Lane County State's Top Fetal-Infant Mortality Rate
September 9, 2010 -- Lane County, home of Oregon’s flagship university, has a high rate of fetal-infant mortality (8.25), a statistic commonly regarded as an indicator of the health and well-being of a population.
Lane’s rate is higher than the state’s (8) and higher than the rate of other metropolitan areas and comparable counties in Oregon. In fact, only recently did Lane’s rate fare better than the national average.
In 2007, Lane County Public Health (LCPH) staff discovered a high rate of fetal-infant mortality. The fetal-infant mortality rate includes both fetal (24 weeks gestation and 500 grams) and infant deaths (through the first year of life) and is measured in deaths per 1,000 births.
Staff substantiated their observation using the Perinatal Periods of Risk (PPOR) methodology, an internationally recognized and evidence-based data analysis tool, to analyze local fetal-infant birth and death data. The PPOR analysis determined that Lane County’s rate of fetal-infant mortality is prevalent and statistically significant in all population groups regardless of socio-economic status, age, education level, geographic location, or cultural background.
Fetal-infant mortality is a multifaceted problem with no obvious or single solution. It’s not just an issue of healthcare access or quality; there are numerous social, economic, and racial/ethnic issues that play a role. The health of a country’s babies is not necessarily about wealth and access to resources. In fact, 29 nations, including Poland and the Czech Republic, have a lower infant mortality rate than the U.S.
The fetal-infant mortality rate can be a symptom of other problems. In other words, underneath these losses of life is the suffering of other children and families -- affecting not only the homes where the loss occurred, but the entire community.
“When we learned the (fetal-infant mortality) rate was high,” said Sandy Moses, former HBHC Coordinator, “it was a red flag for what is going on in our community.”
In response to discovering the high fetal-infant mortality rate in 2007, Lane County’s Public Health Department established the Healthy Babies, Healthy Community Initiative (HBHC) to encourage community involvement in finding answers and creating solutions.
“Knowing that we had the high (fetal-infant mortality) rate, sparked the community to do something; that is how the HBHC was born,” Moses explained. “We knew from the beginning that there were best-practice evidence-based things we could do (to understand and address the high rate). “
HBHC participants adopted the Fetal Infant Mortality Review (FIMR) as its mechanism for problem solving. Developed by the Maternal Child Health Bureau and the American College of Obstetricians and Gynecologists, a multidisciplinary community team conducts the FIMR by examining individual cases of infant and fetal deaths to identify community strengths and weaknesses as well as health and social issues connected with poor outcomes. The goal of the FIMR process is to use the findings to address underlying issues while improving service delivery systems and community resources.
Lane County issued the first FIMR report in 2007. In June, HBHC participants received the 2010 FIMR report for the period of July 1, 2007 to June 30, 2009. According to Moses, this report has not been officially released to the public.
In addition to adopting the FIMR process, the HBHC has also engaged in a Home Visiting Project to identify local home-visiting programs in an effort to create and maintain consistent messaging and to provide outreach that promotes best practices.
“Home visiting is a strategic activity that is important,” Moses explained. “Parenting is stressful, and there is a lot to know in a short amount of time.”
HBHC believes that home visits and outreach should also involve fathers. “The HBHC Perinatal Health Team said we also need to focus on the family (not just mothers),” Moses noted. “We’ve looked at not what just what mom is doing but what dad is doing as well.”
Overall, the goal of HBHC is to save lives and to address issues in the community that lead to the loss of lives. “It’s not a blame game at all.” Moses said. “We’re looking at the system to see how it has failed all of us and to strengthen it where it’s going well.”
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