A community-wide infant mortality review: Findings and implications

The authors present the results of a community-wide infant mortality review , describe implications for the delivery of maternal and child health servi ces, and discuss the value of such reviews in addressing local public healt h concerns. The review included an analysis of birth and death certificates and medical record data; maternal interviews; review of cases and developm ent of recommendations by provider panels; and convening of community group s 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 fr equently identified underlying risk, and smoking was the most frequently id entified prenatal risk. Homelessness, physical and sexual abuse, and alcoho l use were at least twice as likely among women whose babies died than amon g 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 shou ld 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 too l for community education, systems review, and policy development and can b e applied to other public health issues with local significance, (c) Expect ations about the review process's ability to produce conclusions about caus ality or recommendations narrowly geared to reducing infant mortality rates need to be reframed. (d) The model will be strengthened by greater partici pation of families affected by infant death.