PTBi embarked upon a year-long Planning Phase that united the UCSF community and its partners and explored how to best impact the burden of prematurity in our target geographies. This period provided an unprecedented opportunity to scrutinize available data, document gaps in our understanding of prematurity, and form new collaborations across disciplines and sectors.
In addition to revealing which investments were the most promising for impact, it also forced us to examine the way we were doing research: who’s involved, how priorities are identified, how findings are disseminated, and why they’re not getting to or being adopted by the very people who would benefit from them most.
The time was well spent, as we came to realize we must transform how we conduct research.
We learned three important lessons that are shaping PTBi California:
- Place matters and is a "divining rod" for preterm birth, with the highest rates corresponding to areas where those with the lowest socioeconomic status reside. For example, 40 percent of Fresno's preterm births occur in a 2-by 5-mile sector with high poverty and poor access to health care.
- Toxic or chronic stress—what people feel when they are overwhelmed by situations over which they have no control—is a major contributor to preterm birth. Living in situations with increased exposure to violence, lack of safe places to live, access to transportation, and healthy food cause toxic levels of stress.
- Including our patients, community members, and advocates as partners is essential to turning the curve on preterm birth. We interviewed hundreds of women and their families to help us ask the right questions and to approach the problem in ways that we never could have imagined had we not engaged them.
The planning process also provided new insights for PTBi East Africa:
- In particular, given the limitations of tools that can reliably and consistently measure gestational age, we realized that we had to refocus from reducing the preterm birth rate to reducing the neonatal mortality rate. While we remain committed to the goal of reducing the burden of prematurity, we have prioritized interventions that reduce morbidity and mortality among preterm babies specifically, with a benefit to all newborns generally. Our in-country stakeholders and our funder, the Bill and Melinda Gates Foundation, agreed that this should be our priority in Uganda and Kenya.
- Our program in Rwanda, however, does offer a unique opportunity to pilot promising strategies for prevention of preterm birth. Through building a strong partnership with our collaborators in Rwanda, we have decided to explore group models of prenatal and postnatal care. If successful, we hope to scale the model across Rwanda and begin exploring group care in Uganda and Kenya.