· Executive Brief
Prematurity Awareness Month 2026
A practical executive framework for access, ownership, handoffs, measurement, and improvement.
Leadership signal
Prematurity Awareness Month can serve as an executive operating checkpoint.
Awareness can generate questions and requests for help. Executive teams can prepare by clarifying the first point of contact, the qualified team that accepts the request, the handoff standard, and the method used to verify completion without assuming that one route fits every person.
Start by distinguishing what is known from what the organization still needs to learn. A campaign plan, communication volume, or meeting count does not establish that a route is usable. Leaders need direct listening, clear ownership, locally defined measures, and a method for keeping exceptions visible.
Executive opening
Preterm birth is the end point of an operating chain
Preterm birth is usually discussed as a clinical event in a delivery room or a neonatal intensive care unit. For health-system leaders, it is better read as the end point of a long operating chain. That chain runs through coverage, prenatal access, risk identification, birthing-site capacity, neonatal triage and the first weeks after discharge. Each link needs an owner, and each can fail quietly until an infant is born early or a family is lost to follow-up.
The national picture is not improving for every group. Among U.S. households below the federal poverty level, the preterm birth rate rose from 9.7% in 2011 to 11.1% in 2021.[13] Among households at 100% to 199% of that level, it rose from 7.8% to 10.0%, and non-Hispanic Black mothers had the highest rates in every income category.[13] Those trends point to structural exposure that a single clinic or campaign cannot absorb.
Access to the places where care happens is also changing. After hospitals closed all in-county obstetric services between 2010 and 2021, travel time to the nearest obstetric hospital rose by 13.8 minutes on average.[11] The increase was 16.9 minutes in rural areas, compared with 10.3 minutes in urban areas.[11] Executives deciding on service-line consolidation are therefore making perinatal access decisions, whether or not the decision is framed that way.
Prematurity Awareness Month gives leaders a reason to examine the chain end to end. The sections below summarize recent peer-reviewed evidence on burden, risk stratification, coverage timing, unit closures, neonatal triage, discharge follow-up, equity and measurement. They sit beside the executive guidance already on this page. Their purpose is to give boards and operating teams a shared factual base for deciding where to act first.
Current evidence
Where preterm birth risk concentrates and how well it can be predicted
Preterm birth risk is distributed unevenly by place. A national study of 2,122,789 singleton Black or White births in 2023 grouped 3,123 U.S. counties by social vulnerability.[12] In the least vulnerable quartile, preterm birth rates were 9.8% for Black births and 7.8% for White births.[12] In the most vulnerable quartile, the rates were 12.2% and 8.6%, and the racial gap widened as vulnerability rose.[12]
Local analysis shows which factors carry that gap. Among 1,847 Black and White women recruited at delivery in greater Houston between 2021 and 2023, Black mothers had a 6.6% higher prevalence of preterm birth.[7] Measured variables explained 63.0% of the disparity, led by perinatal history at 36.3% and neighborhood characteristics at 32.8%.[7] Living in a more racially minoritized and economically disadvantaged neighborhood accounted for 19.2%, and a previous pregnancy complication for 18.5%.[7] A hypertensive disorder in the index pregnancy contributed 16.7%, and chronic hypertension before pregnancy contributed 16.8%.[7]
Income does not close the gap on its own. In a nationally representative survey of 411,469 mothers, non-Hispanic Black mothers in the lowest income group had a 19% greater risk of preterm birth than non-Hispanic White mothers.[13] In the highest income group, the excess risk was still 13%.[13] The authors concluded that race moderated the association between income and preterm birth and called for examining the role of racism.[13]
Prediction from routine birth data is only moderately sharp. In 3,004,719 complete-case singleton pregnancies from the 2024 national natality file, 8.8% were preterm, and a risk model reached a c-statistic of 0.634.[2] At a 10% predicted-risk cutoff, 17.7% of pregnancies were flagged, and their observed preterm birth rate was 16.9%.[2] Higher cutoffs selected smaller, more enriched groups while capturing fewer preterm births, and the author stated the threshold was not a screening recommendation.[2]
For executives, the pattern is consistent. Risk concentrates by neighborhood, history and social position, while routine prediction identifies only part of it. That argues for reliable prenatal access across whole populations, with risk tools used to direct attention rather than to ration it. It also argues for local analysis, because neighborhood characteristics explained nearly a third of the gap in the Houston study.[7]
Figure 1
Preterm birth rates are highest where vulnerability concentrates
Preterm birth rate, percent of births before 37 weeks, as reported in each study. Values are copied from the cited studies [10], [12], [13]; none is estimated.
Data note. These values come from three different studies, populations, years and data sources, so this is an indirect comparison; pairs within the same study may be compared, but bars from different studies should be read as context rather than ranked against each other.
Limitation. Rates are unadjusted as reported; the county quartile values are limited to Black or White singleton births, the income value is self-reported survey data, and the Hawaiʻi values are state-reported context in a quality improvement study.
