Jump in preterm birth stirs concern
2nd straight year of rise, with minority risk worse
Rates of preterm birth rose both nationally and in California for the second year in a row, a worrying trend that disproportionately affects communities of color and low-income areas.
Numbers released Nov. 1 show that the national rate of preterm births — defined as births that occur at less than 37 weeks of gestation — rose from 9.6 percent in 2015 to 9.8 percent in 2016. In California, the rate was 8.6, up from 8.5. Babies born prematurely have a higher risk of mortality and face risks of health complications.
Lawmakers, physicians and community advocates expressed concern about the problem at a news conference called Wednesday at San Francisco City Hall to draw attention to the issue, commend research by the UCSF Preterm Birth Initiative and commemorate Prematurity Awareness Month.
“People are often shocked when we share that prematurity is the leading cause of death in children under the age of 5 worldwide,” said Larry Rand, principal investigator for the UCSF initiative, a multiyear research effort aimed at reducing premature births in Califor-
nia and East Africa.
It remains unclear why the rise in premature births is occurring, said Laura Jelliffe-Pawlowski, a lead researcher for the UCSF initiative, but one hypothesis is that there has been a rise in stress factors within high-risk communities.
“Psychosocial stress is at the base of it,” Jelliffe-Pawlowski said. “So really, we think it’s a rise in psychosocial stress in particular, and specifically things like segregation and structural racism, but also we hear more and more, especially from women of color, how shut out they feel of the medical system.”
She noted that the rise is occurring despite more research money being devoted to the issue.
The group’s research in San Francisco, Oakland and Fresno has highlighted inequalities in preterm birth rates based on race, ethnicity, income level and ZIP code.
“Frankly, black babies are dying in our community at two to three times the rate of white babies,” Rand said. “That’s in a city with the same resources, the same cutting-edge technology and medical capability that’s supposedly available for all. If nothing else, how do we close that gap?”
Major risk factors for preterm birth include hypertension, diabetes, mental illness, and drug or alcohol abuse, Jelliffe-Pawlowski said. The UCSF initiative seeks to integrate research that ranges from the cell-level to the societal level, and link it to location to better understand how different communities are affected.
Researchers have created maps to depict the disparities. The highest rates are in the Bayview neighborhood of San Francisco among African American women. Jelliffe-Pawlowski said that for white women in Nob Hill, the rate of preterm birth is about 4 or 5 percent, whereas the rate for black women in the Bayview is as high as 12 to 15 percent.
Brianne Taylor, 26, works for the initiative as a community innovator — a researcher and ambassador to the most affected communities.
“I am of the demographic most affected by this epidemic,” said Taylor, an African American woman from a low-income community. One of the major environmental factors that she had experienced and observed in the Bayview was housing insecurity.
She said that in interviewing pregnant women, she’d heard stories of landlords evicting women from residences when they got pregnant and of homeless pregnant women being denied shelter or waiting in long lines in the cold.
“I was floored by the level of neglect these women received, be it from landlords, medical personnel or providers of desperately needed programs,” Taylor said.
Several local politicians called for San Francisco to be on the forefront of the issue and likened it to the city’s leadership in the HIV/ AIDS crisis of the 1980s and ’90s.
“There is a message of hope in all of this,” said San Francisco Supervisor Malia Cohen, “but we do have to roll up our sleeves and stop denying the data, and pay attention and get to work.” Sophie Haigney is a San Francisco Chronicle staff writer. Email: sophie. haigney@sfchronicle.com Twitter: @SophieHaigney