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Fetal-Infant Mortality Review

About FIMR

What is FIMR?

Emerging as a public health strategy in the mid-1980s, Fetal Infant Mortality Review (FIMR) was created as a response to the alarming increase in the infant mortality rate in the United States associated with adverse reproductive and infant health outcomes at the local level. Throughout the country, FIMR is being utilized as an action-oriented community process that continually assesses, monitors, and works to improve service systems and community resources for women, infants, and families.

By reviewing the circumstances surrounding the lives and deaths of these mothers and infants, as well as those who are never born (fetal deaths), and then providing these findings to community action teams (CAT), FIMR teams can come up with creative ideas to help improve birth outcomes and reduce infant mortality rates.  Research shows FIMR is an effective perinatal systems intervention as it examines infant mortality in the large context of social, economic and systems factors.

FIMR is:

  • Community-based
  • Action-oriented
  • Used at the local level to:
    • Assess
    • Plan
    • Improve, and
    • Monitor service systems
    • Develop policy
  • Promoting the health and well-being of women
  • A warning system that can describe effects of health care systems change
  • A method for implementing continuous quality improvement

How does FIMR work?

  • The FIMR process is not about assigning blame. Rather it is an examination of circumstances surrounding the death to identify system gaps. The FIMR process brings a multi-disciplinary community team together to review de-identified infant and fetal death cases. Composed of health, social service, medical, nursing and other professionals, the FIMR case review team examines the case summary, which is comprised of information from medical data abstractions, in conjunction with a maternal interview. Data sources will include birth and death certificates, records from hospitals and physicians, WIC, and Healthy Start. The case is discussed based on all information gathered and gaps in the systems of care are identified.
    Findings are summarized and used to create recommendations to improve the community’s service delivery systems and resources. Community leaders representing government, consumer, key institutions and health & human services organizations serve on the CAT, which acts to implement recommendations. CATs can enhance the credibility and visibility of issues related to Hoosier parents, infants and families about the need for these actions through presentations, media events and written reports. By initiating new creative solutions for service delivery to families and constantly monitoring their applicability and effectiveness within the community, CATs work to improve the health outcomes of mothers and infants in communities.
    FIMR can be used to bolster a variety of Indiana perinatal surveillance efforts. This can and should include the incorporation of FIMR findings into institutionalized Title V activities, such as the 5-year needs assessment and annually reported performance measures. Aside from the obvious positive potential impact on the informed, data-driven resource improvements in Indiana communities, FIMR is a valuable tool to enhance Indiana’s Title V Needs Assessment by:
  1. Examining social, cultural, safety, and health systems factors that are associated with fetal and infant mortality through review of individual cases
  2. Identifying systems barriers and problems that need improvement through case-reviews
  3. Including maternal interview information from consumers to further identify actions needed
  4. Addressing ways of improving service systems and community resources to reduce future fetal and infant deaths
  5. Providing valuable qualitative data to use with the state’s quantitative infant mortality data

Current Teams

View a map and contact information of current county and regional FIMR teams across Indiana.


For questions, please contact:

Linzi Horsley

FIMR Program Manager

Fatality Review & Prevention

Indiana Department of Health