Figure data (5 rows)
| Measure | Value | Population, setting and year as reported | Source |
|---|---|---|---|
| White births, most socially vulnerable county quartile | 8.6% | U.S. singleton births in 2023 across 3,123 counties, highest Social Vulnerability Index quartile | [12] |
| Hawaiʻi statewide | 9.8% | Statewide preterm birth rate reported for Hawaiʻi in a study of a Medicaid-supported perinatal quality collaborative | [10] |
| Households below the federal poverty level, 2021 | 11.1% | Nationally representative survey of U.S. mothers; rate was 9.7% in 2011 | [13] |
| Black births, most socially vulnerable county quartile | 12.2% | U.S. singleton births in 2023 across 3,123 counties, highest Social Vulnerability Index quartile | [12] |
| Native Hawaiian and Pacific Islander women, Hawaiʻi | 12.6% | Reported alongside early prenatal care of 62.7% for the same group | [10] |
Continuum of care
Triage, discharge and postpartum follow-up are where the continuum holds or breaks
The continuum starts before birth, with whether a pregnancy is delivered at a facility matched to its risk. Among 358,155 live births in Arkansas from 2014 to 2023, 76.5% occurred at facilities providing a higher level of care than required.[5] Another 20.1% occurred at risk-appropriate facilities, and 3.3% at facilities providing a lower level of care than required.[5] Under-triage was most common when the nearest risk-appropriate facility was distant, at a mean of 51.2 miles.[5]
The authors concluded that site of care was shaped more by geography, resource distribution and referral structure than by measured clinical risk.[5] They suggested independent transfer triage coordination, preservation of lower-level maternity and nursery capacity, and standardized neonatal intensive care admission practices.[5] Each of those is a system design choice, not an individual clinical decision. None of them depends on new clinical evidence; each depends on agreements between hospitals and the teams that move patients between them.
Discharge is the next fragile handoff. A quality improvement project at a southeastern U.S. regional medical center focused on infants born at 34 0/7 to 36 6/7 weeks of gestation.[1] After staff education and a standardized workflow, scheduled follow-up appointments rose from 52 of 111 infants (46.8%) to 101 of 154 infants (65.6%).[1] Documentation in the discharge summary rose from 42.3% to 64.9%, and in the discharge tab from 25.2% to 54.5%.[1]
That project also shows how much was missing before anyone measured it. More than half of late preterm infants left without a scheduled and documented appointment in the baseline period.[1] The improvement came from iterative Plan-Do-Study-Act cycles and a single place in the record to document appointments, not from new technology.[1] For a health system, the baseline gap is itself the finding: an unmeasured handoff can look reliable until someone counts it.
The continuum also extends to the mother. In a cohort of 3,335 first-time pregnant participants at eight U.S. centers, preterm birth was 45.4 per 1,000 births higher among Black than White participants.[8] Eliminating that preterm birth gap would reduce the Black-White disparity in incident hypertension at a median of three years postpartum by 16.3%.[8] A preterm birth is therefore a signal for coordinated maternal follow-up, not only neonatal follow-up.[8] That makes the discharge plan for a preterm infant a natural place to confirm who will see the mother next, and when.
Figure 3
Why the pathway breaks
People
- Counties without an obstetric clinician
- Fewer pediatricians and mental health providers in maternity care desert states
- Limited staff time for training, drills and follow-up scheduling
Process
- Follow-up appointments not scheduled before late preterm discharge
- No independent transfer triage coordination
- Postpartum maternal follow-up not linked to the preterm birth
Technology
- No single place in the record to document follow-up appointments
- Prenatal care metrics that differ by definition and data source
- Risk models with moderate discrimination used as if they were precise
Environment
- Obstetric unit closures that lengthen travel time, especially in rural areas
- Long distance to the nearest risk-appropriate facility
- High county social vulnerability and neighborhood disadvantage
Policy
- Medicaid enrollment that begins late in pregnancy or at delivery
- Financial pressures on obstetric units
- Quality bundles adopted without targeted disparity-reduction strategies
Measurement
- Outcomes not stratified by race, insurance, language, neighborhood or disability
- Under-triage and follow-up completion not tracked
- Non-native speakers rarely included or reported in neonatal research
Unranked qualitative cause-and-effect diagram for the outcome in the box: Pregnant patients and preterm infants do not reach timely prenatal care, a risk-appropriate birth site and documented follow-up after discharge Causes are assembled from the cited literature [1], [2], [4], [5], [6], [8], [9], [10], [11], [12], [14], [15]; categories are not weighted and their order carries no meaning.
Data note. Qualitative; no frequencies are implied.
Limitation. Causes drawn from published studies may not all apply locally; validate them with frontline teams.
