The United States’ high rate of premature births has earned the state a D, according to the first nationwide Premature Birth Report Card. 23 states received Ds, eight states got Cs and one state, Vermont earned a B. All states failed to meet the federal government’s goal, which was to get the preterm birth rate down to 7.6 percent or less. No state earned an A.

The March of Dimes, a nonprofit group working to improve babies’ health, said there has been more than a 20 percent increase in preterm births in the U.S. since 1990.

Premature birth is the leading cause of infant mortality. Premature babies have a higher risk of respiratory problems, neurological diseases, and their risk of early childhood mortality is up to seven times higher than for babies born at full term.

To reduce premature births, every pregnant woman should have access to health insurance coverage and early prenatal care; they should attend smoking cessation programs and those who have had a previous episode of preterm birth should get weekly shots of the hormone progesterone starting at 16 to 20 weeks’ gestation. In the State of California, a quarter of women of childbearing age aren’t covered by health insurance.

Every year, more than 530,000 babies are born before 37 full weeks of gestation. The rate of premature birth in the United States has reached an alarming 12,7 percent. This rate is more than 60% higher than the federal government’s goal for 2010, according to the report.