States Collaborate to Reduce Infant Mortality

October 27, 2015|2:05 p.m.| Claire Rudolph

The infant mortality rate in the United States is one of the highest among all developed countries, at approximately six infant deaths per 1,000 live births annually. The top five causes of infant mortality make up 58 percent of all infant deaths in the United States, and include birth defects, preterm birth, sudden infant death syndrome, maternal pregnancy complications, and injuries such as suffocation. The infant mortality rate is worse among minority populations in the United States, with African American infants dying at more than twice the rate of non-Hispanic infants, and there are large socioeconomic disparities as well: infants born to women in higher socioeconomic groups are more likely to survive than infants born to less advantaged mothers, especially in the post-neonatal period.

The Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality is a public-private partnership that began in 2012 to improve birth outcomes in the United States. Supported by HRSA’s Maternal and Child Health Bureau (MCHB), CoIIN aims to advance state efforts that address infant mortality rates. In 2013, HHS’ Secretary’s Advisory Committee on Infant Mortality announced the first ever national strategy to address infant mortality and released a framework that includes six key strategic directions and specific recommendations to prevent infant mortality. One of these recommendations was to strengthen CoIIN efforts already in place.

CoIIN began in the southern United States in HHS regions IV and VI to address the area’s higher-than-average infant mortality rates. States in these regions worked together to develop strategies to reduce infant mortality, and early findings indicate that regions IV and VI made progress toward reducing infant mortality. Provisional birth certificate data show that since the first quarter of 2011 there has been a 30 percent decline in elective deliveries, meaning that approximately 85,000 early elective deliveries were averted during that time. These states also saw a 12 percent reduction in smoking during pregnancy. In 2013, CoIIN incorporated several states in region V to build on the successes of regions IV and VI, focusing their efforts on health equity in addition to the other five strategies. These promising results led to a renewed effort to expand the CoIIN model to the entire nation.

In 2014, each state and territory in the country was invited to participate in a summit, held in Arlington, Virginia, to discuss CoIIN’s national expansion. Participants engaged in a two-day meeting to discuss best practices and lessons learned from states in regions IV, V, and VI, and decided on six strategies for reducing infant mortality:

  • Improving safe sleep practices.
  • Reducing smoking before, during, and after pregnancy.
  • Improving access to and the content of preconception and interconception care.
  • Addressing the social determinants of health.
  • Preventing preterm and early term births.
  • Expanding risk appropriate perinatal care.

As part of CoIIN’s national expansion, learning networks composed of state teams of health department staff, state Medicaid representatives, and professionals from community-based organizations, which were developed for each strategy, are testing preliminary methods for reducing infant mortality. The territories and freely associated states in region IX will participate in one CoIIN Learning Network focused on building maternal and child health data capacity while other states self-selected in to the learning network of their choice. The National Institute for Children’s Health Quality (NICHQ) is working with MCHB as a backbone organization in CoIIN’s national expansion.

ASTHO has helped support MCHB and NICHQ to engage federal, state and local leaders, public and private agencies, other health professionals, and communities in employing quality improvement, innovation, and collaborative learning to address infant mortality. As learning networks continue to engage in meaningful work in their states, the hope is that CoIIN will produce a large scale social change through the reduction of infant mortality and other health disparities.

Learn more about ASTHO's work related to maternal and child health.

Claire Rudolph

Claire Rudolph, MPH, CHES, is the senior analyst for maternal and child health at ASTHO. In this position, she manages ASTHO’s support of the Infant Mortality CoIIN initiative. Claire most recently worked at the National Institute for Health Care Management (NIHCM) Foundation where she led NIHCM’s efforts to improve the maternal and child health programs and policies of Blue Cross Blue Shield health plans.