With an emphasis on place-based, whole-person prenatal care, UCSF implements programs to prevent premature births – and the resulting infant deaths – in the Bay Area and beyond.
Premature birth is the leading cause of death worldwide among children under age 5, especially in low-income neighborhoods and nations. Within San Francisco, for example, a baby in Bayview-Hunters Point – one of the city’s most economically disadvantaged neighborhoods – is three times as likely to be born prematurely as a baby in the affluent Presidio Heights neighborhood. Fresno, Calif., with the fourth-lowest median household income of all US cities, bears 10 times San Francisco’s burden of prematurity – one of the nation’s highest rates of preterm birth.
Every year, nearly 400,000 preemies are born in the US alone, and 15 million are born worldwide – 60 percent of them in South Asia and sub-Saharan Africa. Approximately 1 million die shortly after birth.
For UCSF’s Larry Rand, MD (above), those numbers – especially the disparities between rich and poor – are simply unacceptable. “Every child,” he says, “deserves an equal start in life.” The Lynne and Marc Benioff Professor of Maternal and Fetal Medicine, Rand is dedicated to lowering the rate of early births, both at home and abroad.
There are two keys to his efforts to do so. The first is “place” – the idea that the deck is stacked against babies in low-income zip codes or countries. “It’s really synonymous with precision medicine,” Rand says – in this case, the precise combination of factors affecting a given community’s prematurity rate. The second key is what Rand calls “whole-person care” – the idea that risk factors can’t be isolated and addressed in a vacuum.
His work sparked the creation of UCSF’s Preterm Birth Initiative (PTBi). PTBi has two arms – one in California, which Rand heads, and one in East Africa.
Within California, the focus on “place” and “whole-person care” means looking closely at a range of factors: economic issues, like a poor job market; physical constraints, such as inadequate access to public transportation; air pollution and other environmental issues; health problems, including diabetes; behavioral habits like smoking; and social stressors, such as food and housing insecurity or racism.
Meanwhile, Rand’s colleagues in PTBi East Africa are working closely with individuals and institutions in Kenya, Uganda, and Rwanda, looking at factors relevant to those countries.
In all locales, Rand explains, PTBi’s strategy is to run demonstration projects, recognizing that traditional models of prenatal care may not be effective with at-risk populations, then scaling up models that show results. His team has already implemented promising interventions including group prenatal care and home support for preterm babies. Rand’s long-term goal is to make a dent in those numbers that so dismay him.