Louisiana ranks as one of the worst states in the nation for maternal and infant health, especially for Black and Native American women, according to the latest report from the March of Dimes.
Experts said the state’s abortion ban, which went into effect immediately after Roe v. Wade was overturned this year by the U.S. Supreme Court, could make pregnancy and birth even more dangerous.
The report found Louisiana again has one of the nation’s highest rates of preterm birth, which is when a baby is born before 37 weeks of pregnancy and therefore has higher rates of complications, death and disability. The state’s rate was at 13.5% compared to the national average of 10.5%, earning the state an “F.” Baton Rouge and New Orleans each earned failing grades for their individual preterm birth rates: 12.3% and 14.4%, respectively.
Louisiana was among nine states and Puerto Rico to earn an “F”, including Alabama, Mississippi and Georgia.
The March of Dimes evaluates states on infant mortality and maternal health data in addition to preterm birth. On every measure collected by the report, Louisiana ranked worse than the national average. The results are similar to reports from previous years.
“I’m not surprised,” said Maeve Wallace, an assistant professor at the Tulane University School of Public Health who studies maternal and infant health. “This is just a hostile place for maternal and child health.”
Dr. Veronica Gillispie-Bell, an OBGYN and the medical director of the Louisiana Department of Health’s program to improve maternal and infant health, the Louisiana Perinatal Quality Collaborative, said she also wasn’t shocked by the report.
Gillispie-Bell said the pandemic has worsened maternal and infant health across the country, part of the findings from the March of Dimes report. It mirrors a spring report from the Centers for Disease Control and Prevention that found maternity-related mortality jumped 20% in 2020.
Wallace and Gillispie-Bell said Louisiana’s near-total abortion ban could make the state an even more dangerous place for pregnant women and babies.
A series of studies have found abortion restrictions are associated with higher rates of maternal death and complications for mothers and babies, including one study Wallace co-authored that found that women living in states with a higher number of abortion restrictions had a 7% increased chance of death during pregnancy or within one year of birth.
“Our research has shown that decreasing access to abortion is associated with increases in maternal mortality and adverse birth outcomes, including preterm birth,” Wallace said. “So I think we can expect to see with the greater decline in access to abortion even worsening trends in these outcomes.”
A study published in July found that Texas’ 6-week abortion ban led to a 24% spike in serious pregnancy complications, what researchers call maternal morbidity.
Though no studies have yet been done on the impact of Louisiana’s strict abortion ban, Gillispie-Bell said she believes the state’s ban could have a similar impact as Texas’ ban.
“My suspicion is that we're going to have worse maternal and infant outcomes,” Gillispie-Bell said.
The March of Dimes report found preterm rates nationally are dramatically higher for Black and Native American women. Those groups are 62% more likely to have a preterm birth compared to White women, and their babies are twice as likely to die.
In Louisiana, the preterm birth rate for White women was 11%, but it jumped to 14.7% for Native American women and 16.9% for Black women. Black women were by far the most likely to seek abortion services in Louisiana prior to the state’s ban. In 2021, they made up 64% of all abortion patients in Louisiana, according to data from the state health department.
Louisiana also ranked as one of the worst states for infant mortality, according to the March of Dimes — a rate of 7.5 per 1,000 live births compared to the national average of 5.4 per 1,000 live births. That rate is slightly better than last year’s rate of 8 per 1,000 live births.
Louisiana’s failing grade comes despite a series of steps the state has taken to improve maternal health, including a new law that will allow health insurance to cover doulas. The state has implemented all but one key policy recommendation from the report: It has not expanded health coverage for midwives.
The health department has also been able to reduce dangerous complications from pregnancy and birth through a program that implemented evidence-based practices at Louisiana hospitals to manage hemorrhage and hypertension in pregnant patients, the two leading causes of maternal death in Louisiana.
But Gillispie-Bell said to dramatically increase the safety of pregnancy and birth in Louisiana, the state needs to address the web of underlying factors that impact health, which include issues of poverty, education, access to health care, violence and the environment.
“The minimum wage has to be a living wage,” she said. “Until we address the social determinants of health, then our rates are not going to improve.”
The March of Dimes also rates each parish and county based on the complex factors that impact maternal and infant health, including reproductive health care access, physical and mental health, and socioeconomic factors, which it calls the maternal vulnerability index. It found the majority of parishes in Louisiana ranked the worst in these factors, as well.
Louisiana also has higher than national rates of cesarean births for low-risk patients, which can lead to medical complications, and a higher rate of women who did not receive the full recommended prenatal and infant health care — meaning they didn’t have their first prenatal visit until they were more than five months pregnant, or that their baby didn’t have the recommended number of check-ups.
Previous March of Dimes reports have found more than half of Louisiana parishes are “maternity care deserts” — meaning they lack any access to maternal health care. Wallace’s previous research has found women in these parishes face “significantly elevated” rates of maternal mortality.
