Case Studies

Reducing Infant Mortality Rates Across the Country

Between 2013 and 2017, the Health Resources and Services Administration Maternal and Child Health Bureau (HRSA MCHB) engaged NICHQ in what became a nationwide effort to reduce infant mortality and improve birth outcomes called the Collaborative Improvement and Innovation Network to Reduce Infant Mortality (Infant Mortality CoIIN). The three core aims: (1) produce measurable improvements in IMR through collaborative learning and quality improvement (QI) methods; (2) increase synergy among state health officials, maternal and child health directors and state and national public and private partners around evidence-based improvement strategies; and (3) create a unified message and a collection of best practices that can be adopted by states and jurisdictions. 

In 2014, a baby born in the United States was more than twice as likely to die in its first year of life than a baby born in the Czech Republic, Finland, Japan, Portugal or Sweden. These nations are joined by over 25 others who have lower infant mortality rates (IMR) than the United States. Significant racial inequities accompany these staggering figures, with non-Hispanic black babies twice as likely to die compared to white babies in their first year of life in the U.S. If these rates remained unchanged, over 23,000 babies would continue to die annually.

Our Approach

NICHQ addressed the challenge of infant mortality by leveraging a unique methodology that combined quality improvement (QI), innovation and collaborative learning. To effectively unite the 51-participating state and jurisdiction teams around a common goal, we used a collective impact framework where NICHQ served as the backbone organization alongside HRSA MCHB, providing resources and facilitating coordination. Three core methods—the Breakthrough Series, the Model for Improvement and Collaborative Innovation Networks—helped teams test change and collaborate around shared interests. 

Following an iterative process, six strategy areas were identified: safe sleep; smoking cessation; prevention of preterm and early term births; preconception and interconception care; risk-appropriate perinatal care; and social determinants of health. NICHQ recommended that each state focus on at least one but no more than three of the six areas. Along with providing technical QI assistance, NICHQ led communication efforts by developing an online community and shared data infrastructure.

The Results

  • A national decline of 5 percent in IMR (helping reduce what would have been an additional 1,775 infant deaths)
  • 81 percent of states demonstrating a decline in their IMR across all infants born
  • 29 percent of the states showing a 10 percent or greater decline in IMR
  • States/jurisdictions achieving a 5 percent reduction in neonatal mortality rate and postneonatal mortality rate
  • States/jurisdictions achieving a 6 percent reduction in preterm related mortality rate
  • States/jurisdictions achieving a 3 percent reduction in preterm birth rate
  • The creation of an interactive infant mortality prevention toolkit featuring change ideas, case studies, videos and key insights, insures that the learning and action can continue even when the official project ended. Get started.
  • An expert webinar series where participants walked away with actionable insights that contribute to the goal of every child reaching his or her first birthday and beyond. Find recordings here. 
Healthy baby


Without the 5 percent decline in IMR, 87 kindergarten classrooms would have been empty in 2015. The initiative’s success presents a much-needed model for tackling national population based health efforts. The project was also successful in opening up lines of communication between state health departments and state Medicaid offices to better support data sharing and influence new reimbursement policies for maternal and infant health.

Also now with the scaffolding in place—including shared goals and an understanding of how to use QI methods to make successful systems change, as well an accessible date infrastructure that impacts programming in real-time—state health departments and communities around the country can better address the complex systemic challenges related to infant mortality. Through enhanced cross-sector collaboration, they can work towards eliminating the racial and ethnic birth outcome disparities that still persist to ensure that all infants born in the United States reach their first birthday.