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Addressing Preterm Birth

FSG worked with the University of California, San Francisco’s Preterm Birth Initiative to launch a collective impact initiative in Fresno, California addressing preterm birth.

Preterm birth is the single biggest cause of infant mortality around the world: research by the World Health Organization estimates that 15 million babies are born premature each year, and almost 1 million die from complications with preterm birth. In the United States, more than 1 in 10 babies were born premature in 2015 and low-income communities and communities of color are disproportionately affected.

In 2014, the University of California, San Francisco (UCSF), with funding from Marc and Lynne Benioff and the Bill & Melinda Gates Foundation, launched the Preterm Birth Initiative (PTBi) to reduce the incidence of preterm birth and improve the health outcomes of those babies born too soon.  The PTBi strives to better understand the causes of prematurity, a condition driven by many social determinants of health such as poverty; living and working conditions; family and housing instability; perceived discrimination; and poor access to healthcare. UCSF partnered with FSG to explore the use of collective impact to drive sustainable change through the PTBi.

The California arm of the PTBi focuses on 3 communities in California—Oakland, Fresno, and San Francisco. FSG worked with the Initiative to conduct a feasibility assessment on collective impact in these three communities. FSG conducted research in each community to better understand the nature of the preterm birth problem: who is affected, the existing systems of care accessed by mothers, and the community’s readiness for a collective impact approach. Readiness was determined by the existence of local champions interested in a collective impact approach, the urgency for change on this issue, the resources available, and the history of collaboration in the community.

Based on research and interviews with stakeholders from hospitals, community clinics, nonprofits, funders, and local governments, FSG recommended Fresno as the first California community where UCSF could catalyze a collective impact approach to reducing preterm births.

FSG helped the Initiative and local partners in Fresno launch a collective impact effort focused on healthy, well-timed pregnancies. FSG supported the Initiative in assembling a steering committee made up of women who had experienced preterm birth in collaboration with organizational leaders who provide services that may influence a woman’s reproductive life. In addition to input from healthcare experts and rigorous data analysis, the steering committee’s decisions were largely informed by women and families with lived experience. FSG also interviewed women throughout Fresno and conducted focus groups in rural and urban areas in order to develop detailed user journeys of women’s experiences with the health system.

Through this learning process, the steering committee set a goal of significantly reducing preterm birth by 2025 by ensuring good health for all women in Fresno before, during, and after pregnancy. They decided to focus on 3 strategic areas: health and education before pregnancy, care and support for pregnant women, and greater coordination of available social and behavioral health services.

Based on a community-wide vetting process, the PTBi established the backbone function at the Fresno State University, hiring and coaching new staff to support the growing, multi-faceted work of the Initiative. FSG guided the backbone function to define shared measurements and to develop a community engagement strategy, starting with the launch of a number of “Moms’ Councils” across the county to provide strategic suggestions to the future working groups.

Today, the Fresno PTBi continues their work to support healthy mothers and healthy babies in Fresno County. As a result of improved coordination and collaboration, several projects have been initiated as part of the collective impact effort: expansion of reproductive health services in school-based clinics, the development of an enhanced group prenatal care pilot program, and better coordination with local navigation centers to link pregnant women to services.  

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About The UCSF Preterm Birth Initiative
The UCSF Preterm Birth Initiative is a multi-year research effort working to reduce the burden of prematurity in California and East Africa. PTBi engages in holistic, place-based research and respectful care across the reproductive life course.