United States. March of Dimes. November 2024. Accessed November 25, 2024. https://www.marchofdimes.org/peristats/reports/united-states/report-card
2. Klein HE. US earns another low grade on maternal health. AJMC^®. November 25, 2024. Accessed November 25, 2024. https://www.ajmc.com/view/us-earns-another-low-grade-on-maternal-health
3. Collins SR, Radley DC, Roy S, Zephyrin LC, Shah A. 2024 state scorecard on women’s health and reproductive care. The Commonwealth Fund. July 18, 2024. Accessed November 25, 2024. https://www.commonwealthfund.org/publications/scorecard/2024/jul/2024-state-scorecard-womens-health-and-reproductive-care
4. QuickFacts – Vermont. US Census Bureau. Updated July 1, 2023. Accessed November 25, 2024. https://www.census.gov/quickfacts/VT#qf-headnote-b
5. Our changing population: Vermont.USA Facts. Updated July 2022. Accessed November 25, 2024. https://usafacts.org/data/topics/people-society/population-and-demographics/our-changing-population/state/vermont/
6. Behavioral risk factor surveillance system. Vermont Department of Health. January 2024. Accessed November 25, 2024. https://www.healthvermont.gov/stats/population-health-surveys-data/behavioral-risk-factor-surveillance-system-brfss
7. Fleszar LG, Bryant AS, Johnson CO, et al. Trends in state-level maternal mortality by racial and ethnic group in the United States. JAMA. 2023;330(1):52-61. doi:10.1001/jama.2023.9043