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 Healthy Beginnings with Title V: Preterm Birth Priming and Planning

Healthy Beginnings with Title V: Preterm Birth Priming and Planning

AMCHP and birth equity thought leaders developed resources and held conversations to uncover the unique power and flexibility of the Title V MCH Services Block Grant to pull intention and resources related to preterm birth prevention (and improving maternal and infant health outcomes generally) deeper into the roots of racial injustice. Through four webinars and issue briefs, we identified ways to achieve mom-baby dyad wellness by centering health equity and community co-creation in every step of the program planning cycle. This included understanding root causes of racial disparities in preterm birth across the country and by race and geography, supporting emancipatory community engagement in data inquiry, analysis, and translation, and forming equitable partnerships with community-based organizations as the foundation for efforts that advance health equity in birth outcomes. The final webinar and issue brief concludes by highlighting recommendations of actions that Title V programs can take to partner with Black-women led community-based organizations leading in achieving holistic community wellbeing. During this partnership, AMCHP also convened a national meeting of public health, health care, and community thought leaders and institutional partners with a role in preterm birth prevention. Participants in the meeting created recommendations for embedding anti-racism into Title V policies and structures as an essential process to achieve a collective vision: Every parent and baby has the optimal conditions, support, and agency to arrive at full-term, ready to thrive every time.

The COVID-19 pandemic highlights the urgency to adopt racial equity-centered approaches. The disproportionate and unjust impact of COVID-19 on communities of color is a direct result of decades of public health and governmental policies that concentrate advantage in White communities. Governmental public health institutions operate predominantly from a White racial frame, and as a result most programming and resource allocation is based on White racial dominant narratives and biases. This project sought to intentionally identify ways that Title V programs can transfer power to communities most impacted by inequitable governmental and public health policies.

Engaging the Power of Title V for Equity in Preterm Birth Prevention Issue Brief Series

AMCHP, with collaboration from several partners, created a four-part series of issue briefs that explores the unique power of the Title V Maternal and Child Health (MCH) Services Block Grant to support anti-racist strategies and intentionally address the roots of racial injustice in maternal and infant health, including the prevention of preterm birth. Each issue brief describes how MCH programs can disrupt structural violence and shift power toward the expertise of people who birth, communities, and the organizations a community trusts to implement solutions.  

The Oregon Preterm Birth Rate in Context: Zooming in Spatially and Racially
Supporting Contextualized Resilience as a Buffer to Structural Violence and Bridge to Healthier Birth Outcomes
Transforming Approaches to Qualitative and Quantitative Data for Optimal Community Impact
Recommendations for Title V Programs: Co-Creating an Equitable Future with the Wisdom of Communities
Engaging the Power of Title V to Understand and Intervene in Preterm Birth Webinar Series

 Definitions and Trends in Preterm Birth

In a webinar titled "Healthy Moms Strong Babies: Tools for MCH Professionals to Address Prematurity" the presenters share foundational information on the status of preterm birth in the United States. March of Dimes speakers, Dr. Lisa Waddell, MD, MPH and Mr. Roland Estrella, MBA present basic information on case definitions, relationships and trends in infant mortality and preterm birth, and disparities in preterm birth, including disparities stratified by race and geography. They will also present the recently released 2019 March of Dimes Report Cards.

In this webinar, participants:

  • Learn about current trends in preterm birth, its relationship with infant mortality, and disparities in preterm birth outcomes
  • Develop an understanding of current trends in preterm birth, the methodologies and processes behind the March of Dimes Report Cards, and how these impact state Title V programs

This webinar took place on January 9, 2020.

Presentation Slides    Video

 Emerging Research in Preterm Birth

​In her webinar titled "Racism as a Root Cause for Preterm Birth: Considerations for Achieving Reproductive Health Equity" Dr. Monica McLemore from the University of California-San Francisco Preterm Birth Initiative (UCSF PTBi) discusses research findings elucidating the root causes of preterm birth. This session focuses on the necessity of digging deeper to explore the disproportionate distribution of risk factors across communities and social and cultural contexts. Dr. McLemore discusses research about toxic stress and resilience.

In this webinar, participants:

  • Gain a deeper understanding of the existing and ongoing research about the causes for and impacts of toxic stress and resilience on preterm birth
  • Engage in a discussion about the typical approach to researching preterm birth and the need to explore root causes

This webinar took place on February 4, 2020. There were technical difficulties in the recording of this webinar and video is not available. Individuals can listen to the audio while viewing the slide deck.

