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 A Framework to Address the Persistent and Complex Issue of Infant Mortality

By Lauren Smith, MD, MPHLSmith photo.jpg
Senior Strategic Advisor, Infant Mortality Collaborative Improvement and Innovation Network

Elaine L. Fitzgerald, DrPH, MIA
Project Director, Infant Mortality Collaboration Innovation and Improvement Network

According to 2010 statistics, 6.15 babies out of every 1,000 born in the United States die before their first birthday. This compares to an average of five babies for all other industrialized nations. Worse still, American minority populations are disproportionately affected with non-Hispanic Black babies dying at twice Elaine.jpgthe rate of non-Hispanic White babies. Efforts to reduce infant mortality and improve birth outcomes have been long underway producing varying levels of effectiveness. The Infant Mortality Collaborative Innovation and Improvement Network (IM CoIIN) was expanded nationwide, including affiliated Pacific Basin territories, earlier this year. The Infant Mortality CoIIN provides a unique opportunity to collectively leverage the experiences, expertise, and resources of a diversity of stakeholders committed toward improving infant health. The strength of the CoIIN is in uniting partners from all levels – federal, state, community, private and public – to collaborate and coordinate their work around a common aim in a rapid cycle timeframe (18-24 months) to accelerate saving the lives of babies.

The Infant Mortality CoIIN Framework is a tool developed through the efforts of the IM CoIIN Specific Strategies Workgroup that presents the primary factors contributing to infant mortality in the United States and enables states, MCH leaders, and other stakeholders to identify where to focus their efforts. The framework synthesizes recommendations, evidence-based and promising practices, as well as innovative ideas into one organizing structure. The structure of the framework includes periods of engagement to intervene and reduce infant mortality, aligned with recommended strategic priorities. Periods of Engagement correspond to time frames along the life course when interventions to improve birth outcomes are possible. States and jurisdictions are encouraged to identify periods of engagement based on state-level epidemiological data, existing initiatives, identified gaps and areas of need, as well as political will and opportunities for improvement. Identified strategic priorities are organized by the Periods of Engagement. These strategic priorities were informed through an environmental scan, including recommendations from the Secretary's Advisory Committee on Infant Mortality (SACIM) and resources developed by partner organizations such as, AMCHP, March of Dimes, the Association of State and Territorial Health Officials (ASTHO), Centers for Medicare and Medicaid Services (CMS), National Governors Association (NGA) and many others. Each strategic priority in the framework is broken down further with visual representation of how potential actions support the overall Infant Mortality CoIIN Framework. These potential actions are ideas and changes that have been collected and synthesized from the work of our partners, serving as options to illustrate possible choices, not as an exclusive or exhaustive list. Finally, the framework includes overarching domains necessary to the success of any infant mortality reduction effort (e.g., engaged leadership, aligned state and local initiatives, improvements in state-level data quality).

The Infant Mortality CoIIN Framework is a tool that will evolve through collaborative learning, innovation and improvement. We view the framework as a comprehensive approach to support national and state efforts to change the status quo, to be "productively disruptive" in order to maximize our collective impact, while leveraging existing resources and expertise, all in an effort to optimize infant health. ​