Figure data (6 rows)
| Category | Causes drawn from the cited literature |
|---|---|
| People | Counties without an obstetric clinician; Fewer pediatricians and mental health providers in maternity care desert states; Limited staff time for training, drills and follow-up scheduling |
| Process | Follow-up appointments not scheduled before late preterm discharge; No independent transfer triage coordination; Postpartum maternal follow-up not linked to the preterm birth |
| Technology | No single place in the record to document follow-up appointments; Prenatal care metrics that differ by definition and data source; Risk models with moderate discrimination used as if they were precise |
| Environment | Obstetric unit closures that lengthen travel time, especially in rural areas; Long distance to the nearest risk-appropriate facility; High county social vulnerability and neighborhood disadvantage |
| Policy | Medicaid enrollment that begins late in pregnancy or at delivery; Financial pressures on obstetric units; Quality bundles adopted without targeted disparity-reduction strategies |
| Measurement | Outcomes not stratified by race, insurance, language, neighborhood or disability; Under-triage and follow-up completion not tracked; Non-native speakers rarely included or reported in neonatal research |
Access
Coverage timing, distance and unit closures shape who reaches prenatal care
Access begins with coverage. In a cohort of 913,229 deliveries in Texas Medicaid from 2010 to 2014, 26.4% of women enrolled before conception and 40.0% during the first trimester.[6] Another 14.3% enrolled in the second trimester, 6.1% in the third, and 13.5% at delivery.[6] Most women had their first Medicaid-covered encounter in the same trimester as enrollment, which ties the start of care closely to the start of coverage.[6]
Later enrollment carried measurable risk. Second- and third-trimester enrollment were associated with higher risks of small-for-gestational-age birth, with adjusted relative risks of 1.15 and 1.18.[6] Later enrollment was more common among Hispanic and foreign-born women.[6] Enrollment support, presumptive eligibility workflows and early scheduling are therefore access tools that health systems can influence directly. Coverage navigation that begins at the first contact, rather than at the first visit, addresses part of that gap.
Distance is the second barrier, and it is growing. Across 60,516 census tracts in 3,033 continental U.S. counties, 2.7% of tracts were in a county that lost all hospital-based obstetric services between 2010 and 2021.[11] Those closures were associated with a 13.8-minute average increase in travel time to the nearest obstetric hospital.[11] The authors noted that this is a barrier because almost all U.S. births occur in hospitals.[11]
State-level patterns suggest the effects reach beyond delivery. States where at least 21% of counties had no hospital or birth center providing obstetric services were classed as having a high prevalence of maternity care deserts.[15] Medicaid recipients in those states were about 14% less likely to receive timely prenatal and postpartum care.[15] They also had an 18.34% greater risk of infant mortality and an 8.92% greater risk of low birthweight, although the analysis was descriptive and cross-sectional.[15] The same states had a 34.20% greater risk of maternal mortality.[15]
Distance and prenatal care also appear in community-level studies. Among Montana births from 2014 to 2022, American Indian and Alaska Native individuals had 41% higher odds of preterm birth than non-Hispanic White individuals.[3] Adequacy of prenatal care and distance to deliver were among the factors that partly explained that association.[3] For rural and tribal service areas, the access question is whether prenatal care is reachable, adequate and culturally safe.[3] Leaders can map those three conditions for each community they serve before choosing where to add capacity.
Executive guidance · System route
Build one visible operating route for Prematurity Awareness Month.
Use this route as a discussion framework. Replace each stage with the organization’s approved process, qualified roles, current service capacity, and applicable requirements. Do not infer a clinical protocol from the observance title.
The route at a glance
- Listen
- Clarify entry
- Coordinate the partner route
- Protect transitions
- Verify and learn
Reliability rule: Every stage needs a named owner, an observable status, an approved escalation path, and a defined signal that shows whether responsibility moved or remained unresolved.
Listen
Gather questions and friction points from people using the route, frontline teams, and community-facing staff. Separate observed barriers from assumptions.
Clarify entry
Publish a plain-language first step and identify who receives requests through each approved channel.
Coordinate the partner route
Align internal teams and external partners around one current message, real entry point, receiving owner, escalation path, and follow-through signal.
Protect transitions
Use acknowledgment and status visibility when responsibility moves between services, locations, or organizations.
Verify and learn
Review unresolved work, repeat contacts, and avoidable handoffs. Use the findings to improve the route rather than blame individuals.
Figure 2
The system route as one flow
The five stages of the system route described in this brief, drawn as one flow with a learning loop back to the start. The stages are the page’s original executive guidance, not a clinical protocol.
Data note. Shows sequence and handoffs only; it carries no counts or rates.
Limitation. Local processes may add, merge or reorder stages under organizational policy.