Presentation Slides    Audio

 Opportunities in Qualitative and Quantitative Data

​This webinar brings together Alexis Cobbins, Associate Director of the California Preterm Birth Initiative and AMCHP's Associate Director of Epidemiology and Evaluation, Dr. Cheryl Clark. Ms. Cobbins presents the Research Prioritization by Affected Communities (RPAC) Protocol and discusses the necessity of qualitative approaches, including being led by the wisdom of individuals with lived experience in efforts to understand preterm birth and prioritize action for intervention. Dr. Clark provides supplemental information on assessing existing data sources for inclusion and relevancy, explores new data sources or data elements, and discusses the importance of having input into how and what is being collected and by whom.

In this webinar, participants:

  • Explore the necessity of qualitative approaches related to preterm birth and understand one protocol for engaging individuals with lived experience that centers affected communities in research design
  • Think creatively about the limits and possibilities of existing data sources
  • Recognize the importance of providing input into the design of data collection systems/processes, data utilization, and data translation/communications.

This webinar took place on February 20, 2020.

Presentation Slides    Video

 Prioritizing Action in Preterm Birth

​This webinar brings together Aza Nedhari, Co-Founder and Executive Director of Mamatoto Village, Jennie Joseph, Founder and Executive Director of Commonsense Childbirth, and Jeretha McKinley, Interim Executive Director of HealthConnect One. Ms. Nedhari, Ms. Joseph, and Ms. McKinley present on their organization's unique community-based programs and their approach to maternal and infant wellness and preterm birth prevention. They also make recommendations for Title V programs who want to take action to change the systems that perpetuate inequities in preterm birth that disproportionately affect Black women in America.

In this webinar, participants:

  • Increase knowledge of key community-based programs and efforts tackling racial disparities in birth outcomes through equitable approaches
  • Identify actions Title V programs can take to support community-based organizations best positioned to address the inequities in our systems that produce racial disparities in preterm birth and other birth outcomes

This webinar took place on May 19, 2020.

Presentation Slides    Video


Strategic Action to Prevent Preterm Birth Meeting

On March 12-13, 2020 AMCHP convened a national meeting of public health, health care, and community thought leaders and institutional partners with a role in preterm birth prevention. The design of the meeting was co-created with thought leaders Brenda Blasingame, Alexis Cobbins, Jennie Joseph, and Aza Nedhari and was facilitated by AMCHP CEO Jonathan Webb.

The goal of the meeting was to develop joint strategic actions to improve birth outcomes for the mother-baby dyad, particularly related to preventing preterm birth. To do this, the group first came to a clear vision, a north star, for effective preterm birth prevention. This north star was rooted in a reproductive justice framework and specifically centered eliminating racial disparities in health outcomes between Black and Brown women and White women and their babies. The group aligned to a single, overarching vision: Every parent and baby has the optimal conditions, support, and agency to arrive at full-term, ready to thrive every time.

The duration of the meeting was spent developing bold, anti-racist strategies for preterm birth prevention in the U.S.  The key strategies developed across four categories (programs, data, policy, and cross-cutting) were:

  • Ensure perinatal and social determinants data inclusive, relevant, and accessible to all stakeholders
  • Invest in comprehensive perinatal data systems for states and community-based organizations
  • Restructure Title V funding requirements to support community-based organization and interdisciplinary perinatal providers with an anti-racist, equity-centered, reproductive justice framework
  • Cover the costs of necessary supports to prevent preterm birth (clinical and non-clinical – the comprehensive perinatal workforce) with public and private funds (governmental and health insurance)
  • Standardize the accountability of health systems to the patient experience

The group identified that additional support is needed in providing continuous anti-racism training within state and governmental public health institutions. As the meeting concluded, participants were eager to formalize the coalition and continue to work nimbly together to dismantle racism in governmental public health systems and structures. The participants wanted to move toward an anti-racist practice rooted in a reproductive justice framework.

This body of work is a foundational step for future efforts focused on anti-racist strategies for preterm birth prevention. Stay tuned for updates and opportunities to become active and engaged in the next phase of this work!

This work is made possible with the support of the Pritzker Children's Initiative.