R01 grants, an average of 12 a year. The track record has been worse for training grants. However, there has been some progress. In 2004, 31 departments of obstetrics and gynecology had more than five NIH awards.
There needs to be increased recognition of the importance of research in obstetrics, whether it is done in a basic science department or a clinical department in the context of an academic medical center. In addition to neonatology, pediatrics, and obstetrics and gynecology departments, other departments need to include investigations of preterm birth in their research programs. Importantly, deans of medical schools should expect their obstetric and gynecology departments to develop research programs that address preterm birth and should support them in those efforts.
Medical schools and research institutions need to create opportunities for physician scientists to conduct research on preterm birth by providing protected time, funds, and appropriate ethical guidance and oversight. Obstetrics research is difficult for obstetricians and gynecologists because they must spend large amounts of time in practice. Therefore, an infrastructure like those that exist in research-intensive departments is also needed to assist with manuscript preparation, grant applications, and administrative activities that support clinical practice and research.
Appropriate leadership, administrative structures, and organizations will facilitate the changes that are needed to make more progress on reducing the rates of preterm birth. This may require the creation of a center of excellence that is outside of departments of obstetrics and gynecology but that is associated with them and that has an administrative structure different from that of departments of clinical medicine. Although NIH has helped to build faculties in obstetrics and gynecology in schools of medicine, NIH cannot provide complete support for faculty members. Serious research programs must be prepared to share the costs for the faculty time and the resources needed to attract and train talented investigators who are committed to careers in biomedical research on preterm birth and its consequences.
Finding 13-1: There is need for a major focus on the problem of preterm birth. This will require the efforts of individuals from a broad spectrum of clinical, basic, and social science disciplines; the recruitment of more investigators; and increased funding. There are special barriers to the recruitment and participation of physician scientists who are trained in obstetrics and gynecology, such as a paucity of departments of intensive research in obstetrics and gynecology, the length of time required for combined clinical and research training, and the cost of liability insurance that is not proportional to clinical activity.