Fetal and Infant Mortality Review: Historical Foundations, Evaluation Findings, and Future Directions
The Fetal and Infant Mortality Review (FIMR) process is used by communities to determine the community-level factors associated with individual cases of fetal or infant death. FIMR teams think about infant mortality in the larger context of social, economic, and systems factors, with the ultimate goal of improving commuity resources and health service delivery systems for women, infants, and families.
The WCHPC undertook an evaluation of FIMR between 1997 and 2001, with funding from the federal Maternal and Child Health Bureau (MCHB). MCHB's Division of Perinatal Systems and Women's Health, the National FIMR Program at the American College of Obstetricians and Gynecologists, and a panel of national FIMR experts provided technical advice to the study team.
- To determine the impacts of FIMR on community resources and service delivery systems for women, infants, and their families
- To identify the key factors contributing to the effectiveness of FIMRs in improving community resources and service systems available to women, infants, and their families
- To assess the implications of FIMR for maternal and child health practice in terms of public health core functions
The full range of FIMR programs, including those initiated through funds from the NFIMR Program, MCHB, Healthy Start Program, and state and/or local health agencies, were examined in the study. Because FIMR is only one of many existing mechanisms for effecting systems change, the evaluation identified the features of the FIMR model, process, and outcomes that are unique relative to other community-level strategies. The evaluation was conducted in three phases, with the work of each phase informing those that followed.
Our study shows that FIMR programs contribute significantly to improvements in systems of health care for pregnant women and infants through enhanced public health activities in communities. Communities with FIMRs were more likely to report activities in the areas of data assessment and analysis, client services and access, quality improvement for systems of care, partnerships and collaboration, population advocacy and policy development, as well as enhancement of the health workforce.
The findings from the FIMR evaluation are presented in a special issue of the MCH Journal (December 2004), a Final Report presented to the Maternal and Child Health Bureau, as well as a series of policy briefs:
Faculty taking the lead on this evaluation are Donna Strobino, Dawn Misra, Holly Grason, and Karen McDonnell.