Rhode Island is among 23 states to get a grade of “D” from the March of Dimes for the high rate of premature births. The nation as a whole also got a “D.”

The grades, announced today, appear on the charity’s first Premature Birth Report Card, which it intends to issue each November to draw attention to the continuing and costly problem of babies born too early.

Premature births, defined as births occurring before 37 weeks’ gestation, are the leading cause of death in the first month of life and often result in lifelong disabilities.

In Rhode Island, 12.1 percent of babies born in 2005 were premature. That rate is the highest in New England and close to the national average of 12.7 percent. On the nationwide ranking Rhode Island is number 19.

But Rhode Island is in the lead in other ways, says Betsy Akin, Rhode Island state director of the March of Dimes. In 2006, the Health Department convened a Prematurity Task Force to examine ways to address the problem, and that task force has been moving ahead on such efforts as improving health education in the schools and better health care for vulnerable women.

“We were the first in the country to establish that task force. We’ve seen that replicated in a couple of other states,” Akin said. Premature births, she added, are “a complex and difficult problem. It’s going to take many years to achieve a significant impact.”

In preparing its report card, the March of Dimes compared each state and the nation with the national goal of reducing premature births to 7.6 percent by 2010. The number one state, and the only state to receive a “B,” is Vermont, with a 9 percent prematurity rate. Eight states got a “C” and 18 states plus the District of Columbia and Puerto Rico were graded “F.” Mississippi (18.8 percent) and Puerto Rico (19.7 percent) had the highest rates of premature birth.

Multiple social and biological factors lead to premature births, and the causes are not fully understood. With its report card, the March of Dimes zeroed in on three factors it believes can be addressed immediately: lack of health insurance, smoking among women of child-bearing age and late preterm deliveries resulting from early induction of labor and C-sections.

Akin said the report card’s purpose is to spur action by others. “We want to encourage the federal government, state governments, hospitals and businesses to take action that may contribute to the reduction of this preterm birth rate,” she said. That includes improving access to health care for all women and workplace practices, such as flex time, that support maternal and child health.

The March of Dimes is calling on hospitals to review all labor inductions and C-sections that occur before 39 weeks’ gestation, to make sure they’re medically necessary. That practice is already occurring at Women & Infants Hospital, where most Rhode Islanders’ babies are born, according to Dr. Joanna M. Cain, chief of obstetrics and gynecology.

But one in seven women of childbearing age in Rhode Island has no health insurance and nearly one in five women of child-bearing age smokes tobacco, which can lead to premature birth.

Women without health insurance are at high risk of having a premature baby: in Rhode Island 20 percent of births to uninsured women are premature, compared with 11 percent of those with private coverage.

This is in spite of the state’s high rate of women receiving prenatal care. Often, once a woman is pregnant it’s too late to make the changes necessary for a healthy baby, Cain says. For example, if a woman needs to overcome addiction to drugs or tobacco, lose weight, escape an abusive relationship or even just improve her eating habits, those efforts must start before she finds out she’s pregnant. Teenagers need good health care and information, to prevent pregnancy in the first place.

The interval between pregnancies is also a critical time for preventing a second premature birth, Cain said –– but many women are dropped from public health coverage six weeks after giving birth.

“There is so much we can do and we miss the opportunity and it’s tragic,” Cain said.

Dr. James F. Padbury, pediatrician-in-chief at Women & Infants, said an important aspect of prematurity is reducing the effects of preterm birth. In the fall of 2009 Women & Infants plans to open a new unit for sick and premature newborns designed to reduce the neurodevelopmental impairments that often result from being born too soon.

The Rhode Island public, Padbury said, “should know that their community –– people with expertise and commitment –– have really been in front of things nationally to try and really help on this issue.”

Starting soon in The Journal and on projo.com: An occasional series on premature births –– causes, costs and the lives of families affected by them.

ffreyer@projo.com