Alejandra Sanchez, 33, knows all too well the flood of emotions that come with giving birth to a premature baby. All four of her children were born dangerously early. Two of her sons were born at 26 weeks. One child didn’t survive. Her other son, now 12, contends with cerebral palsy.
“He was in the NICU for three months,” Sanchez said.
Sanchez’s birth experiences aren’t unique. According to the World Health Organization (WHO), 15 million babies are born prematurely each year. One million children die within the first 28 days of life. Those infants who do survive are at an increased risk of serious lifelong health challenges including neurological conditions, diabetes and high blood pressure.
The United States contends with the problem too, with a premature birth rate of 9.8, according to 2017 data, an increase of 2 percent over the previous year.
The March of Dimes Premature Birth Report Card found the preterm birth rate in California increased to 8.6 percent, reaching a six-year high. Before 2015, preterm birth rates had been declining for almost a decade.
The March of Dimes analysis also showed significant racial disparities in the state. The preterm birth rate among black women in California was 46 percent higher than other women. Latina and American Indian women in California also had disproportionately higher rates of premature births.
Hoping to address these disparities, and reduce the health risks related to preterm births and low birth weight, organizations such as the Alameda County Public Health Department, the University of California, San Francisco (UCSF) and the University of California at Berkeley, School of Public Health, are concerned with the conditions that affect women’s health throughout their life, not just during pregnancy.
“There is increasing evidence that health disparities such as preterm birth and infant mortality are driven by social conditions,” said Kiko Malin, director of the Alameda Public Health Department’s Family Health Services Division in an e-mail. Those conditions include poverty, homelessness, discrimination and experiences of violence and trauma.
Malin, in conjunction with the UC Berkeley School of Public Health, oversees the Best Baby Zone Initiative (BBZ) program in Oakland’s Castlemont neighborhood. By mobilizing communities, BBZ hopes to improve the social determinants that affect health such as housing, education, childcare and transportation.
In 2012, with an initial $2.75 million grant from the W.K. Kellogg Foundation, the BBZ launched programs in Cincinnati, Ohio, New Orleans, La., and the Castlemont program in Oakland. In 2017, the program added three new BBZ sites in Indianapolis, Ind., Kalamazoo, Miss., and Portland. Ore.
“Our work strives to transform the community into a healthy place for pregnant women, children and families to live,” Malin said.
Castlemont was chosen as both the first Bay Area and California site because more babies are born prematurely in the Oakland neighborhood, or with low birth weights, compared to the rest of Alameda County.
In addition to the UC Berkeley and Alameda County public health departments, the program works closely with Building Blocks for Health Equity Unit in partnership with Youth UpRising, Castlemont High School, Lotus Bloom, First Five Alameda County and other organizations.
Claudia Zaugg, program associate for the BBZ Initiative at the UC Berkeley School of Public Health, said the project began with focus groups, and surveys where Castlemont residents were asked about the four top priorities for their community. They identified public safety, community building, education and the local economy.
“One of the Castlemont BBZ’s biggest successes has been the monthly first Saturday market that provides opportunities for local entrepreneurs, as well as a place to buy goods and services that boost the local economy,” Zaugg said. The market first launched in 2013.
Silvia Guzman, community outreach coordinator for the Building Blocks for Health Equity Unit, said the Castlemont BBZ connects infant mortality with economic development.
“We provide flyers and information outreach at the market and in the community for Alameda County Family Health Services programs including Community Baby Showers, Daddy Boot Camps, and Pregnancy Basics,” Guzman said.
In addition to the BBZ program, Malin said the Alameda County Public Health department offers a comprehensive set of voluntary early childhood home visiting and family support programs that focus on reaching women who have medical and social challenges that may put them at risk for preterm birth and other problems.
“Most of these programs pair a seasoned home visitor – nurse, social worker or community health worker – with women and their families to provide culturally responsive, client-centered guidance, counseling and support during pregnancy and/or until the child is two or three years old,” Malin said. Two of the programs, she noted, are specifically for African-American women.
Staff make sure their pregnant clients have a medical home, steady health insurance and are attending their prenatal care visits, Malin said.
They also do comprehensive assessments to determine challenges the clients may face that might prevent them from having a healthy pregnancy and birth outcome, such as health conditions, homelessness, food insecurity, mental health concerns, exposure to trauma and violence.
Involving Parents in the Process
At UCSF, the Preterm Birth Initiative explores different ways of reducing birth disparities through community partnerships, with parents and providers being included in the discussion of research and interventions. The program seeks to close the gap in preterm birth disparities in Oakland, San Francisco and Fresno.
“We’re approaching research differently,” said Linda Franck, professor of nursing and chair of Family Health Care Nursing at UCSF. “We’re partnering with women of color to determine the research questions that should be asked and which studies should be funded.”
Alejandra Sanchez, who gave birth to her sons at UCSF was asked to be a peer parent mentor in the Preterm Birth Initiative, a multi-year research effort funded by Marc and Lynne Benioff and the Bill and Melinda Gates Foundation.
“I wish that I had known someone who had a baby preterm when I was going through the experience,” Sanchez said. “I also learned the importance of kangaroo care when babies are born early, and how that skin-to-skin contact with their parent can help preterm babies by regulating their heart rate, breathing and temperature, have a shorter hospital stay, experience less pain and crying, and more.”
Shanell Williams, community engagement specialist in the UCSF program said that by connecting with community members, researchers can ensure they are conducting culturally-relevant research.
“Birth disparities are a multifaceted issue and by tackling the root causes, we can work to improve outcomes,” Williams said.