conduct of an infant mortality assessment entails identifying and
answering an organized array of questions about the factors or determinants
that contribute to the risk of an infant death or other adverse
pregnancy outcome. Factors that contribute to an infant death occur
across a continuum, from preconception, to the time of birth and
beyond. Thus, when conducting infant mortality assessments, it is
important to examine a wide range of factors and identify those
that can be addressed with available resources and technology.
1) What are
the causes of death? (Based on the ICD-9 classification)
- Birth Complications
& Birth Asphyxia
When are the deaths taking place (neonatal or postneonatal
- Are specific
causes of death associated with certain ages at death?
- Is the association
between cause of death and age at death changing over time?
3) What are
the associated adverse pregnancy outcomes that contribute to infant
- Low birth
weight (<2500 gms) and very low birth weight (<1500gms)
- Small for
malformation and anomalies
4) How do these
adverse pregnancy outcomes relate to infant mortality?
- Are the
trends both increasing/decreasing/stable or are they disparate?
- How does
the risk of mortality vary by birth weight and gestational age
- How have
the risks of mortality by these outcomes changed over time?
- How much
of the IMR is explained by these associated adverse outcomes?
5) Are there
racial/ethnic disparities in IMRs?
- How have
the racial/ethnic disparities in mortality and associated outcomes
changed over time?
- What risk
factors underlie these disparities?
6) What risk
factors are associated with a high IMR or an adverse pregnancy outcome?
- Lack of
- Lack of
- Low education
- Stress and
lack of support
- Poor access
to or inadequate use of prenatal care
or substance abuse
- Poor nutrition
- First pregnancy
or high parity
- Short birth
- Age of mother
(too young / too old)
- Low weight
gain during pregnancy
complications (hypertension, diabetes, etc)
hospital level for delivery
7) What are
the relative risk (RR) and the attributable risk (AR) for these
Relative risk is
The incidence of the disease among those with the risk factor
The incidence of the disease among those without the risk factor
Attributable risk is
in total population) – (Incidence in non-exposed
8) How does
the distribution of these risk factors vary?
- Over time?
- By region,
- By specific
9) Are there
successful IM prevention programs in place?
- How has the
impact been demonstrated?
- Are these programs reaching the appropriate populations?
What is the availability of high-risk obstetrical and newborn
care (relative to need or indication of need)?