State and community family health leaders are not surprised that Hawaii received a D grade in a March of Dimes Premature Birth Report Card.

They spent two days discussing the issues last month at a perinatal health summit on the Big Island.

The report card was not out then, “;but as providers we're all aware our statistics are not as good as they could be,”; said Kari Wheeling, project director for the Healthy Mothers, Healthy Babies Coalition. “;Hopefully, we can begin to critically look at the situation we're in as a state in providing care.”;

The nation as a whole scored a D, with a 12.7 percent premature birth rate based on 2005 data.

March of Dimes released the report card on the nation's sixth Annual Prematurity Awareness Day yesterday to call public attention to premature birth.

More than 530,000 babies nationally - including 2,100 in Hawaii - are born too early each year, according to the report. Premature birth, before 37 weeks' gestation, is the leading cause of newborn deaths and disability.

Hawaii, with a pre-term birth rate of 12.2 percent, was one of 23 states earning a D. No state had an A and Vermont drew the only B. The report used data available from federal agencies from 2005 to 2007.

Hawaii's pre-term birth rate is 60 percent higher than the Healthy People 2010 target of 7.6 percent. It increased by 13 percent between 1995 and 2005.

“;The rate keeps growing. It's just terrible,”; said Carmella Hernandez, state director, March of Dimes Hawaii Chapter. “;We have to find out what's causing it and what we can do to stop it.”;

She said Caesarean deliveries and labor inducements are a big reason for increased late pre-term births (34 to 36 weeks' gestation).

Caesarean sections have increased 42 percent since 1999, according to the state Health Department's Pregnancy Risk Assessment Monitoring System, accounting for 8.6 percent or one in 12 live births in Hawaii.

Other factors cited in the report for Hawaii's pre-term birth rate: 10.4 percent of women of childbearing age have no health insurance, and 17.3 percent smoke.

Loretta Fuddy, chief of the state Health Department Family Health Services Division, said there is a strong correlation between increasing C-section and prematurity rates. However, she noted some differences in the other factors showing up in the Hawaii Pregnancy Risk Assessment Monitoring System, which surveys 10 percent of all women delivering babies.

The uninsured rate for pregnant women surveyed was 2.4 percent, she said, noting they have a higher eligibility rate for the state's QUEST program. “;About 1 percent were still not insured at delivery, so we are doing good for insurance coverage.”;

Fuddy and Wheeling both pointed to decreased access to prenatal care as a contributing factor because of a shortage of obstetrician/gynecologists in the state, especially on the neighbor islands.

Wheeling said socioeconomic factors and lack of resources contribute to Hawaii's premature birth rate, “;and we are going into a recession. ... What do you do when you reach a critical point?”;

Fuddy said the Health Department supports March of Dimes' “;call for action”; for more research and investigation as to the causes of pre-term delivery and support to make sure women of childbearing age have health care coverage and access to services.