As D.C. forges on through month nine of a global health crisis, new data shows the city’s infant health metrics have trended in the wrong direction, as racial disparities in healthy births widen.

According to the March of Dimes in its newly released 2020 report, the District’s preterm birth rate — the second-leading cause of infant mortality in the U.S. — ticked up from 10.1% in 2018 to 10.4% in 2019, dropping the city from a C grading to a D+. Preterm births occur when a baby is born before the 37th week of pregnancy, according to the Centers for Disease Control and Prevention. Factors including age, race, income, and stress level can increase the likelihood of preterm birth.

Nationally, the U.S. only received a C- grade, recording a preterm birth rate of 10.2% in 2019, up slightly from 10% in 2018. The report graded each of the 50 states by comparing preterm birth rates to the March of Dimes’ goal of reaching a rate of 8.1% by 2020. Louisiana reported the highest rate in the country, at 13.1%.

In the first half of the past decade, the District’s preterm birth rate saw a steady decline, dropping from 11.0% in 2009 to 9.6% in 2014. The metric trended up in the latter half of the decade, hitting 10.7% in 2016, but dropping back in the years following.

2020’s report reflects the first time in three years that the city’s preterm birth rate has increased.

Racial and ethnic disparities in the city’s preterm births also widened over the past year. According to the March of Dimes 2019 report, D.C.’s preterm birth rate among Black women was 65% higher than all other racial groups. That gap increased to 74% in the latest data.

The report also includes the city’s strikingly high infant mortality rate of 7.4% — one of the worst in the country, only behind Louisiana and Arkansas. While this rate has dropped over the past decade in D.C., it’s still well above the national rate of 5.7%.

As the city continues to navigate a pandemic — one that disproportionately impacts the city’s Black and Latinx residents — the report tracked D.C.’s social determinants of health to determine what areas necessitate improvement. Compared to national averages, the city reports a higher rate of inadequate prenatal care amongst mothers, as well as a higher cost of preterm birth care.

The newest numbers on infant health reflect another decades-long crisis in the city: D.C.’s high maternal mortality rate. In 2018, the city reported a maternal mortality rate double that of the national average.  In 2019, the city recorded 35.6 deaths per 100,000 lives births, compared to 29.6 nationally. The rate is substantially higher for black women in the District, with 71 deaths per 100,000 live births.