Perinatal Periods of Risk Approach to Monitor Women's Health and Suggest Intervention Strategies for High Risk Populations

Infant mortality continues to pose a significant challenge to society and the public health system. Rates for infant mortality indicate a disparity not only among minorities but tend to cluster geographically among underserved, high risk communities. In order to better understand the complex causes that contribute to the majority of infant deaths in Tarrant County, the Perinatal Periods of Risk (PPOR) approach for data analysis was adopted by the Tarrant County Infant Mortality Task Force to explore disparities between local and national reference groups. The local Infant Mortality Task Force was created to examine fetal-infant mortality data and design data-driven interventions to decrease the county's infant mortality. The PPOR model determines the most preventable infant deaths by focusing on four specific contributing areas. Analyses were conducted using Tarrant County aggregated data for years 2001-2003. A geographic information system (GIS) was employed to geographically identify high risk groups and assess the availability of local health care services and community resources in order to cultivate effective interventions. After identifying the excess number of deaths (phase I), Maternal Health/Prematurity component of perinatal health reflected the highest fetal-infant mortality rate with 3.1 deaths per 1,000 live births and fetal deaths, accounting for 39.2% of all deaths. Specific socioeconomic and behavioral risk factors were identified (phase II) and analyzed for their contribution to specific fetal-infant deaths. These results have succeeded in providing support for the task force's main goals of changing attitudes, mobilizing countywide partnerships, and building political will to address maternal health and prematurity.