Figure data (5 rows)
| Stage | What the stage requires |
|---|---|
| Listen | Gather questions and friction points from people using the route, frontline teams, and community-facing staff. Separate observed barriers from assumptions. |
| Clarify entry | Publish a plain-language first step and identify who receives requests through each approved channel. |
| Coordinate the partner route | Align internal teams and external partners around one current message, real entry point, receiving owner, escalation path, and follow-through signal. |
| Protect transitions | Use acknowledgment and status visibility when responsibility moves between services, locations, or organizations. |
| Verify and learn | Review unresolved work, repeat contacts, and avoidable handoffs. Use the findings to improve the route rather than blame individuals. |
Equity and trust
Disparities persist across income, place, insurance and language
Equity gaps in preterm birth are not confined to one group or one mechanism. The Montana study found that disparities for American Indian and Alaska Native individuals were larger at older maternal ages, consistent with the weathering hypothesis.[3] The authors emphasized addressing barriers to culturally responsive and safe prenatal care.[3] That is an operating standard health systems can define, staff and measure. The same study found 15% higher odds of low birth weight, and prenatal smoking was another partial mediator.[3]
Quality programs do not automatically narrow gaps. In Hawaiʻi, the statewide preterm birth rate was 9.8%, but Native Hawaiian and Pacific Islander women had a rate of 12.6% and early prenatal care of 62.7%.[10] A Medicaid-supported perinatal quality collaborative helped hospitals implement maternal safety bundles, yet racial and ethnic disparities in severe maternal morbidity persisted.[10] Interviews emphasized infrastructure and adaptation rather than targeted disparity-reduction strategies.[10] The authors concluded that targeted strategies beyond inpatient bundle implementation are likely necessary to reduce disparities.[10]
Insurance shapes where infants are born. In the Arkansas cohort, Medicaid-covered births experienced under-triage nearly twice as often as privately insured births, at 4.31% compared with 2.55%.[5] When the payer mix of a service area predicts whether a high-risk birth reaches the right level of care, transfer agreements and triage rules become equity policy.[5] The authors described a regionalized system that may experience inequitable access and supply-sensitive utilization at the same time.[5]
Language is a less visible gap, and it extends into the evidence itself. A review of 267 completed interventional trials involving preterm infants found that only 1.5% explicitly included non-native speakers.[4] Another 14.2% explicitly excluded them, and 84.3% made no reference to them at all.[4] Exclusion rates were highest in family integrated care studies, at 48.4%, and in trials of parent-infant dyads, at 50%.[4] All four trials that explicitly included non-native speakers were from the United States.[4]
That finding matters for neonatal units that adopt family integrated care. The models may have been tested with few families who speak a language other than the study language.[4] Leaders who stratify their own participation and outcome data by language, insurance and neighborhood can see whether local programs reach the families most exposed to risk.[4][12] In the income study, the association between income and preterm birth attenuated to the null once race and ethnicity entered the model.[13] That finding suggests income-only stratification may understate the gap.
Human infrastructure
Perinatal capacity depends on clinicians, units and the routines they share
Perinatal services are only as reachable as the workforce behind them. A review of maternity care deserts reported that one-third of U.S. counties lack an obstetric clinician.[14] It described closures as multifactorial but driven by hospital financial pressures and staff shortages.[14] Nearly two-thirds of maternity care deserts are in rural areas, and they disproportionately affect rural, low-income and Black women.[14] The review also noted that more than 80% of U.S. maternal deaths are preventable.[14]
The workforce gap extends beyond obstetrics. Medicaid recipients in states with a high prevalence of maternity care deserts had 36% fewer pediatricians, at 14.25 versus 22.31 per 100,000 population.[15] They also had 30% fewer mental health care providers, at 487.50 versus 696.50 per 100,000.[15] Those are the clinicians that preterm infants and their parents rely on after discharge. Infants in those states were also 28.62% less likely to receive influenza vaccination before their second birthday.[15] Follow-up capacity appears to thin out across the whole pediatric pathway, not only at the delivery unit.
Proposed responses are structural. The deserts review called for increased Medicaid reimbursement, expanded Medicaid access, a larger perinatal workforce and standards for safe distances between maternity units.[14] The state-level study pointed to family medicine physicians, doulas, telehealth and rural obstetric readiness.[15] Executives can test which of those levers are within their own service area and partnerships. The review also outlined drawbacks of many previously proposed solutions, a caution against assuming that any single fix will hold.[14]
Shared routines are also human infrastructure. The late preterm discharge project depended on educating staff on two units and standardizing where appointments were documented.[1] The Hawaiʻi collaborative relied on training, drills, structured monthly meetings and peer exchange within a cooperative culture.[10] Neither gain was possible without protected staff time for learning and review. In Hawaiʻi, the authors concluded that a state-level pay-for-performance arrangement effectively facilitated bundle implementation among Medicaid-serving hospitals.[10]
Capacity decisions in smaller hospitals carry regional consequences. The Arkansas authors identified preservation of lower-level maternity and nursery capacity as one strategy for aligning neonatal need with site of care.[5] When a system closes or consolidates a unit, the workforce plan needs to account for transport, triage and receiving-unit staff, not only the unit that closes.[5][11] Workforce reviews for this observance can ask a direct question: if a neighboring unit closed next quarter, which teams would absorb the transfers, and with what staff?
Executive guidance · Operating dashboard
Use a small dashboard to expose friction and ownership.
Do not publish a number until the organization defines its numerator, denominator where relevant, owner, source system, exclusions, review cadence, and limits. The candidates below are management prompts, not benchmarks or reported results.
Four operating signals
Each signal pairs an executive question with one candidate local measure, set out below.
Executive guidance · Signal
Entry-point clarity
Can people and staff identify the approved first step without searching across conflicting instructions?
- Candidate local measure
- Locally defined contact, routing, and repeat-contact signals by channel and service.
Executive guidance · Signal
Ownership reliability
Does a specific team accept each request and make its status visible?
- Candidate local measure
- Requests without an owner, aged work, transfers, and escalations using locally approved definitions.
Executive guidance · Signal
Partner-route reliability
Do participating teams share one current route and understand who owns each dependency?
- Candidate local measure
- Locally defined conflicting instructions, unaccepted handoffs, unresolved dependencies, repeat contacts, and partner feedback.
Executive guidance · Signal
Improvement closure
Does the organization correct recurring friction and report what changed?
