Addressing social determinants of health key to tackling the burden of preterm births
By Kakaire Ayub Kirunda |
World Prematurity Day is commemorated on November 17 every year. During this very week, the Preterm Birth Initiative (PTBi) holds its annual symposium either in San Francisco, California in the United States or East Africa. This year the symposium was held in San Francisco and I was among the participants from East Africa to attend this week long meeting.
As expected there were presentations on the progress of the studies being undertaken under PTBi in East Africa (Uganda, Rwanda and Kenya) and the State of California. So far so good albeit with some challenges and we shall discuss this in a different article. However, one of the key highlights that caught my attention at the symposium was the following narrative by a woman coming from one of the study communities.
“Let me tell you a story about a woman. A woman, 25 years old, finds out she is pregnant, eight weeks, at ten weeks she’s told her baby has no heartbeat. She grieves. Tries her best to prepare for her loss.
Let me tell you the story of a woman who shows up at the emergency room on the same day her unborn child’s uncle is murdered on a door step. Her baby still has a heartbeat.
A woman who shows up for prenatal care at 12 weeks, introduces and establishes rapport with her care provider, sharing her challenges that she faces. A black woman, a woman who has gone through traumatic event after traumatic event.
A woman committed to prenatal care, committed to having a healthy baby, committed to showing up
A woman who leaves prenatal appointment after prenatal appointment month in and month out, and if you asked her she would tell you that she and her baby are just fine.
A woman who shows up for her prenatal appointment at 32 weeks to be told that she is pre-eclamptic. Now she’ll be admitted to the hospital. She’ll be staying here until she’s induced. A woman who had no idea of what any of that meant.
A woman who gave birth to a child at 35 weeks, 4 pounds 11 ounces and must leave their child in the hospital for a period of nine days.
A woman, strong woman, but uninformed woman. Now imagine that woman showing up for their initial prenatal visit and her provider listening to her story and the unique challenges that she faces that will have effect on her outcome. Imagine her provider knowing her being African-American made her at risk. Her being highly stressed made her triple time at risk… these circumstances make me emotional…”
If it were not for the unit of measurement used for weight (the pounds and ounces) and the description of race (African-American) in the narrative, you would think that these anecdotes came from a woman staying somewhere on the African Continent. Ironically, just like the women she was referring to in her narrative, the narrator was an American citizen residing in California – one of that country’s top ten richest states.
A visit to the San Francisco Black Infant Health Program during the week and more testimonies from African-American women who have given birth to preterm babies further made me appreciate the challenges of this section of the US Population. Chronic stress, social isolation, limited access to services, racial inequities, and economic hardship dotted testimony after testimony.
I also learned that in 2016, California’s preterm birth rate was 8.6 percent, described “as an increase from 2015 and a six-year high.” In this same State, African American women have the highest rate of preterm births at 11.8 percent, which is 46 percent higher than the rate among all other women.
In my own country Uganda, the preterm birth rate stands at 14 percent and preterm birth related complications contributing to one third of newborn deaths. The social determinants of health in Uganda are not any different from those cited in California. Yet some studies have indicated that the cited social determinants of health can modify how genes in a woman’s body are expressed and these differences can affect pregnancy length.
Where do we go from here?
As clinical interventions take centre-stage, beyond these, if I may borrow from the thinking of the University of California San Francisco Chancellor Sam Hawgood, a multi-pronged approach involving partnerships and collaborations to address the health inequities brought about by social determinants of health will be vital in registering progress towards addressing the preterm birth burden around the world.