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Perinatal Periods of Risk: A Community Approach for Using Data to Improve Women and Infants’ Health

Abstract

This paper provides an overview of the origins, purpose, and methods of the Perinatal Periods of Risk (PPOR) approach to community-based planning for action to improve maternal and infant health outcomes. PPOR includes a new analytic framework that enables urban communities to better understand and address fetal and infant mortality. This article serves as the core reference for accompanying specific PPOR methods and practice articles. PPOR is based on core principles of full community engagement and equity and follows a six stage community-based planning process. In Stage 1, communities are mobilized and engaged, related planning efforts aligned, and community and analytic readiness assessed. In Stage 2, feto-infant mortality is mapped, excess mortality is estimated, likely causes of feto-infant mortality are determined, and appropriate actions are suggested. Stage 3 produces action plans for targeted prevention strategies. Stages 4 and 5 include implementation, monitoring, and evaluation. Stage 6 fosters political will to sustain efforts. PPOR can be used in local maternal child health (MCH) practice for improving perinatal outcomes. MCH programs can use PPOR to integrate health assessments, initiate planning, identify significant gaps, target more in-depth inquiry, and suggest clear interventions for lowering feto-infant mortality. PPOR enables greater cooperation in improving MCH through more effective data use, strengthened data capacity, and greater shared understanding of complex infant mortality issues. PPOR offers local health departments and their community partners a comprehensive approach to address the health of women and infants in their jurisdictions.

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Acknowledgments

We extend our gratitude to Dr. Brian McCarthy for developing and sharing his original methods and encouraging us to expand and adapt the approach for use in the United States. Thanks to Kathy Carson (Seattle WA) and others in the original pilot cities (Seattle, Boston and Honolulu) for giving us the green light to move ahead. Kudos to the Perinatal Periods of Risk Practice Collaborative (PPOR-PC) and Practice Advancement Collaborative (PPOR-PAC) teams for shaping best practices and harvesting lessons learned. Patrick Simpson and Dr. Vera Haynatzka at CityMatCH were instrumental in assuring strong foundations for developing the approach, and Carol Gilbert and Dr. Laurin Kasehagen provided critical expertise to finalize publication. And special thanks to Dr. Milton Kotelchuck for lending enduring expert editorial advice in shaping this keystone article. This work was supported in part by the following Cooperative Agreements: Merging Research and Practice for Urban Child Health—TS-283-14/16 (under CDC Cooperative Agreement U50/CCU300860); Building Urban MCH Capacity—TS 0922 (under CDC Cooperative Agreement U50/CCU300860); Toward Greater Science Use in Urban Health Agencies—TS-1337 (under CDC Cooperative Agreement U50/CCU300860); and the Maternal, Infant, and Reproductive Health: Science-Based Capacity Building for Major Urban Public Health Agencies (5 U65 DP724969-05) between CityMatCH at the University of Nebraska Medical Center and the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, with supplemental support from the National Center for Birth Defects and Developmental Disabilities, and the Health Resources and Services Administration, Maternal and Child Health Bureau. Additional support was provided by the National March of Dimes Birth Defects Foundation, and the University of Nebraska Medical Center, Department of Pediatrics.

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Correspondence to Magda G. Peck.

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The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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Peck, M.G., Sappenfield, W.M. & Skala, J. Perinatal Periods of Risk: A Community Approach for Using Data to Improve Women and Infants’ Health. Matern Child Health J 14, 864–874 (2010). https://doi.org/10.1007/s10995-010-0626-3

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Keywords

  • Perinatal periods of risk (PPOR)
  • Community health planning
  • Feto-infant mortality
  • Preconception health
  • Health disparities