Louisiana continues to get a failing grade when it comes to the number of premature births, according to a new national survey by the March of Dimes released Thursday.

Louisiana received an F on the report card that for the first time also graded the state’s cities.

Louisiana’s pre-term birth rate was 12.3 percent in 2014 — far shy of the March of Dimes 2020 goal of 8.1 percent. Baton Rouge and Shreveport had pre-term birth rates that were worse than the statewide rate — 13 percent and 18.8 percent, respectively. New Orleans and Lafayette were better than the state rate at 12.1 percent and 10.4 percent.

Babies born prematurely have medical problems that often continue impacting their quality of life, while dramatically driving health care costs up.

“Louisiana still has much work to do, and too many of our babies must fight to overcome the health challenges of an early birth. Premature birth is the number one killer of babies and many of our families still face that fear,” said Frankie Robertson, director of the March of Dimes Louisiana.

The March of Dimes is working with the state Department of Health and Hospitals on ways to decrease pre-term births.

The F grade is not new for Louisiana, which consistently ranks among the worst states in the U.S. on premature births.

DHH Secretary Kathy Kliebert said despite the poor grade, “major strides” are being made in reducing pre-term births.

“The changes we are implementing don’t show immediate results in the data, but we are confident that the rate in future years will reflect the changes we’ve made for Louisiana babies and their families,” Kliebert said in a statement.

Louisiana is improving birth outcomes by adopting Medicaid standards that do not allow elective births before 39 weeks of gestation and Blue Cross and Blue Shield of Louisiana has adopted a voluntary 39-Week Initiative, Kliebert said. The efforts resulted in thousands fewer babies needing to spend time in neonatal intensive care units and over $12 million in taxpayer dollars saved, DHH reported.

Recently, Louisiana has adopted policies aimed at reducing C-section rates by getting hospitals to pledge that they will not perform elective births before 40 weeks of gestation.

The U.S. earned a C on the 2015 Report Card. Idaho, Oregon, Vermont and Washington earned A’s, 19 states received a B, 18 states — including Texas and Arkansas, and the District of Columbia got a C, six others a D, and Alabama, Mississippi and Puerto Rico received an F. The U.S. pre-term birth rate ranks among the worst of high-resource countries, the March of Dimes says. Worldwide, 15 million babies are born pre-term, and nearly one million die due to an early birth or its complications. Babies who survive an early birth face serious and lifelong health problems.