FIMR Process

The Fetal and Infant Mortality Review (FIMR) Process - A Tool States Can Use

FIMR programs are currently being implemented in approximately 40 states. Of those 40 states, 25 have specifically designated a state FIMR coordinator, who provides training and technical assistance to local programs. What makes this local program so important at the state level? This article describes the FIMR process and discuss the many benefits of FIMR at the state and local level.

The overall goal of FIMR is to enhance the health and well being of women, infants and families by improving the community resources and service delivery systems available to them. The FIMR process brings together key members of the community to review information from individual cases of fetal and infant death in order to identify factors associated with those deaths, establish if they represent system-level problems or gaps in care that require change, develop recommendations for change, assist in the implementation of change and determine community effects.

Nationwide evidence demonstrates that FIMR is an effective perinatal systems intervention. A national evaluation of FIMR has systematically documented that (1-3):

  • The presence of FIMR appears to significantly improve a community’s performance of public health functions as well as enhance the existing perinatal care system’s goals, components and communication mechanisms.
  • The focus of FIMR on systems of care and identifying gaps in care results in action being taken in a way that interpretation of vital statistics data alone does not necessarily promote.

FIMR is a continuous quality improvement (CQI) technique. The FIMR process is used at the local level for assessing, planning, improving and monitoring the service systems and broad community resources that support and promote the health and well-being of all women, infants and families, but especially minority families, which are disproportionately affected by infant mortality.

Local FIMR programs and state Title V agencies are benefiting from close collaboration. State Title V agencies understand state maternal and child health policies, programs and funding streams. FIMR programs have real time, important information about local issues, gaps in care and service delivery systems to share. Examples of the ways both benefit include:

  • A need identified by several very different FIMR programs in the same state may point to a need for overall statewide policy/program development.
  • Conversely, statewide publicity about one FIMR program’s findings and interventions may help the state generate additional funding to address infant mortality.
  • Unique findings from one at risk, underserved FIMR community may provide insights that can enhance the ability of the state to provide technical assistance or target funding to that community.
  • Anecdotes (with identifiers removed) about families who have lost an infant may be used by both state and local partners to illustrate breakdowns in systems of care. Anecdotes also provide a human face to infant mortality data and may be more compelling than statistics to local legislators or other policy makers.
  • Common findings and recommendations of local FIMR programs about important issues such as prematurity and infant health disparities may clarify and/or enhance important needs assessment and policy development plans that states develop in collaboration with the Maternal and Child Health Bureau.
  • Common findings and recommendations of local FIMR programs include the voices of women who have experienced an infant loss and community advocates and consumers, as well as many other local team members. Thus, broad community input will inform state policy development.

For states that would like to begin or expand their local FIMR reviews, technical assistance is available through the National Fetal and Infant Mortality Review Program (NFIMR). NFIMR is a collaborative effort between the American College of Obstetricians and Gynecologists (ACOG) and the federal Maternal and Child Health Bureau (MCHB). Contact NFIMR at or e-mail NFIMR at



  • Grason HA, Liao M. Fetal and infant mortality review (FIMR): A strategy for enhancing community efforts to improve perinatal health. Baltimore (MD): Johns Hopkins University Bloomberg School of Public Health, Women’s and Children’s Health Policy Center; 2002
  • Strobino DM, Baldwin KM, Grason H, Misra DP, McDonnell KA, Liao M, Allston AA. The relation of FIMR programs and other perinatal systems initiatives with maternal and child health activities in the community. Matern Child Health J 2004;8(4):239-49.
  • Allston AA, Baldwin KM, Grason H, Liao M, McDonnell K, Misra D, Strobino D. The evaluation of FIMR programs nationwide: Early findings. Baltimore (MD): Johns Hopkins University Bloomberg School of Public Health, Women’s and Children’s Health Policy Center; 2001