From 2004-2006, AMCHP partnered with the Centers for Disease Control and Prevention (CDC) and the National March of Dimes Birth Defects Foundation to form the State Infant Mortality Collaborative (SIMC). This three-year project supported five multidisciplinary state teams, as they investigated the infant mortality problem in their jurisdictions and made plans to address it as they deemed feasible and appropriate. The five teams included Delaware, Hawaii, Missouri, North Carolina and Louisiana and represented five of 13 U.S. states with unusually high, stagnant or increasing infant mortality rates in 2004, the year the project began. The overarching goal of the Collaborative was aimed at bringing the nation's experts together to work with these teams.
AMCHP Staff followed up with the Delaware SIMC team to learn about their accomplishments since the Collaborative. Additional information on the SIMC can be found at http://www.amchp.org/publications/Downloads/SIMC_Report.pdf.
In conjunction with preliminary results from the State Infant Mortality Collaborative, an Infant Mortality Task Force assembled 20 recommendations aimed at reducing infant mortality (IM) in Delaware including a Healthy Mother and Infant Consortium. The Delaware IM initiative is composed of a consortium of public health professionals including neonatalogists, maternal-fetal medicine specialists, registered nurses, internists, hospital administrators, non-profit organization directors, federally qualified health care center directors, state legislators, concerned citizens, researchers, and staff at the Delaware Division of Public Health. The IM initiative is fully endorsed and supported as a Governor’s initiative and thus receives state funds dedicated to research and intervention aimed at reducing infant mortality. The goal of the initiative is to reduce IM through collaborative research, program implementation and evaluation.
Since the initiative began in late 2005, the Delaware Division of Public Health (DPH) has implemented an evidence-based intervention during the prenatal and postpartum period for women considered high-risk (i.e., uninsured or underinsured, member of a minority, residing in a ZIP code identified as having a high proportion of infant deaths, living with a chronic disease, or experienced a previous poor birth outcome such as premature delivery, low birth weight delivery, stillbirth, fetal or infant death) providing supplemental care during pregnancy and up to two years postpartum for mothers and infants. Additionally, DPH implemented an evidence-based intervention program for women during the preconception period considered high-risk (i.e., using the same criteria as the prenatal program) providing supplemental care up to pregnancy or menopause. The high-risk criteria were developed through research using state vital records data, CDC recommendations for preconception care, and Fetal Infant Mortality Review pilot data.
As of June 2008, the prenatal and postpartum program has served over 4,000 pregnant women in Delaware, with 2,549 served in the last year. In a state that averages 11,226 births per year, the program impacted 23 percent of all live births. Of the number served, nine infant deaths occurred, much less than expected in this high risk population. Similarly, the preconception program has served 19,663 in the first 16 months of operation, 11 percent of the population of women of childbearing age in Delaware. Evaluation of the effectiveness of both programs is currently underway, with results expected by the close of 2009. For a full summary of program services and accomplishments, visit http://www.dhss.delaware.gov/dhss/dph/pubs2.html.