- Candidate local measure
- Selected barriers, assigned actions, completion status, and post-change review.
Figure 4
The operating system behind the dashboard
The four operating signals from this brief’s dashboard, each tied to the candidate owner named in the executive scorecard, around one accountable route. Drawn from the page’s original executive guidance.
Data note. Structural diagram; no measured values.
Limitation. Owners are candidates to be confirmed locally.
Figure data (4 rows)
| Operating signal | Candidate owner |
|---|---|
| Entry-point clarity | Executive sponsor and operational lead |
| Ownership reliability | Operational owner and participating teams |
| Partner-route reliability | Sending and receiving owners |
| Improvement closure | Improvement owner and executive sponsor |
Executive guidance · Handoff workflow
Close the loop across teams, settings, and partners.
A handoff is reliable only when the sending party knows who is expected to receive the work, the receiving party acknowledges responsibility, and any unresolved exception remains visible. Local policy and qualified judgment control the actual process.
How responsibility moves
Lane A
From message to accepted ownership
- Confirm the approved message and intended audience.
- Publish the actual entry point and receiving role.
- Acknowledge receipt using the locally approved method.
- Escalate when ownership or response remains unclear.
Lane B
From accepted ownership to verified follow-through
- Record the next accountable owner and visible status.
- Name the sending and receiving owners, shared information, current status, and unresolved dependency.
- Keep unresolved work visible across boundaries.
- Confirm closure or document the continuing exception.
Executive guidance · Executive scorecard
Give leaders one view of route reliability and improvement.
The scorecard keeps review focused on decisions. Leaders should set definitions locally, examine variation without overclaiming cause, and pair quantitative signals with the experience of people who use and operate the route.
Who reviews what
- Executive sponsor and operational lead
- Operational owner and participating teams
- Sending and receiving owners
- Improvement owner and executive sponsor
Candidate owners named in the scorecard, confirmed locally.
| Operating signal | Executive question | Candidate owner | Suggested review point |
|---|---|---|---|
| Entry-point clarity | Can people and staff identify the approved first step without searching across conflicting instructions? | Executive sponsor and operational lead | At campaign launch and close |
| Ownership reliability | Does a specific team accept each request and make its status visible? | Operational owner and participating teams | At a locally defined cadence |
| Partner-route reliability | Do participating teams share one current route and understand who owns each dependency? | Sending and receiving owners | At a locally defined cadence |
| Improvement closure | Does the organization correct recurring friction and report what changed? | Improvement owner and executive sponsor | Until action is verified |
Figure 5
Control points for the perinatal access and transition pathway
| Control point | Risk if missing | Owner | Evidence of control |
|---|---|---|---|
| Coverage and first prenatal visit linked at enrollment | Care starts late because coverage starts late | Patient access and revenue cycle leaders with obstetric clinic operations | Share of enrollees with a first prenatal visit scheduled, by trimester of enrollment |
| Access impact review before any obstetric unit change | Travel time rises and rural patients lose nearby care | Chief strategy officer and chief medical officer | Documented travel-time, transfer and receiving-capacity analysis reviewed by the board |
| Regional transfer triage agreement | High-risk births occur at facilities with a lower level of care than required | Perinatal service line leader and transport medical director | Under-triage rate tracked by insurance and distance |
| Standardized late preterm and NICU discharge workflow | Infants leave without a scheduled, documented appointment | Nurse managers for mother-baby and neonatal units | Share of discharges with follow-up scheduled and documented in one record location |
| Maternal follow-up linked to preterm birth | Postpartum cardiovascular risk goes unaddressed | Women’s health and primary care leaders | Share of mothers of preterm infants with postpartum follow-up arranged |
| Stratified equity review | Disparities persist inside overall improvement | Chief health equity officer and quality leader | Measures reported by race and ethnicity, insurance, language, neighborhood and disability |
| Published metric definitions | Public figures mislead because definitions and sources differ | Chief quality officer and communications lead | Definition, data source and limits stated with every published prenatal access figure |
Control points derived from the cited evidence [1], [4], [5], [6], [8], [9], [10], [11], [12] and this brief’s executive guidance.
Data note. Each row is a control to verify, not a measured result.
Limitation. Owners and evidence of control must follow local policy and applicable requirements.
Public communication
Clear measures and honest messages build trust in perinatal services
Communication about prematurity starts with accurate measurement. A cohort study of 1,963,496 patients with a live birth in 2023 and 2024 tested whether electronic health record network data could support prenatal care surveillance.[9] After weighting, record-based estimates of early prenatal care were lower than national natality estimates, at 68.0% compared with 76.1%.[9] The study applied weights so the network sample matched national births by age, race and ethnicity, insurance, risk factors and region.[9] Estimates of adequate prenatal care were equivalent, at 76.0% compared with 75.2%.[9]
The lesson for leaders is that definitions change the story. An early-care measure and an adequacy measure drawn from the same records did not behave the same way against the national reference.[9] Organizations that publish prenatal access figures should state the definition, the data source and its limits. Near real-time data can improve timeliness, but only if the public can trust what the number means.[9]
Risk communication needs similar care. The national prediction study showed that a cutoff can flag a large group of pregnancies with only moderately higher observed risk.[2] The author was explicit that the derived threshold was neither a treatment threshold nor a screening recommendation.[2] At a 20% cutoff, 4.5% of pregnancies were flagged, with an observed preterm birth rate of 27.4%.[2] Public and patient materials should not present risk scores as more certain than the evidence supports.
