Still too many babies born too soon for Fresno County to celebrate this report card

Fresno County no longer has the highest preterm birth rate in California.

The county’s rate of preterm births decreased from 10.1 percent in 2017 to 9.2 percent in 2018, ranking it No. 2, behind Kern County’s preterm birth rate rate of 9.5 percent, according to the latest March of Dimes Premature Birth Report Card released Thursday.

Prematurity puts infants at increased risk of death before their first birthday or a lifetime of disabilities. The March of Dimes, which rates and grades states and counties for preterm births, said rates in 2018 worsened in 30 states. The organization gave California a grade of “B” for a preterm birth rate of 8.7 percent, the same grade it received in 2017 when the rate was 8.6 percent.

Fresno County received a “B” in 2018 from the March of Dimes, an improvement from the “C” it got in 2017. But disparities within the African American community remain a key issue in Fresno and the state.

The preterm birth rate for black women in California is 44 percent higher than the rate among all other women and 55 percent higher than white women, the March of Dimes said. The preterm birth rates in the 100 U.S. cities with the most births is a “tale of two cities,” the organization said, citing the Fresno preterm birth rate of 9.4 percent being 71 percent higher than the 5.5 percent for Irvine, which had the lowest rate among the 100 cities.

The decrease in Fresno County’s preterm birth rate to 9.2 percent would seem worthy of celebration — the county had the highest rate in California in 2016 and 2017 — but health leaders tempered their responses, saying disparities in the preterm rates for black infants continue to persist, despite community efforts to improve them.

Education is key

“We’re going in the right direction, although we still have to work to do,” said Amber Costantino, spokeswoman for the Fresno County Preterm Birth Initiative. The initiative is a 10-year effort led by UC San Francisco that was created in May 2015 with funding from the Lynne and Marc Benioff and Melinda and Bill Gates foundations. The initiative’s priorities are health and education before pregnancy, care and support during pregnancy and coordination of care.

Fresno County has had the highest black infant preterm birth rate in California. And it remains so, although the rate decreased from 15.4 percent in 2013-2015 to 14.9 percent in 2014-2016, the latest statistics available.

Costantino said the initiative is focusing on reducing the black preterm birth rate. An African American Parent Council made recommendations, including the need for family-focused and youth-focused resiliency programs, and there now is a program for African American women and one for African American men, Costantino said.

The initiative also is focusing on the effects of structural barriers and structural racism on preterm birth rates, Costantino said. For example, historical “redlining” policies that prevented black families from getting home loans to buy homes affected their health as well as birth outcomes. Reducing premature births will take work “at the system level,” she said. “It has to be shifts in health care, the economy and housing.”

And the issue of “culturally respectful care” will be addressed, Costantino said. “We know that is one issue this (parent council) group wants to take on.”

Caring for pregnant women

John Capitman, executive director of the Central Valley Health Policy Institute at Fresno State, said racism causes stress for pregnant women of color, and stress is a risk factor for preterm birth. “I think our unfortunate tradition of institutionalized and interpersonal racism means women of color experience disrespectful and ineffective care that continues to be a challenge.”

Fresno County is making strides to reduce preterm birth, but more can be done to improve the living environments of pregnant women, said Shantay Davies, March of Dimes maternal and child health director for Fresno and counties from San Joaquin to Kern.

Davies said the March of Dimes also is working with West Fresno Family Resource Center to implement a birth spacing project (time between pregnancies) for women in the 93706 ZIP code that also will address maternal depression and smoking.

And another March of Dimes grant, through UCSF Fresno, will provide care delivered in the pediatrician’s office. “We know lots of moms miss their appointments, but what they do is they take their kids to the doctor,” Davies said. “We can capture them during their well-child visits and we can take care of the moms at the same time.”

And Fresno County is one of 15 jurisdictions with Black Infant Health programs that will receive more funding to expand home visitations and other services under the California Perinatal Equity Initiative, Davies said. Home visitation and Black Infant Health programs have a very positive effect on preterm births, she said.

The funding will allow Fresno County to increase or add services that support pregnant women, said Rose Mary Rahn, maternal, child and adolescent director at the Fresno Couny Department of Public Health. “We think that’s a step in the right direction.”