Dr. Larry Rand is spearheading preterm birth efforts nationwide. Photo Credit: UCSF

Dr. Larry Rand speaks with passion and purpose. As the director of Perinatal Services at the UCSF Fetal Treatment Center, he has a responsibility to care for very young lives and be an advocate for, and on behalf, of mothers. In his position as an obstetrician and gynecologist, specializing in maternal-fetal medicine and high-risk pregnancy – the life of the baby and mother is vital to him.

On Sept. 1st, he served as the keynote speaker at the fifth annual State of our Children breakfast, hosted by the Children’s Movement of Fresno.  There, he talked about the important role that the collective impact approach will play in reducing preterm birth rates in Fresno County.

The Fresno County Preterm Birth Collective Impact Initiative, a local collaborative effort to reduce the number of babies born prematurely in Fresno County, has been making waves in the Valley since it was first introduced in 2015.

The Fresno initiative is part of the larger $100-million, 10-year Preterm Birth Initiative (PTBi) led by UCSF, and funded by Lynne and Marc Benioff and the Bill and Melinda Gates Foundation. Fresno County is one of six sites selected for the Preterm Birth Initiative, and the only site implementing the collective impact model. Alameda County and San Francisco are the other two U.S. locations, with international sites that include Kenya, Rwanda and Uganda.

Dr. Rand speaking at the State of our Children breakfast, Sept. 1, 2016.

The Central California Center for Health and Human Services at Fresno State serves as the backbone organization, helping to drive all major local efforts of the initiative.

As the principal investigator, Dr. Rand has taken a lead role in this very important project. We talked to him about some of the local efforts:

CHHS: What is the impact of preterm birth?

Larry Rand:  Preterm Birth is a massive health problem. 15 million preterm births occur worldwide each year, and one million preterm babies do not survive. In fact, prematurity is now the leading cause of childhood death (under 5 years old) across the world.

CHHS: Why act now?

Larry Rand:  Although we have been doing research on prematurity for many years, we haven’t made NEARLY the progress we need to, and have never seen more alarming statistics. Of the 14 million children who survive each year, the majority face major health risks: making it to their first birthday; childhood complications; and adult diseases like high blood pressure, diabetes, and obesity.

CHHS: What is the importance of the mother’s health?

Larry Rand:  When you look carefully at the risk factors for prematurity, it’s clear that they span a woman’s reproductive life course — including high blood pressure, diabetes, obesity, her diet, substance/medication use, environmental exposures, and especially her general health before pregnancy, even how far apart her pregnancies are spaced, and once she’s pregnant, how early and often she gets prenatal care, the quality of that care, and availability/implementation of any existing interventions that might help reduce her risk. During labor and birth, being in the right hospital and getting the right care make all the difference for outcomes, and of course, the care of a preemie is extremely complicated and also very much determines outcomes.

CHHS: Why was Fresno one of the six sites selected internationally?

Larry Rand:  The statistics in Fresno County are unfortunately alarming — it has one of the highest number of preterm births in the state, costing over $78 million annually. It also has some of the most dedicated and “can-do” leaders we have ever met, who are willing to come to the table, roll up their sleeves and work together to try to change these terrible statistics. The question for us quickly became “how could we not chose Fresno?”.

CHHS: Why enact collective impact efforts for this particular area?

Larry Rand:  The PTBi could only formally support a major collective impact effort in one county and it was clear that Fresno was the place that needed it most — but also had incredibly motivated and willing senior leaders who are among the most energetic “can-do” people I have ever come across! It has been an honor to get to know the members of this incredible Steering Committee, who are all doing what they do for the right reasons, who care about the mothers/babies and families of Fresno and want to see a better future and outcome at one of the most critical moments in any child/person’s life — the beginning of life!

We firmly believe that by working together effectively, we can address social- and health-system disparities across the county and demonstrate to the rest of the state and nation how to turn the curve on this stubborn and tragic epidemic.

CHHS: What are ultimate goals of the PTBi efforts?

Larry Rand:  The Steering Committee has set its goal of ensuring that all women in Fresno County are in the best health before, during, and after pregnancy (across the “reproductive life course”) so that more babies are born healthy. With the support of the Central California Centers for Health and Human Services, we will engage many key stakeholders — affected women and communities, government, businesses, schools, universities, community colleges, churches, nonprofit organizations, and healthcare providers, and monitor our progress. We will adjust the strategy as needed so that by 2025, many fewer babies will be born prematurely in Fresno County as a result of good health for all women before, during, and after pregnancy.

The next few months will offer more opportunities to learn about preterm birth. On November 17, Fresno State will host World Prematurity Day to bring awareness to this health concern that affects so many women and children right here in the Valley. Stay connected to the College of Health and Human Services blog for the latest information!



Fresno Bee: Fresno County picked for global initiative to reduce preterm birth (5/29/15)

Fresno State News: Fresno County Preterm Birth Initiative names new director (7/18/16)

Jweekly.Com: Labor of love: UCSF’s ‘billboard doctor’ leads study on infant mortality (6/26/14)