Preterm birth, defined as delivery before 37 completed weeks of gestation, remains a major public health concern in the United States. In 2023, nearly one in ten U.S. infants (approximately 374,000 babies) were born preterm, and more than 15% of these were born before 32 weeks, placing them at very high risk for morbidity and mortality. Florida’s burden is even higher, with nearly one in nine births occurring preterm, translating into hundreds of affected families each week across the state.1
Preterm birth is not only common but also life-threatening. According to the March of Dimes, complications related to prematurity and low birthweight account for over one-third of infant deaths nationwide, making it the second leading cause of infant mortality, surpassed only by congenital anomalies.2 Infants who survive often experience lifelong consequences, including cerebral palsy, neurodevelopmental delays, and learning disabilities.3
The economic impact is similarly substantial. Preterm and very low-birthweight infants frequently require prolonged neonatal intensive care unit (NICU) admissions, with average stays exceeding six weeks for very preterm infants.4 In 2021, the mean cost of a single NICU admission exceeded US$70,000, and lifetime societal costs related to preterm birth in the U.S. have been estimated at over $25 billion annually, driven by health care utilization, special education, and lost productivity.5
Against this backdrop, the Central Hillsborough Healthy Start (CHHS) program in Tampa, Florida, offers compelling evidence that preterm birth is preventable with well-designed policy interventions. Serving a population characterized by elevated risk—including young, Black, unmarried, and low-income mothers—the program has consistently demonstrated approximately 30% reductions in preterm and low-birthweight births among high-risk participants, with sustained benefits documented from 2008 through 20206.
A cornerstone of the program’s success is early risk identification. CHHS employs Florida’s standardized Healthy Start prenatal risk screening at the first prenatal visit. This validated tool effectively identifies pregnancies at heightened risk while minimizing unnecessary referrals, ensuring efficient allocation of limited resources.7 Early detection allows tailored interventions long before complications emerge.
Following screening, participants receive nurse-led home visits, coordinated prenatal and postpartum care, mental health screening, and education focused on modifiable risk factors such as smoking, substance use, obesity, diabetes, and hypertension—all well-established contributors to preterm birth.8 The program also emphasizes interconception care, promoting optimal birth spacing, a critical factor given evidence that short interpregnancy intervals significantly increase preterm birth risk.9
Importantly, CHHS integrates medical and social services through strong community partnerships, including WIC programs and local health organizations. A coordinated referral and follow-up system ensures continuity of care, even when funding streams change.
County-level outcomes reflect these efforts. Hillsborough County’s preterm birth rate consistently falls below state and national averages, translating into fewer NICU admissions and millions of dollars avoided in health care costs annually. Gains are particularly notable among Black mothers, single mothers, and individuals with obesity—groups historically experiencing the greatest disparities.
The Central Hillsborough Healthy Start program demonstrates that health inequities are not inevitable. With early screening, personalized support, and sustained investment, communities can significantly reduce preterm birth, improve infant survival, and lower long-term societal costs. This model offers a practical, scalable blueprint for states and counties seeking evidence-based solutions to one of maternal–child health’s most persistent challenges.
References
- CDC. Preterm Birth. Centers for Disease Control and Prevention; 2024.
- March of Dimes. Premature Birth Report Card. March of Dimes; 2023.
- Blencowe H, et al. Born too soon: the global epidemiology of preterm birth. Reprod Health. 2013;10(Suppl 1):S2.
- Raju TNK, et al. Length of stay and outcomes for very preterm infants. Pediatrics. 2017;139(2):e20161635.
- Mangham LJ, et al. The cost of preterm birth throughout childhood. BJOG. 2009;116(1):105–112.
- Healthy Start Coalition of Hillsborough County. Program Evaluation Reports. Tampa, FL.
- Florida Department of Health. Healthy Start Prenatal Risk Screen Validation. Tallahassee; 2018.
- Goldenberg RL, Culhane JF. Low birth weight in the United States. Am J Clin Nutr. 2007;85(2):584S–590S.
- Conde-Agudelo A, et al. Birth spacing and risk of adverse perinatal outcomes. JAMA. 2006;295(15):1809–1823.
Read more...