Messages also need to reach families in the language they use. Most neonatal trials made no reference to non-native speakers, and family integrated care studies had the highest exclusion rates.[4] The review authors called for language-inclusive recruitment supported by institutional policy, funding and researcher training.[4] The same principle applies to discharge instructions, follow-up scheduling and parent education. Instructions that a family cannot read are not a completed handoff.
Finally, trust depends on candor about disparities. The income study concluded that Black race moderated the association between income and preterm birth and pointed to the need to examine racism.[13] The postpartum hypertension findings give families a reason to hear that follow-up after a preterm birth matters for the mother too.[8] Prematurity Awareness Month messages are strongest when they name a real next step that the organization can deliver.
Executive guidance · 90-day plan
Turn the observance into one sustained operating change.
The time boxes below are a management framework, not a clinical timeline. Adjust them to risk, scope, governance, resources, stakeholder participation, and applicable review requirements.
Ninety days, three moves
- Days 1–30See the current route
- Days 31–60Build the reliable path
- Days 61–90Make the change visible
Days 1–30 · Listen and map
See the current route
- Name an executive sponsor and an operational owner.
- Listen to people using the route and representative frontline teams.
- Map how Prematurity Awareness Month communications connect to real entry points, owners, transitions, and escalation.
- Select one recurring barrier that the organization can responsibly address.
Days 31–60 · Design and test
Build the reliable path
- Define the trigger, receiving owner, required information, acknowledgment, escalation, and closure signal.
- Validate the design with every sending and receiving team involved.
- Test one internal or partner handoff and correct a verified communication, dependency, or ownership gap.
- Test the route in more than one representative setting or operating period where practical.
Days 61–90 · Implement and verify
Make the change visible
- Launch the redesigned route with a small set of locally defined measures.
- Review unresolved work and recurring friction using a learning approach.
- Correct implementation barriers and record who owns each remaining dependency.
- Report what changed, what evidence was reviewed, and what still requires live oversight.
Figure 6
The 90-day plan on one timeline
The 90-day plan from this brief drawn as a timeline: each action sits in the 30-day window the plan assigns it. The full wording of each action is in the figure data and in the plan above.
Data note. Time boxes are a management framework, not a clinical timeline.
Limitation. Durations are uniform 30-day windows; real tasks may span windows.
Figure data (12 rows)
| Window | Action |
|---|---|
| Days 1–30 · Listen and map | Name an executive sponsor and an operational owner. |
| Days 1–30 · Listen and map | Listen to people using the route and representative frontline teams. |
| Days 1–30 · Listen and map | Map how Prematurity Awareness Month communications connect to real entry points, owners, transitions, and escalation. |
| Days 1–30 · Listen and map | Select one recurring barrier that the organization can responsibly address. |
| Days 31–60 · Design and test | Define the trigger, receiving owner, required information, acknowledgment, escalation, and closure signal. |
| Days 31–60 · Design and test | Validate the design with every sending and receiving team involved. |
| Days 31–60 · Design and test | Test one internal or partner handoff and correct a verified communication, dependency, or ownership gap. |
| Days 31–60 · Design and test | Test the route in more than one representative setting or operating period where practical. |
| Days 61–90 · Implement and verify | Launch the redesigned route with a small set of locally defined measures. |
| Days 61–90 · Implement and verify | Review unresolved work and recurring friction using a learning approach. |
| Days 61–90 · Implement and verify | Correct implementation barriers and record who owns each remaining dependency. |
| Days 61–90 · Implement and verify | Report what changed, what evidence was reviewed, and what still requires live oversight. |
Executive guidance · Leadership close
Make Prematurity Awareness Month a starting point, not an endpoint.
Recognition matters. It becomes durable when leaders also listen, clarify the route, support the people operating it, close an identified gap, and report the result without claiming more than the evidence supports.
Leadership commitment
Make ownership visible, test the route, and report what improved.
Executive action kit · Month observance
Turn Prematurity Awareness Month into accountable action.
A practical executive framework for access, ownership, handoffs, measurement, and improvement.
Leadership focus
Use this observance to examine trustworthy information, prevention access, and community connection. Select one verified barrier, assign an accountable owner, and carry the improvement beyond the campaign window.
Workforce lens
Ask whether staffing, role clarity, training, tools, workload, and escalation support the people operating the information, access, coordination, and follow-through pathway.
Patient and community lens
Make the approved first step clear. Test whether a person can move from information to an acknowledged next action without navigating conflicting instructions.
Equity and access lens
Review language, disability, transportation, digital access, geography, trust, and other barriers using protected feedback and locally appropriate data.
Five-minute briefing
Inspect the operating sequence
Listen with people using the pathway, frontline teams, operational leaders, and community partners. Find one a message, request, referral, or handoff that does not reach an accountable owner, then test the locally approved route from entry through acknowledged follow-through.
