Maternal and Child Health Journal

, Volume 14, Issue 6, pp 851-863

Perinatal Periods of Risk: Phase 2 Analytic Methods for Further Investigating Feto-Infant Mortality

  • William M. SappenfieldAffiliated withDivision of Reproductive Health, Centers for Disease Control and PreventionCityMatCH, Department of Pediatrics, University of Nebraska Medical CenterDivision of Family Health Services, Florida Department of Health Email author 
  • , Magda G. PeckAffiliated withCityMatCH, Department of Pediatrics, University of Nebraska Medical Center
  • , Carol S. GilbertAffiliated withCityMatCH, Department of Pediatrics, University of Nebraska Medical Center
  • , Vera R. HaynatzkaAffiliated withCityMatCH, Department of Pediatrics, University of Nebraska Medical Center
  • , Thomas BryantIIIAffiliated withDuval County Health Department, Institute for Public Health Informatics and Research

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The perinatal periods of risk (PPOR) methods provide a framework and tools to guide large urban communities in investigating their feto-infant mortality problem. The PPOR methods have 11 defined steps divided into three analytic parts: (1) Analytic Preparation; (2) Phase 1 Analysis—identifying the opportunity gaps or populations and risk periods with largest excess mortality; and (3) Phase 2 Analyses—investigating these opportunity gaps. This article focuses on the Phase 2 analytic methods, which systematically investigate the opportunity gaps to discover which risk and preventive factors are likely to have the largest effect on improving a community’s feto-infant mortality rate and to provide additional information to better direct community prevention planning. This article describes the last three PPOR epidemiologic steps for investigating identified opportunity gaps: identifying the mechanism for excess mortality; estimating the prevalence of risk and preventive factors; and estimating the impact of these factors. While the three steps provide a common strategy, the specific analytic details are tailored for each of the four perinatal risk periods. This article describes the importance, prerequisites, alternative approaches, and challenges of the Phase 2 methods. Community examples of the methods also are provided.


Perinatal periods of risk (PPOR) Feto-infant mortality Health disparities methodology