Advocacy & Health Policy: ACOG Community-Driven National Fetal-Infant Mortality Review Program

Fetal-Infant Mortality Review (FIMR) is a community-based and action-oriented process used to improve service systems and resources for women, infants, and families. This evidence-based method examines fetal and infant deaths, determines preventability, and engages communities to take action.

Fetal-Infant Mortality Review Process

A multi-disciplinary team first reviews case summaries from de-identified infant and fetal deaths. These case summaries include interviews with mothers for their perspective on why the death occurred. The team then makes recommendations for system changes, and a team of community leaders (Community Action Team) is assembled to take action. The Community Action Team works with at-risk families and other partner agencies in the region to develop and implement street-level outreach activities. The goal is not to assign blame, but rather examine the circumstances surrounding an infant or fetal death to identify what went wrong and prevent deaths in the future.

The Success of FIMR Beyond Review of Fetal and Infant Deaths

The FIMR program was a collaborative effort between ACOG and the Maternal and Child Health Bureau (MCHB) established in 1990 to address the rate of infant and fetal deaths. The creation of the National FIMR Resource Center was the result of a presidential initiative from ACOG Past President Ezra Davidson, MD, who promoted this promising public health approach.

ACOG, funded by the Centers for Disease Control and Prevention (CDC) and the Association of State and Territorial Health Officials, is using the FMIR method to conduct a Maternal Influenza Review Program (MIRP). The process will help determine potentially preventable issues and barriers (e.g., system failures, vaccine hesitancy, patient concerns around vaccine safety) that contribute to maternal morbidity and mortality caused by seasonal influenza in pregnant women and make recommendations (e.g., systems changes) for prevention.

The FIMR method was additionally adopted by ACOG in a joint CDC project to investigate mother-to-child HIV transmission. The project successfully identified systems issues, including lack of family planning and reproductive health care for HIV-infected women and the need for better integration between Maternal & Child Health Bureau (MCHB) and HIV state and local agencies. This FIMR/HIV method is now a standard approach in state perinatal grants. In 2013, the CDC expanded this review process to include review of cases of congenital syphilis.

In 2016, a lack of knowledge around the deaths of homeless people led the Indianapolis Police Department to use FIMR to conduct reviews of homeless deaths. The FIMR process identified actions police and the community can take to decrease these deaths. This police-led public health approach to preventing homeless deaths is reported in the 2016 Journal of Social Distress and the Homeless.

The National FIMR program is no longer funded by MCHB, but publications, guides, and technical materials to support and sustain FIMR programs are available online at

Click on an ACOG Fellow below to hear about the FIMR process for physicians.

Charlene Collier, MD
 Washington Hill, MD  Christine Curry, MD


American College of Obstetricians and Gynecologists
409 12th Street SW, Washington, DC  20024-2188
Mailing Address: PO Box 96920, Washington, DC 20024-9998