- Listen
- Clarify entry
- Coordinate the partner route
- Protect transitions
- Verify and learn
Leadership actions for this week
- Name an executive sponsor and frontline operating owner.
- Ask people using and operating the pathway where ownership becomes unclear.
- Test one representative route from first question to acknowledged next step.
- Select one barrier that can be corrected without overstating the evidence.
- Set a review date and define how completion will be verified.
Candidate measures
Define every numerator, denominator where relevant, owner, data source, exclusions, cadence, and limitation locally. These are management prompts, not external benchmarks.
- Locally defined contact, routing, and repeat-contact signals by channel and service.
- Requests without an owner, aged work, transfers, and escalations using locally approved definitions.
- Locally defined conflicting instructions, unaccepted handoffs, unresolved dependencies, repeat contacts, and partner feedback.
Department readiness checklist
- The public and staff entry points match the actual approved process.
- A specific role accepts each request, referral, or escalation.
- Handoffs include acknowledgment and a visible unresolved state.
- Language, disability, digital, transportation, and trust barriers receive explicit review.
- Communications do not introduce unsupported themes, statistics, or clinical advice.
- A named leader will review what changed after the observance.
Intended audiences
- Executive and Operational Leaders
- Public Health and Community Partners
Staff communication template
During Prematurity Awareness Month, our organization will connect awareness with a practical review of the information, access, coordination, and follow-through pathway. Use approved information, identify the correct entry point, confirm ownership when work moves, protect privacy, and escalate unresolved barriers through local channels.
Community communication template
Prematurity Awareness Month is an opportunity to share trustworthy information and make the next step easier to find. Use our approved channels for information and support. If a request changes hands, our goal is to keep ownership and follow-through visible.
Measurement worksheet
- Signal
- What observable condition will show whether the route works?
- Definition
- What is included, excluded, and counted?
- Owner
- Who reviews the signal and acts on exceptions?
- Cadence
- When will leaders review it?
- Equity check
- Which differences require protected, locally appropriate review?
- Closure
- What evidence will confirm the improvement was completed?
- Editorial review
- Completed
- Source records
- 2 listed under Authoritative resources
- Review standard
- Sourced facts remain separated from original executive guidance
- Clinical boundary
- No new statistical or clinical claim was added by this action kit
Sources and content boundary
Authoritative resources
Use note: All operating models, measures, scorecard questions, and action steps are original executive guidance. This article supports leadership planning and education. It does not replace clinical judgment, emergency procedures, legal advice, professional standards, organizational policy, or applicable federal, state, and local requirements.
Peer-reviewed references
References
Fifteen peer-reviewed sources, newest first. Each was individually verified through authenticated academic research databases. Bracketed numbers in the text link here; the original executive guidance on this page carries no citations because it is guidance, not a sourced claim. Sources last checked in those databases on .
- 1.Williford AL, Barnes J. Improving the Process for Late Preterm Infant Discharge Follow-Up After Birth. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2026. https://doi.org/10.1016/j.jogn.2026.08.002
- 2.Balayla J. Threshold‐Based Stratification of Predicted Preterm Birth Risk in a National Natality Cohort: An Empirical Application of the Prevalence Threshold. Paediatric and Perinatal Epidemiology. 2026:ppe.70194. https://doi.org/10.1111/ppe.70194
- 3.Thorsen ML, Krueger CD, Palacios JF. Maternal Weathering and Infant Health: Understanding Low Birth Weight and Preterm Birth Among American Indians. Journal of Racial and Ethnic Health Disparities. 2026. https://doi.org/10.1007/s40615-026-03071-2
- 4.Giva S, Gaffney F, Cleary B, Tamgumus S, O’Brien F, McCallion N. NEOLINGUA —A Review of Language Inclusivity in Neonatology Research Studies. Journal of Paediatrics and Child Health. 2026:jpc.70593. https://doi.org/10.1111/jpc.70593
- 5.Sharon MAK, Eksioglu SD, Bogulski CA, Gomez Pomar E. Inequitable access to risk-appropriate neonatal care: evidence from a regionalized perinatal system in Arkansas. Frontiers in Reproductive Health. 2026;8:1914178. https://doi.org/10.3389/frph.2026.1914178
- 6.Toyin-Thomas P, Leggett CG, Goodman DC, Leyenaar JK. Timing of Medicaid Enrollment During Pregnancy and Associated Infant Outcomes. Academic Pediatrics. 2026;26(8):103419. https://doi.org/10.1016/j.acap.2026.103419
- 7.Valentine-King MA, Whitworth KW, Chan W, Parsons PJ, Chutcharavan PM, Kloog I, et al. A decomposition analysis to evaluate the role of social, chemical, and neighborhood factors on the Black/White disparity in preterm birth in Greater Houston, Texas. Environmental Epidemiology. 2026;10(5):e527. https://doi.org/10.1097/ee9.0000000000000527
