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Vital Statistics Essential for Effective State Programs to Reduce Infant Deaths

One of America's most embarrassing health statistics is the country's abysmal infant mortality rate, one of the most fundamental indicators of a nation's health. In fact, the United States ranks at the bottom of all industrialized countries with more than six babies per 1,000 born dying before their first birthday. In comparison, Finland and Japan have just more than two per 1,000 babies dying before their first birthday. To address this public health challenge, an initiative at the National Institute for Child Health Quality (NICHQ) brings together federal, state and local leaders, public and private agencies, professionals and communities to raise awareness and promote safe habits to prevent infant deaths.

The project, dubbed the Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN), is funded by the Maternal and Child Health Bureau at the Health Resources and Service Administration. IM CoIIN focuses on six strategies for reducing infant deaths, including safe sleep practices; smoking cessation before, during, and after pregnancy; pre/intercontraception health care; the social determinants of health; prevention of pre- and early-term birth;, and risk appropriate perinatal care. All 50 states currently participate in this multifaceted approach to improving this vital public health measure, and already some localities are seeing a significant reduction in infant deaths.

The core of IM CoIIN is in the collaboration of jurisdictions across the country. Through data and idea sharing, jurisdictions are able to learn about the best and worst practices for reducing infant deaths and closing the racial disparity in infant mortality. New York officials have been a leader in the effort, offering their experience in dramatically improving their statistics in recent years. In 1990, Harlem, New York infant deaths were 20 per 1,000 babies born--more than triple the national rate. In response, public health officials implemented a strategic approach focusing in on the lowest income populations in Harlem and creating a community based approach to educating and empowering new parents. As a result, Harlem was able to reduce infant mortality to just seven per 1,000. Now, these officials share their experiences about what does and doesn't work with the Network to expand best practices across the country and optimize efforts.

Jurisdictions are also experimenting and sharing their experiences in new approaches. For example, in Baltimore, public health officials are launching programs led by women at risk for other women at risk. In these arenas, women discuss the barriers to proper infant care and what resources are needed to improve health outcomes for infants. They can then implement programs to address these needs and share information about their successes and failures through IM CoIIN. In another experiment in Broward County, Florida, first responders have been trained to recognize unsafe sleep conditions for infants, educate families on safe practices, and distribute "Safe Sleep Kits."

The success in reducing the infant mortality rate has largely relied on this type of community-based approach but it involves buy-in from all members of the community, including vital records offices (VROs). Indeed, VROs are an essential partner in the IM CoIIN initiative. Programs need timely access to vital statistics on infant deaths, even if these data are provisional, to evaluate their programs and determine if their approaches have meaningful effects. NAPHSIS members, as the gatekeepers to vital statistics data, are critical partners who need to actively participate in this effort for it to be successful. We encourage VROs in each state to work with IM CoIIN programs to determine the best ways to share provisional data so that the success of IM CoIIN efforts can be measured in as close to real time as possible. The dependence of IM CoIIN infant mortality reduction efforts on vital statistics data to measure progress is yet another example of how vital statistics are #Vital4AReason.

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