Perinatal Periods of Risk Approach in U.S. Cities

A joint initiative of CityMatCH at the University of Nebraska Medical Center,
The Centers for Disease Control and Prevention,
The National March of Dimes Birth Defects Foundation, and
the Health Resources and Services Administration/Maternal and Child Health Bureau

BACKGROUND

For over a decade, the Perinatal Periods of Risk approach has been used in developing and developed countries by Dr. Brian McCarthy from the Centers for Disease Control and Prevention (CDC) and other World Health Organization collaborators, to monitor and investigate fetal-infant mortality. Since 1997, in partnership with CDC and the March of Dimes and several major cities, CityMatCH has led national efforts to validate, enhance and adapt this approach for greater use in U.S. cities. Four key factors spurred a more in-depth look at this new approach:

  • No simple, standardized, widely accepted approach for communities to examine infant mortality.
  • Current approaches don't readily identify potential gaps in the community for further reductions.
  • Current approaches don't directly lead to action to targeted studies, investigations or prevention activities.
  • Current approaches are not simply and easily communicated to community partners, which can inhibit mobilization.
APPROACH

The overall intent of the PPOR Approach is to develop a simple method that can be used by communities to mobilize and prioritize prevention efforts. The Perinatal Periods of Risk Approach has six major steps for addressing fetal-infant mortality:

  1. Assure Analytic and Community Readiness;
  2. Conduct Analytic Phases of PPOR;
  3. Develop Strategic Actions for Targeted Prevention;
  4. Strengthen Existing and/or Launch New Prevention Initiatives;
  5. Monitor and Evaluate Approach; and
  6. Sustain Stakeholder Investment and Political Will.

Each of these steps is an essential building block, with each building upon the previous. The approach divides fetal-infant mortality into four strategic prevention areas: maternal health/prematurity, maternal care, newborn care, and infant health. PPOR mapping of fetal-infant mortality enables communities to identify and further investigate areas in which there are the greatest opportunities for local impact. Follow-up investigations provide in-depth information and strategic direction for targeted prevention of fetal and infant mortality.