Francisco Xavier Gomez was one of thousands of babies born last year in Fresno County. He is considered a miracle to his mother Lucy Gomez, who previously experienced preterm births with two other children — Rodrigo, born at 23 weeks, and a daughter whom she lost at 18 weeks.
After experiencing traumatic and heart-wrenching births, Gomez knew she wanted to take preventative measures to make sure Francisco was born full-term. Based on her history, the chances of another preterm birth (before 37 weeks of pregnancy) was high.
Researchers with the Central Valley Health Policy Institute at Fresno State say demographics, such as race and place, are key indicators of maternal health. The Fresno County Preterm Birth Initiative — a collective impact effort to reduce the number of babies born prematurely in Fresno County explores this work
Fresno State has served as the backbone of the initiative for the past five years. Although the University of California, San Francisco’s five-year funding period for this backbone will sunset on July 31, the work will transition to include community partners and Fresno State, which will continue to build on their shared achievements.
Because of her past experiences, Gomez joined the Parent Council for Moms, a strategy born out of the initiative to bring together mothers with living experience. Using the knowledge and confidence she gained in the council, Gomez pursued potential interventions to reduce the risk of prematurity when she found out she was expecting with Francisco. This included attending counseling and researching her rights. Her efforts proved successful, as Francisco was born healthy at 39 weeks.
“Many families saw their babies born three to 16 weeks early and thought it was normal,” said Sandra Flores, program director of the Fresno County Preterm Birth Initiative. “Many moms thought they had done something wrong to contribute to preterm birth, but the fact is preterm birth is a complex issue. Through the initiative, families collaborated and learned with us and are now better able to support and advocate for services that may help before, during and after pregnancy.”
Across Fresno County, experts and families agree that improving the health of women and babies is very important. One major challenge is the high rate of babies born prematurely. Fresno County has one of California’s highest rates of babies born prematurely: approximately 1 out of every 9 babies. Being born too soon can cause serious physical and mental disabilities or even death before the baby’s first birthday. It has enormous human and financial costs for our families and affects the overall health of our community. Conditions in Fresno County must be changed so that more women can have healthy pregnancies and healthy babies.
The initiative work began in 2015 when one out of every 10 babies in Fresno County — or 1,500 each year — was born prematurely. These rates were among the highest in the nation. Premature babies are at risk of lifelong disability and chronic diseases that have far-reaching consequences.
With a partnership and investment from the UCSF California Preterm Birth Initiative, the Fresno County initiative goal was to reduce preterm birth rates from 10.3 percent to 7 percent by 2025, an overall reduction of more than one-third. As of 2018, Fresno County has seen an 8.4 percent reduction in preterm birth rates.
Since the launch of Fresno County’s initiative, workgroups were implemented to address three priority areas that span the reproductive life course and address the social and environmental factors that lead to preterm birth: health and education before pregnancy, care and support during pregnancy, and coordination of care before, during and after pregnancy.
In schools across Fresno County, students are learning about comprehensive sexual health education — a goal set by the health and education workgroup to help youth gain the skills necessary to protect their health. To date, 7,500 middle and high school students were taught this curriculum, facilitated by the Fresno County Superintendent of Schools, who also oversees the workgroup.
“Prenatal health was the initial focus of this workgroup,” said Dr. Kathryn Catania, deputy superintendent of educational services for the Fresno County Superintendent of Schools. “It then transitioned into preventative care strategies, like high school education.”
At the Fresno County Department of Public Health, Rose Mary Rahn and her team focus on the care and support during pregnancy workgroup, in partnership with the Maternal Child and Adolescent Health/Babies First program. This workgroup brought about new dialogue to increase enrollment in the national Women, Infant and Children program, known to help improve birth outcomes.
In collaboration with Dr. Subha Ladella, a perinatologist at UCSF Fresno, the workgroup also helped develop and implement a study about interventions during pregnancy to prevent preterm birth. This workgroup will maintain its dedication to improving birth outcomes of women in Fresno County, while addressing ongoing racial health disparities.
The third workgroup, coordination of care, is dedicated to increasing the use of and simplifying access to social services and behavioral and physical health care for mothers and families in Fresno County. Mothers with living experience and other community members have taken the lead and serve as chairs in this workgroup.
For the past five years, community leaders Lynne Ashbeck, senior vice president of community engagement and population wellness at Valley Children’s Healthcare, and Artie Padilla, executive director of Every Neighborhood Partnership, have led the Fresno County Preterm Birth Initiative steering committee. Comprised of leaders in health, education, faith, law enforcement and business, the committee’s goal has been to guide the work of the preterm birth initiative in Fresno County.
“Collaboratives are so powerful,” Ashbeck said. “The only things that are going to change the landscape of our community are unlikely partners and new alliances, working together around a common interest and toward a shared goal.”
A key component and driving factor of the work has been community-based input and participation, including the involvement of parents with living experience of preterm birth.
“Preterm birth is a challenge we all share as a community,” Ashbeck said. “Just because it doesn’t happen in your family or mine, it doesn’t mean that we collectively don’t struggle with this. Babies born early have more challenges in life. As a community, we all have a role in lifting up those families and children to give them their best chance for a healthy life.”
In December 2018, the second cohort of the African American Youth Leadership Academy graduated from a comprehensive, 16-week program meant to give girls and women the opportunity to learn about social justice issues, systemic racism, reproductive and mental health and civic engagement. Mirroring this program is Keeping It Real, a 12-week leadership enhancement program for African American fathers or young men. In total, 36 women and 25 men have participated.
Among the academy graduates is Andrea Avila. In 1985, her son, Jason, was born at 28 weeks, weighing just 2 pounds. Jason, now 35, takes five medications daily to treat his health and developmental delays. Avila believes the lack of care she received during pregnancy was a primary factor.
Avila is not the only one in her family to face preterm birth. Just six years later, her sister, Wendy Moultrie, delivered daughter Kolby at just seven and a half months. Three decades later, Avila’s daughter, Amber Daniels, has experienced two preterm births.
This example is not uncommon, nor is it a new issue, according to researchers at the Central Valley Health Policy Institute. Adverse birth outcomes among African American women have been a concern for decades.
After five years, the Fresno County Preterm Birth Initiative has left a lasting impact on the community and brought much-needed awareness to the issue.
"The Fresno County initiative was able to successfully accomplish many of our goals within the last five years," Flores said. "Although there will be a shift in the work, our community partners are dedicated to building on the successes of the initiative and will continue to raise awareness and work towards reducing preterm birth in Fresno County.”
Fresno State will take a substantial role in the transition, with the Central Valley Health Policy Institute leading the shared measures and policy portion of ongoing work.
In September, the institute will begin collaborative work with UCSF PTBi-CA on a $5.6 million initiative to research the effectiveness of group prenatal care for low-income women in Fresno County. Funded by the Patient-Centered Outcomes Research Institute, the study will compare two approaches to enhanced prenatal care to improve maternal and child health in the Central Valley to see which is most effective at reducing rates of preterm birth, decreasing depression and anxiety and increasing satisfaction with care.
The enhanced group prenatal program to be compared is Glow! – a strategy incubated through the Fresno County initiative and implemented by First 5 Fresno County in partnership with the Central Valley Health Policy Institute and UCSF.