- 8.Petito LC, Huang X, Bairey Merz CN, Bello N, Catov J, Licon E, et al. Racial Differences in Adverse Pregnancy Outcomes and Incident Hypertension: A Mediation Analysis. Journal of the American Heart Association. 2026;15(13):e035681. https://doi.org/10.1161/jaha.123.035681
- 9.Conderino S, Howland RE, Thorpe LE, Brandt JS, Hong C, Fair A, et al. Defining Prenatal Care Surveillance Metrics Using Electronic Health Record Data. JAMA Health Forum. 2026;7(6):e261295. https://doi.org/10.1001/jamahealthforum.2026.1295
- 10.Ng AC, Ravida M, Gerrits-Goh RG, Yuan F, Iwata C, McKinsey E, et al. Perinatal Quality Improvement Among Medicaid Populations in Hawai‘i: Insights from a Statewide Learning Collaborative. Health Equity. 2026;10:24731242261448657. https://doi.org/10.1177/24731242261448657
- 11.Ranchoff BL, Kofner A, Baker O, Costa R, Argetsinger S, Mast M, et al. Effect of Hospital Obstetric Unit Closures on Travel Time to Obstetric Care in the United States. O&G Open. 2026;3(4). https://doi.org/10.1097/og9.0000000000000197
- 12.Pershad A, Adams G, Robbins L, Saade G, Kawakita T. The association between social vulnerability and racial disparities in preterm birth. Pregnancy. 2026;2(3):e70279. https://doi.org/10.1002/pmf2.70279
- 13.Cordova-Ramos EG, Ruiz SY, Guyol GG, Kalluri NS, Elansary M, McConnell M, et al. Trends in US Preterm Birth Rates by Household Income and Race and Ethnicity. JAMA Network Open. 2026;9(1):e2550664. https://doi.org/10.1001/jamanetworkopen.2025.50664
- 14.Bartick M, Payton C, Jegier B. Maternity Care Deserts: An Urgent Public Health Problem in Need of Financial Solutions. Maternal and Child Health Journal. 2025;29(11):1489-1496. https://doi.org/10.1007/s10995-025-04168-6
- 15.Gleeson DE, Busch SH, Ickovics JR. State-Level Prevalence of Maternity Care Deserts: Association With Healthcare Access, Utilization, and Outcomes Among Medicaid Recipients. AJPM Focus. 2025;4(5):100362. https://doi.org/10.1016/j.focus.2025.100362
Claim-to-source matrix
What each source supports
Every sourced claim in the new sections maps to the references that support it, the section where it is used, and the limitation a reader should keep in mind. Original executive guidance carries no sources because it is guidance, not a finding.
| Claim group | Sources | Years | Used in | Limitation |
|---|---|---|---|---|
| Preterm birth trends by household income and race and ethnicity | [13] | 2026 | Current evidence | Self-reported survey data from 2011 to 2021; cross-sectional design. |
| County social vulnerability and widening Black-White preterm birth gaps | [12] | 2026 | Current evidence | Cross-sectional 2023 natality data limited to Black or White singleton births; county-level exposure. |
| Contributors to the Black-White preterm birth disparity in one metropolitan area | [7] | 2026 | Current evidence | Single metropolitan area; women recruited at delivery; measured variables explained 63.0% of the disparity. |
| Performance of predicted-risk cutoffs for preterm birth | [2] | 2026 | Current evidence | Single-author analysis of public-use 2024 data; moderate discrimination; explicitly not a screening recommendation. |
| Risk-appropriate birth site, under-triage and insurance | [5] | 2026 | Continuum of care | One state’s regionalized system; birth certificate linkage; association, not causation. |
| Standardized late preterm discharge follow-up workflow | [1] | 2026 | Continuum of care | Single-site pre-post quality improvement project over a short period. |
| Preterm birth and later maternal hypertension disparities | [8] | 2026 | Continuum of care | Nulliparous cohort recruited 2010 to 2013 at eight centers; 17% Black participants; mediation estimates. |
| Timing of Medicaid enrollment and infant outcomes | [6] | 2026 | Access | Texas Medicaid deliveries from 2010 to 2014; retrospective; residual confounding possible. |
| Obstetric unit closures and travel time | [11] | 2026 | Access | Measures travel time from tract centroids, not patient-level travel or outcomes. |
| State prevalence of maternity care deserts and access and outcomes among Medicaid recipients | [15] | 2025 | Access | Descriptive, cross-sectional, state-level analysis of 52 jurisdictions; ecological associations. |
| Preterm birth disparities and prenatal care adequacy and distance among American Indian and Alaska Native individuals | [3] | 2026 | Equity and trust | Montana birth certificates from 2014 to 2022; cross-sectional; mediators explain only part of the gap. |
| Statewide perinatal quality collaborative and persistent disparities | [10] | 2026 | Equity and trust | Mixed-methods study with 10 interviews; severe maternal morbidity trends are observational. |
| Language inclusivity in neonatal and family integrated care trials | [4] | 2026 | Equity and trust | Based on registry and publication reporting; lack of reporting does not establish actual exclusion. |
| Drivers of maternity unit closures and workforce shortages | [14] | 2025 | Human infrastructure | Narrative review and policy analysis rather than original data. |
| Electronic health record network metrics for prenatal care surveillance | [9] | 2026 | Public communication | Network population differed from national births before weighting; early-care metric not equivalent to national estimates. |
About the author
Greg Wahlstrom
MBAHCM
President and Chief Executive Officer, The Healthcare Executive
View Greg’s profile©2014 – 2026 The Healthcare Executive. All rights reserved.