Giving More Babies a Healthy Start in Life: An Anthem Foundation & March of Dimes Collaboration to Reduce Preterm Birth

One in every 10 babies born in the United States is born prematurely,¹ and prematurity is the leading cause of death for newborns.² Babies born prematurely—before 37 weeks gestation—can face numerous short- and long-term health issues, including breathing problems, difficulty with feedings, cerebral palsy, developmental delays, and vision and hearing impairments.³

Following eight years of steady decline,⁴ the U.S. preterm birth rate rose in 2015 to 9.6 percent.⁵ Racial and ethnic disparities and geographical variations in these preterm births are widespread.⁵ Black women experience higher rates of preterm births than the national average.⁵ The Pacific Northwest has the lowest preterm birth rate, while southern states have the highest rates. In addition to the unfair toll on babies and their families, premature birth accounts for more than $26 billion annually in avoidable medical and societal costs.⁶

Investing in Healthy Maternal Practices

Anthem Foundation—the philanthropic arm of Anthem, Inc.—is an active partner in the fight to improve public health through its Healthy Generations program, a multigenerational initiative to provide charitable contributions to improve public health and produce measurable impact. The Foundation used their state-by-state compilation of public health measures to identify key focus areas that were in need of charitable giving and attention. After selecting maternal and newborn health as one of the key areas, Anthem Foundation began working to reduce low birth weight and preterm births across 15 of the markets where Anthem, Inc. does business.

Since 2010, the Anthem Foundation has provided more than $4.3 million in grant funding to the March of Dimes to scale up and implement several programs that encourage and facilitate first trimester prenatal care and help at-risk mothers commit to behaviors that reduce the numbers of low-birthweight babies. These programs include a group prenatal care model called CenteringPregnancy® (CP), smoking cessation programs, quality improvement initiatives related to the elimination of early elective deliveries, and Healthy Babies are Worth the Wait Community Programs®.

Prenatal Care with Peer Support

CenteringPregnancy® (CP) is a group prenatal care model that has demonstrated positive maternal and infant outcomes, including lower preterm birth rates, higher satisfaction with care and higher breastfeeding rates, compared to traditional prenatal care.⁷The program brings together 8 to 10 women with similar due dates, and from all races, ages and socio-economic backgrounds.

Women receive the recommended 10 prenatal visits,⁸ however each visit can last between 90 minutes and 2 hours, allowing participants 10 times more face-time with their providers than traditional prenatal care.⁸ Women participate in their health assessments by taking their own blood pressure and weight. After individual health assessments and consultations are complete, the women “circle up” with providers and support staff to form an interactive and facilitated discussion group. Discussion topics and educational material can range from nutrition and common discomforts during pregnancy, to labor and delivery, to breastfeeding and infant care post-delivery.

Studies have demonstrated the program's benefits including a recent 5-year retrospective study from the University of South Carolina that found a CP pilot program in South Carolina reduced premature births by 36 percent and reduced NICU stays by 28 percent.⁹ The study also highlighted the potential cost-savings of the program: $22,667 for every premature birth prevented.

Over the past year, Anthem Foundation's collaboration with March of Dimes has supported CP at more than 30 prenatal care sites in 12 states (Fig. 2) and enroll more than 3,000 women in a CP prenatal care group. These specific groups met for an average of eight or nine sessions and had approximately nine women each. Most women (86 percent) started CP by 26 weeks of pregnancy, and 7.4 percent delivered preterm (<37 weeks), lower than the U.S. average of 9.6 percent. Participants were diverse across educational levels, and racial and ethnic groups: 47 percent were Hispanic, 31 percent were African American, 18 percent were Non-Hispanic white, and 68 percent of the participants had a high school education or less.

