Logo
Daily Brief
Following Why
How Florida Cut Preterm Births 30% While America's Crisis Deepens

How Florida Cut Preterm Births 30% While America's Crisis Deepens

A Tampa program shows what works—but most states aren't following the playbook

Overview

Central Hillsborough Healthy Start in Tampa screened every pregnant woman in high-risk ZIP codes, sent nurses to their homes, and cut preterm births by 30%. Among single mothers, very preterm births dropped 52%. Obese mothers saw a 61% reduction in extremely preterm births. The results held steady from 2008 through 2020.

Meanwhile, the U.S. earned its fourth straight D+ for preterm birth in 2025. Black mothers deliver preterm at 1.5 times the national rate. Mississippi and Louisiana both failed, with preterm rates hitting 15% and 14%. Nearly 380,000 babies were born too soon last year—one every 90 seconds. The gap between what works and what's happening is widening.

Key Indicators

30%
Preterm birth reduction in Central Hillsborough
Among highest-risk families in the program, sustained from 2008-2020
10.4%
U.S. preterm birth rate
Unchanged for three consecutive years, earning fourth straight D+ grade
14.7%
Preterm rate for Black mothers
1.5 times higher than overall rate, worsening from previous year
48 states
Extended postpartum Medicaid to 12 months
Up from 60 days, covering critical recovery period
20+ states
Now cover doula services under Medicaid
Reimbursement ranges from $450 to $3,500 per birth
3x
Black maternal mortality multiplier
50.3 deaths per 100,000 vs 14.5 for White women

People Involved

Kamala Harris
Kamala Harris
Vice President of the United States (Led Biden Administration's maternal health initiatives since 2021)
Lauren Underwood
Lauren Underwood
U.S. Representative, Illinois 14th District (Co-founder of Black Maternal Health Caucus, lead sponsor of Momnibus Act)
David Olds
David Olds
Founder, Nurse-Family Partnership (Professor of Pediatrics, University of Colorado; created evidence-based model in 1977)

Organizations Involved

FL
Florida Healthy Start
State maternal-infant health program
Status: Active statewide since 1991, with 32 county coalitions

First-in-the-nation program to universally screen every pregnant woman and infant for health risks, then intervene with nurse home visits.

March of Dimes
March of Dimes
Nonprofit maternal-infant health advocacy organization
Status: Leading national tracker of preterm birth rates and maternal health outcomes

Shifted from polio prevention in the 1960s to become the nation's preterm birth watchdog, issuing annual state-by-state report cards since 2008.

BL
Black Maternal Health Caucus
Congressional caucus
Status: Active, pushing Momnibus Act through Congress

Bipartisan House caucus driving comprehensive legislation to close racial disparities in maternal mortality and birth outcomes.

Timeline

  1. Florida Healthy Start Highlighted as National Template

    Analysis

    Research shows Central Hillsborough's 30% reduction sustained through 2020, offering replication roadmap.

  2. U.S. Earns Fourth Consecutive D+ on Preterm Births

    Report

    10.4% national rate unchanged three years running; Mississippi and Louisiana fail with 15% and 14%.

  3. 20+ States Now Cover Doula Services Under Medicaid

    Policy

    Eight states added coverage in 2024; reimbursement rates range $450-$3,500 per birth.

  4. Biden-Harris Announces $558M Maternal Health Investment

    Funding

    $440M dedicated to nurse home visiting programs modeled on proven interventions.

  5. 48 States Extend Postpartum Medicaid to 12 Months

    Policy

    Nearly universal adoption of extended coverage, up from 60 days.

  6. Momnibus Act Reintroduced With 181 Cosponsors

    Legislation

    13-bill package gains broadest support yet for maternal health equity.

  7. First White House Maternal Health Day of Action

    Policy

    VP Harris calls for 12-month postpartum Medicaid and $3B in new maternal health funding.

  8. Black Maternal Health Caucus Founded

    Policy

    Reps. Underwood and Adams create caucus to address three-fold mortality gap for Black mothers.

  9. First March of Dimes State Report Cards Released

    Advocacy

    Annual grading system begins tracking preterm birth rates in all 50 states.

  10. Central Hillsborough Reports 30% Preterm Birth Reduction

    Research

    Peer-reviewed study shows dramatic improvement among highest-risk Tampa families through nurse home visits.

  11. March of Dimes Launches Prematurity Campaign

    Advocacy

    National campaign aims to cut preterm births 15% and raise awareness from 35% to 60%.

  12. Florida Creates First Universal Prenatal Screening Program

    Policy

    Governor Chiles signs Healthy Start into law, establishing 32 coalitions to screen every pregnant woman.

  13. First Nurse Home Visiting Trial Begins

    Research

    David Olds launches randomized trial in Elmira, NY proving nurses reduce preterm births.

