A community-wide infant mortality review: findings and implications

Abstract

The authors present the results of a community-wide infant mortality review, describe implications for the delivery of maternal and child health services, and discuss the value of such reviews in addressing local public health concerns. The review included an analysis of birth and death certificates and medical record data; maternal interviews; review of cases and development of recommendations by provider panels; and convening of community groups to develop strategies to improve the health and health care of women and infants. The review focused on 287 infant deaths during 1990-1993.More than half of all neonatal deaths were attributable to "previable" or "borderline viable" births. Sexually transmitted infections were the most frequently identified underlying risk, and smoking was the most frequently identified prenatal risk. Homelessness, physical and sexual abuse, and alcohol use were at least twice as likely among women whose babies died than among a high risk comparison group. Panelists identified fragmented health care over the course of women's reproductive lives as a predominant theme. The authors conclude that: (a) The focus of maternal and child health care should shift to a model of women's health care that addresses the chronicity of social and clinical risks. (b) Infant mortality reviews are a valuable tool for community education, systems review, and policy development and can be applied to other public health issues with local significance. (c) Expectations about the review process's ability to produce conclusions about causality or recommendations narrowly geared to reducing infant mortality rates need to be reframed. (d) The model will be strengthened by greater participation of families affected by infant death.

Influence of childhood sexual abuse on pregnancy, delivery, and the early postpartum period in adult women

“…Sexual abuse was at least twice as likely among women whose babies died neonatally than among another high-risk comparison group [83].…”

Reducing Infant Mortality Rates Using the Perinatal Periods of Risk Model

“…One very successful prevention effort is the national Back to Sleep campaign (American Academy of Pediatrics, Task Force on Infant Sleep Position and Sudden Death Syndrome, 2002; Pollack & Frohna, 2002). Preterm babies of viable gestational age, generally considered 24 weeks, are at higher risk of death due to the nutritional state of the mother, medical conditions of the mother, smoking status of mother, genetic factors, and many others (Maloni, 2000; McCloskey et al, 1999). Interventions for this stage of development should focus on efforts to improve the health of the mother prenatally, and the general health and well‐being of women of childbearing age.…”

Women's Public Health Policy in the 21st Century

“…Maternal and child health experts within public health are beginning to acknowledge the intimate relationship between women's health and the well‐being of children and families (19‐22). The importance of integrated, comprehensive care for women to improve perinatal outcomes is one of the most politically powerful arguments for expanding the scope of women's health initiatives within MCH agencies (22,23). When women do not receive comprehensive care prior to pregnancy, they may enter pregnancy with unaddressed medical and social risk factors that compromise the health of both infant and mother.…”

“…Qualitative evidence also demonstrates that comprehensive women's health care is essential for healthy birth outcomes. For example, in one infant mortality review (23), 73% of the infant death cases were preceded by fragmentation and discontinuity of health care over time, even among women with high‐risk histories who might have benefited from interconceptional care; in 50% of the cases, women had severe social risks that were unrecognized or unmatched by needed services; in 40% of the cases, mothers had repeated unintended and closely spaced pregnancies, often preceded by sexual abuse histories; and in 38% percent of the cases, mothers, particularly women of color, voiced dissatisfaction with the interpersonal aspects of health care (23). These study results prompt the investigators (23) to recommend implementation of a system of comprehensive and continuous primary care for women, which involves interdisciplinary care teams and community‐based health workers.…”