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Strengthen the Evidence for Maternal and Child Health Programs

Infant Mortality Toolkit

Resources for a Public Health Approach

The Right Information at the Right Time

Resources compiled by the MCH Digital Library and the National SUID/SIDS Resource Center


Public Health Approach to Infant MortalityThe number of deaths among near- and full-term infants (>36 "weeks' gestation") remains higher in the United States than in most of the industrialized world. Internationally, the United States now ranks 34th in infant mortality1—behind Japan, Singapore, Hong Kong, Australia, New Zealand, Canada, Israel, and most European nations.2 In 2010 (the most recent year for which statistics are available), the U.S. infant mortality rate was 6.15 deaths per 1,000 live births.3

This toolkit provides resources to help the Maternal and Child Health (MCH) work force strategically integrate the evidence base into plans for addressing infant mortality.

These resources are organized by a four-part conceptual model of public health, detailed below.

1. Surveillance and Monitoring

Resources in defining the problem through the systematic collection of information about the magnitude, scope, characteristics and consequences, of infant mortality.

2. Identifying Risk Factors and Protective Factors

Resources in establishing why infant mortality occurs using research to determine causes and correlates of infant mortality, factors that increase or decrease risk for infant mortality, and factors that could be modified through interventions.

3. Developing and Testing of Prevention Strategies

Resources to find out what works in preventing infant mortality by designing, implementing and evaluating interventions in five areas of targeted improvement, as identified by Health Resources and Services Adminstration's (HRSA's) Maternal and Child Health Bureau (MCHB): (1) reduce elective delivery at <39 weeks, (2) expand access to interconception care through Medicaid, (3) increase smoking cessation among pregnant women, (4) prevent SIDS/SUID, and (5) expand perinatal regionalization.

3.1.  Reduce elective delivery at <39 weeks

Perinatal morbidity is higher in infants delivered before 39 weeks' gestation.

3.2.  Expand access to interconception care through Medicaid

3.3.  Increase smoking cessation among pregnant women

  • Centers for Disease Control and Prevention (CDC). Smoking: How to Quit.
  • National Cancer Institute (NCI). Free Help to Quit Smoking. Provides a toll-free quit line, online chat service, and links to smoking-cessation materials. Telephone: 1-877-44U-QUIT (448-7848)
  • SmokeFree.Gov. The section titled SmokeFree Women includes guidelines for pregnant women. This site also provides
    • An online Quit Guide.
    • Information on SmokefreeTXT. a free, smoking-cessation text messaging service designed for adolescents and young adults across the United States.
    • Information on the free Smokefree Smartphone Applications: QuitGuide and quitSTART, each designed to help smokers manage their smoking habits and gain skills to help them quit.
    • Resources for health professionals. Includes the QuitNowTXT Message Library developed by NCI's Tobacco Control Research Branch to provide health departments, academic institutions, and government agencies with an algorithm and database of messages designed to serve as smoking-cessation intervention for individuals who are ready to quit smoking.
  • SmokefreeMOM. Coordinated program focused on providing pregnant women who wish to quit smoking with personalized, interactive, and evidence-based health text messages. DHHS partners in the project include CDC, the Substance Abuse & Mental Health Services Administration, the National Institutes of Health (NIH), and the Food and Drug Administration.
  • Tobacco and Nicotine Cessation During Pregnancy. (2020). American College of Obstetricians and Gynecologists.
  • MCH Digital Library Resources: Resource brief | Bibliography | Reproductive health services

3.4.  Prevent SIDS/SUID

3.5.  Expand perinatal regionalization

Regionalized perinatal systems ensure that high-risk deliveries occur in the hospitals best equipped to optimize outcomes.

4. Ensuring Widespread Adoption

Resources to implement effective and promising interventions in a wide range of settings. The effects of these interventions on risk factors and the target outcome should be monitored, and their impact and cost-effectiveness should be evaluated.

Materials for Professionals

Materials for Families


1. United Nations, Department of Economic and Social Affairs, Population Division. 2011. UN World Population Prospects Report, by 5 Year Averages.

2. Central Intelligence Agency. 2012. CIA World Factbook, Infant Mortality Rate (2012 estimates). Washington, DC: Central Intelligence Agency.

3. Centers for Disease Control and Prevention, National Center for Health Statistics. 2013. Vital Statistics Available Online.

Infant Mortality Toolkit (May 2013). (Updated March 2022)

Authors: John Richards, M.A., AITP, and Beth DeFrancis Sun, M.L.S., MCH Digital Library and National SUID/SIDS Resource Center.
Reviewers: Rochelle Mayer, Ed.D., and Olivia K. Pickett, M.A., M.L.S., MCH Digital Library and National SUID/SIDS Resource Center.
Editor: Ruth Barzel, M.A., MCH Digital Library.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.