Infant mortality rates have long been a major health status indicator of childbearing women and their children in any population group, community, or nation. Measurement of infant mortality allows comparisons among population groups including other industrialized nations. An infant mortality rate is usually determined by counting the number of infant deaths, multiplying that number times 1000 and dividing by the total number of births per year. This method does not take into account fetal or stillborn deaths that were of viable gestational age and/or weight, and as such, does not present a clear picture of the health of mothers and their infants. A new model for assessing fetal-infant mortality, the perinatal periods of risk model (McCarthy, 1995), accounts for fetuses of at least 24 weeks gestation and 500 grams who die at or before term in addition to those live births who die during the neonatal or post neonatal period.
Objective: The main research objective was to determine the population most at risk for fetal- infant mortality in order to plan targeted, community-based interventions.
Design: The study used a retrospective descriptive research design incorporating the perinatal periods of risk model (McCarthy, 1995).
Population, Sample, Setting, Years: The population was all 1997 fetal and infant mortality data contained in one county’s statistics in a Midwestern state.
Concept or Variables Studied: The overall concept of concern was infant mortality rates. Variables in the perinatal periods of risk model included age at death in weeks and birth weight for fetuses and infants. Additionally, differences in death rates by race were examined using the risk model.
Methods: Secondary analysis was conducted using county, state, and national fetal-infant mortality vital statistics databases. Using the perinatal periods of risk model, fetal-infant mortality rates for fetal mortality, neonatal mortality, and post-neonatal mortality were determined and converted into the appropriate risk cell for maternal health, maternal care, newborn care, or infant health.
Findings: Results of the study indicated the maternal health cell contained the highest rate of fetal-infant mortality with 4.3 fetal deaths per 1000 live births and fetal deaths combined; then maternal care with 3.3 deaths per 1000 live births and fetal deaths combined; then infant health at 2.7 deaths per 1000 live births and fetal deaths combined; then newborn care at 1.7 deaths per 1000 live births and fetal deaths combined. Additionally, when the variable of race was examined in the maternal health cell it was found that rates differed among races: Blacks had a 6.02/1000 rate, whites 2.7/1000 rate; and American Indians 1.7/1000 rate. The rates were then compared to other counties of similar size.
Conclusions: After examining the opportunity gaps among the four cells, it was determined the maternal health cell was contributing the most dramatically to the fetal-infant mortality rate of the county.
Implications: Community-based nursing interventions for targeted population groups are important for changing health status indicators such as infant mortality rates. Planned interventions to reduce fetal-infant mortality rates should be targeted at maternal health in the population under study. Some interventions to be enhanced include family planning access and services, nutrition and exercise, substance abuse prevention and treatment, smoking prevention and cessation efforts, stress reduction, basic education, and empowerment of childbearing-age women.
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