Additionally, Anthem Foundation has provided funding and support directly to the Centering Healthcare Institute (CHI)—an organization that works to expand access to Centering programs by supporting participating clinical practice sites through training and implementation support as well as advocacy.¹⁰The funding support has helped CHI to bolster its data collection, reporting and communications in an effort to raise awareness and pinpoint the impact of CP—including enhancing CHI’s data collection tool, system programming and development, IT infrastructure, website design, and reporting.¹¹The tool will be accessible through the CHI website and mobile applications, improving the quality of data collected, supporting reporting compliance, reducing burdens due to data maintenance, and archiving evidence that can be used to evaluate program impact.

Smoking Cessation During Pregnancy & Beyond

In 2015 nearly 14 percent of adult females were current smokers,¹² and a National Vital Statistics Report found that 8.4 percent of pregnant women smoked at some point during pregnancy.¹³ Research has shown that babies born to women who smoke during pregnancy are more likely to have birth defects, low birth weight or be premature compared to babies born to nonsmokers.¹⁴ While not all preterm births can be prevented, one way pregnant women can reduce their risk for delivering early is by not smoking during pregnancy. To make smoking cessation programs more accessible, Anthem Foundation collaborated with March of Dimes to implement programs in Florida and Wisconsin.

In the Tampa, Florida area, funding supported a collaborative effort between The Smoking Cessation Reduction in Pregnancy Treatment (SCRIPT) program and the Healthy Start Coalition of Hillsborough County. Designed to effectively help pregnant women quit smoking, the SCRIPT program can be integrated into a broad patient education program for prenatal providers.¹⁵ This award-winning and evidence-based program provides several intervention components including a guide to quitting smoking, a multi-language Commit to Quit DVD, comprehensive counseling, and follow-up care to maintain a smoke-free home. Healthy Start staff provide SCRIPT smoking cessation services through their home visiting program. Seventy-one Healthy Start staff have received training in the SCRIPT model and more than 200 pregnant women who screened positive for smoking received smoking cessation direct messaging and counseling.

In Wisconsin, a local tobacco cessation program called First Breath was used to train nearly 120 providers at 16 health care settings in 2016. First Breath is free to pregnant women and provides one-on-one counseling and personalized goal setting.¹⁶ With the help of Anthem Foundation funding, more than 90 pregnant women received smoking cessation counseling and education and 43 of these women also enrolled in Text.Connect.Quit to receive four texts per week to aid in cessation goals. Seventy-three percent of women participating in First Breath reduced or quit smoking before delivery.

Collaborative, Community-Based Programs

March of Dimes has also continued to scale and spread the Healthy Babies Are Worth the Wait® (HBWW) program—a collaborative initiative that integrates public and clinical health, improves systems of care, and reduces preterm birth through a range of interventions, including smoking cessation programs and CenteringPregnancy®. Launched in Kentucky in 2007 as a collaboration between March of Dimes, Johnson & Johnson Pediatric Institute and the Kentucky Department for Public Health, HBWW has now spread to ten additional sites.

HBWW is aimed at reducing preterm birth by:

• Increasing access to prenatal care
• Strengthening care coordination for patients
• Optimizing access to evidence-based interventions

Anthem Foundation supported HBWW in New Jersey (Newark and Burlington), New York (Queens), and at several locations each in Kentucky and Kansas. Each site selects interventions to implement based on local needs. Many sites are implementing CP and smoking cessation programs. Some are focused on quality improvement initiatives to reduce early elective deliveries and on increasing access to progesterone shots, known as 17P, which may help prevent preterm delivery for women with a history of premature births. Across the four states, this program provided direct services for 3,700 pregnant women and professional education for 916 providers. In addition, program sites reached over 38,000 individuals through community awareness campaigns.

Supporting Healthy Pregnancies, Preventing Preterm Birth

The recent rise in premature births illustrates the continued need for programs like those offered by March of Dimes. This startling statistic, coupled with the Anthem Foundation-March of Dimes collaboration's impressive program results, has resulted in a renewed commitment from Anthem Foundation to March of Dimes. In 2017 the organizations’ long-standing effort will continue to expand the programs' reach through a new $1.1M grant providing necessary funding to implement these evidence-based programs in 19 states.¹⁷