Fetal and Infant Mortality Review

National Fetal and Infant Mortality Review (NFIMR) z American College of Obstetricians and Gynecologists (ACOG) NFIMR is a collaborative effort between the: z Federal Maternal and Child Health Bureau, Health Resources and Services Administration (MCHB)

FIMR 1988

FIMR Today

Rationale for FIMR Reviews “Infant mortality is the most sensitive index we possess of social welfare.” Julia Lathrop, MD 1913

FIMR is CQI

2001 Johns Hopkins University Study Validates Components of FIMR. “ [The FIMR program] …also creates a setting and a set of concrete activities wherein everyone has a contribution to make and everyone learns from the process. The case study findings indicate that because the FIMR process extends beyond problem identification to promote problem solutions, observable changes in practice and programs occur; ‘things get fixed’ and participants are inspired to take further action.” Source: Women's and Children's Health Policy Center, Johns Hopkins University. The evaluation of FIMR programs nationwide: early findings. [Online, 2002]. Available from:

Selected Components of FIMR

1. Confidentiality Is Key! zFIMR cases are de-identified so that the names of families, providers and institutions are confidential – the FIMR focus is on improving systems assigning blame. NOT

2. FIMR Focuses on Systems  Each FIMR case review provides an opportunity to improve communication among medical, public health and human service providers and develop strategies to improve services and resources for women, children and families.

“The process that brings together people to learn from the story of a family that experienced a fetal or infant loss helps awaken both commitment and creativity. The stories illustrate community needs that are concrete, local and significant. The interaction among diverse community participants generates ideas for action that might lie beyond the imagination and power of an individual provider or agency.” Seth Foldy, MD Former Commissioner of Health, Milwaukee WI

3. FIMR Includes a Family Perspective The FIMR process includes a home interview with the mother who has suffered a loss and the mother’s story is conveyed to the FIMR team members.

“Maternal interviews give a voice to the disenfranchised in my community, those without clout or power. FIMR provides a rare opportunity for the ‘providers’ in a community to hear from the consumers.” Patt Young, FIMR Interviewer, Alameda/Contra Costa Counties, CA

4. FIMR Promotes Broad Community Participation zFIMR is a community coalition that can represent all ethnic and cultural community views and becomes a model of respect and understanding.

“The Growing Into Life FIMR Task Force…has built respect and friendship among races, between classes, around language, and among those of differing political and economic interests.” Karen Papouchoado Former Mayor Aiken, SC

5. FIMR is Action-Oriented. FIMR leads to multiple creative community to improve resources and service systems for women, infants and families. actions

“The mother and infant do not live in a vacuum. If they do not have adequate housing education, food, transportation or job opportunities, if they live in isolation with no one to turn to for the emotional nurturing we all need, then we as their neighborhood must reach out to to enable them not only to avoid infant death, but to enable each mother and child to enjoy health in its fullest meaning.” Mary Hibbard, MD Former Commissioner of Health Suffolk County, NY

National Fetal and Infant Mortality Review (NFIMR) Since 1990, NFIMR has been a resource center working with states and communities to develop fetal and infant mortality review programs. For more information about FIMR, call (202) , us at or visit us at

FIMR/CFR:Working Together Include a representative from the SIDS community on both teams. Both could benefit from training about bereavement and SIDS risk reduction activities. Work together to ensure that all families who have lost a child as well as friends/peers of older children who have died have access to culturally appropriate bereavement services. Identify one or two members who are common to both teams to provide continuity and share aggregate, de-identified recommendations back and forth. Hold a joint FIMR and CFR meeting annually to share aggregate findings related to fetal and infant mortality, identify any mutual recommendations and discuss ways to collaborate on moving from those recommendation to action.

FIMR Does Not:  Manage cases  Review infant abuse and neglect cases  Review cases in litigation  Assign blame to providers/institutions