Scenarios

1

20 States Replicate Florida Model, Cut National Preterm Rate to 8.5%

Discussed by: Public health researchers at The Conversation, maternal health policy analysts at Georgetown University's Center for Children and Families

States with failing grades—Mississippi, Louisiana, Texas, Arkansas—adopt Florida's playbook: universal screening, nurse home visits for high-risk mothers, care coordination, prenatal education, and depression/substance abuse support. Federal Medicaid matching funds from the Biden-Harris $558M investment help states hire nurses and build coalition infrastructure. Within five years, states implementing comprehensive programs see 25-30% preterm reductions in disadvantaged communities. Black-White disparity gap narrows from 1.5x to 1.2x as nurse visitors address social determinants. The U.S. climbs from D+ to C+ by 2030.

2

Crisis Worsens as Medicaid Cuts Gut Home Visiting Programs

Discussed by: National Health Law Program warning about reimbursement sustainability, state budget analysts

Economic pressures force states to slash Medicaid budgets. Doula reimbursement rates—already inadequate in many states at $450-800—get cut further. The $558M federal investment expires without renewal. States abandon nurse home visiting programs due to cost. Mississippi, Louisiana, and Alabama see preterm rates climb above 16%. Black maternal mortality, currently 50.3 per 100,000, rises to 60. The Momnibus Act stalls in Congress without Republican support. By 2028, the U.S. slides to an F grade, and the gap between Florida's success and national failure becomes unbridgeable.

3

Momnibus Passes, Mandates Universal Screening and Home Visiting Nationwide

Discussed by: Black Maternal Health Caucus advocates, March of Dimes policy staff

Shocking new maternal mortality data—showing the gap between Black and White mothers widening to 4x—galvanizes bipartisan support. The Momnibus Act passes in 2026 with amendments securing Republican votes in the Senate. Federal law requires all states to implement Florida-style universal prenatal screening and nurse home visiting for high-risk mothers. CMS creates Centers of Excellence modeled on Central Hillsborough to train coalitions. Community health workers, doulas, and peer support workers get standardized Medicaid reimbursement floors ($2,000 minimum per birth). Climate impact provisions fund cooling centers in heat-vulnerable regions. By 2030, all 50 states have functioning coalitions. The preterm rate drops to 8% and racial disparities shrink dramatically.

Historical Context

Nurse-Family Partnership Trials (1977-1994)

1977-1996

What Happened

David Olds spent 17 years proving nurse home visits work. His Elmira trial (1977) showed nurses reduced preterm births and improved mother-child outcomes. Memphis (1988) confirmed results with mostly Black families. Denver (1994) tested nurses versus paraprofessionals with 735 Hispanic and White mothers—nurses won decisively. All three randomized controlled trials reached the same conclusion: trained nurses visiting high-risk mothers at home prevent preterm births.

Outcome

Short Term

Evidence convinced policymakers to fund national expansion in 1996, reaching all 50 states.

Long Term

Created the evidence base Florida's Healthy Start and similar programs rely on today; over 30 years of data proves the model works across demographics.

Why It's Relevant Today

Florida didn't guess—it copied a proven blueprint from Olds' research, then proved it works at scale. Other states can do the same.

WIC Program Expansion (1972-1989)

1972-1989

What Happened

The Special Supplemental Nutrition Program for Women, Infants, and Children started as a pilot in 1972 serving 88,000 people. Early studies showed participants had longer pregnancies, fewer premature births, and higher-birthweight babies. Despite initial resistance over cost, Congress made WIC permanent in 1975 and gradually expanded funding. By 1989, WIC served 4.5 million women and children.

Outcome

Short Term

Each dollar spent on prenatal WIC saved $1.77-$3.13 in Medicaid costs for newborns and mothers in the first 60 days.

Long Term

WIC now serves over 6 million people annually and is credited with improving birth outcomes for low-income mothers; it proved preventive maternal programs deliver ROI.

Why It's Relevant Today

Like WIC, nurse home visiting requires upfront investment but saves money by preventing expensive NICU stays and long-term health costs. History shows maternal programs scale when evidence proves savings.

Medicaid Postpartum Coverage Extension (2021-2025)

2021-2025

What Happened

Before 2021, Medicaid coverage ended 60 days after delivery—right when many complications emerge. The American Rescue Plan Act of 2021 gave states the option to extend coverage to 12 months. VP Harris made it a priority at the December 2021 Maternal Health Day of Action. States adopted rapidly: by January 2025, 48 states plus DC had implemented the extension, making it nearly universal in just four years.

Outcome

Short Term

Millions of mothers gained access to treatment for postpartum depression, hypertension, diabetes, and other conditions previously uncovered.

Long Term

Demonstrates federal-state partnerships on maternal health can achieve near-universal adoption when funding and political will align; sets template for national nurse visiting program.

Why It's Relevant Today

Proves states will adopt evidence-based maternal health policies quickly when the federal government provides funding and leadership. Florida's model could spread the same way.

15 Sources:
+9
The Conversation WLRN March of Dimes PR Newswire KFF Florida Department of Health Maternal and Child Health Journal The White House CDC Congress.gov NASHP National Health Law Program Wikipedia March of Dimes March of Dimes