Responding to Infant Mortality in Kent County

The rate of fetal and infant (defined as before a child’s first birthday) death is recognized by the Center for Disease Control and Prevention, among other leading health organizations, as an important indicator of a community’s overall health.

According to the Centers for Disease Control and Prevention Mortality Frequency Measures, factors impacting maternal and infant health—and IMR—include access to prenatal care, the prevalence of prenatal health behaviors (such as alcohol or tobacco use and proper nutrition during pregnancy), postnatal care and behaviors (such as childhood immunizations and nutrition), sanitation, and infection control. This indicator Persistent racial disparities in IMR are also indicative of health and socioeconomic inequities within communities. (Source Kent County Community Needs Assessment, 2020)

The most recent available data from 2015-2018 shows the overall infant mortality rate in Kent County to be at 5.3 per 1,000 live births. As data is disaggregated, we see disparities among race and ethnicities. White, Non-Hispanic rate of mortality stands at 4.5 per 1,000 live births, Latinx/Hispanic mortality is at 6.1 per 1,000 live births and African American is 8.1 per 1,000 live births. (Source Kent County Community Needs Assessment, 2020)

To better understand the specific causes behind infant mortality here in Kent County, the Ready by Five Early Childhood Millage has supported the Kent County Health Department (KCHD) with leading the Fetal Infant Mortality Review (FIMR) Network in Kent County.

What does Fetal Infant Mortality Review Network do?

Following defined process and best practice, the FIMR Network reviews incidents of fetal and infant deaths by means of interviews with caretakers and chart reviews. The Michigan Department of Health and Human Services describes the Fetal Infant Mortality Review (FIMR) as an evidence-based process of identification and analysis of factors that contribute to fetal and infant death. FIMR complements other studies of infant death but uses an approach that is community-based, action-oriented, and designed to bring together local health providers, consumers, advocates, and leaders.

The Fetal Infant Mortality Review has two overarching goals:

• Describe significant social, economic, cultural, safety, health, and systems factors that contribute to mortality; and
• Design and implement community-based action plans founded on the information obtained from the reviews.

To ensure all partners in Kent County are aware of findings, the KCHD will publish an annual report for Kent County that would include recommendations for improving access to critical services to reduce disparities in care, increasing cultural relevance within service delivery, identifying enhance supports for families before and after birth, inform the funding of services, community-based education, and communications initiatives to support families as well as additional key findings.

More about Kent County’s FIMR work

In 2020, Marissa Brown was hired to lead the FIMR work at Kent County Health Department. With the FIMR Network, infant mortality cases from 2020 are currently under review. Once the backlog of cases has been completed, 2021 cases will be reviewed.

As cases are reviewed, the network develops recommendations that are submitted to MDHHS.

Recommendations that have been developed and submitted by the Kent County FIMR Network to date include:

• Offering more social support with community health workers, home visitors, doulas, infant mental health, etc. during pregnancy and after birth to improve management of pre-existing conditions

• Integrating the transition from pediatric care into obstetrical care by using group meetings to discuss specific patient information to improve care coordination and communication between providers

• Utilizing drug toxicology screening for all pregnant women to improve policies regarding systems of care, prevention initiatives, screening, and treatment programs
  
• Review/disperse a policy on Emergency Medical Services (EMS) procedures in transporting patients to the hospital immediately after injury to improve policies regarding systems of care, prevention initiatives, screening, and treatment programs

• EMS personnel determine fetal well-being via doppler during transport to hospital to improve policies regarding systems of care, prevention initiatives, screening and treatment programs

• Increase CPS reporting in the Emergency Department (ED) when a mother discloses domestic violence to address Safety issues/conditions for families.

• Increased education on domestic violence for mandated reporters via mandatory CEU credits in domestic violence to improve training and education for providers

• Increased education on safe sleep for caregivers and family members to improve trainings and education for providers

The Kent County Health Department anticipates a compiled report of findings will be available in late 2022.

For questions related to Kent County’s FIMR work, please contact Brandi Berry-Lovelady, LLMSW at brandi.berry@kentcountymi.gov or Marissa Brown RN, BSN at marissa.brown@kentcountymi.gov.