Delaware County report finds rising excess Black infant mortality; maternal health, prematurity cited as leading contributors

The Delaware County Board of Health on Jan. 23, 2025 received a Perinatal Periods of Risk (PPOR) analysis covering 2016–2020 that found excess Black infant mortality increased compared with earlier five‑year periods.

The PPOR analysis, presented by Victor (senior epidemiologist, Delaware County Health Department), compared three five‑year windows and assigned infant deaths to four periods of risk — maternal health and prematurity, maternal care, newborn care and infant health — to identify where excess deaths between Black and White infants are concentrated.

Victor told the board the county’s most recent PPOR showed the largest contribution to excess Black infant mortality came from the maternal health and prematurity period. "If you look at the Pennsylvania 1 and then the Delaware County is 1 with the square, ... look what happens in Delco. It goes up," Victor said, describing the county’s trend against statewide declines. He and staff said the method links birth certificates to death records and groups deaths by birth weight and age at death to pinpoint preventable causes.

Why it matters: county staff said the PPOR is intended to support a community action plan and to guide the county’s community health improvement plan (CHIP). Laura (director, Delaware County Health Department) said the report was released on National Maternal Health Awareness Day and will be embedded into ongoing maternal, parental and child health work groups. "This is a brand ... hot off the presses," Laura said.

The report used three five‑year windows (including 2016–2020) because the PPOR method requires multi‑year counts for reliable rates; staff noted fetal deaths were counted at least at 16 weeks' gestation per the analytic method, though jurisdictions sometimes use 24 weeks. Victor said the county performed multiple prior PPORs with partners including the Foundation for Delaware County and that the foundation’s Healthy Start grant and other local programs are potential implementation partners.

Board members and staff discussed next steps. Victor said recommended strategies align with the PPOR categories: for maternal health and prematurity, measures include preconception care and addressing maternal health behaviors; for maternal care, improving prenatal care quality and referral systems; for newborn care, strengthening perinatal and neonatal management; and for infant health, interventions around safe sleep, breastfeeding support and injury prevention.

Laura said the department will embed the PPOR results into the CHIP work groups, seek partner collaboration and include evaluation measures. Victor said the department and partners will use goal‑based evaluation measures (inputs, outputs and outcomes) and that future PPOR work will be done at roughly five‑year intervals given data preparation time and state data request processes.

Ending — what’s next: staff said they will present the report and proposed community actions to the maternal‑child health committee in March and continue coordinating with the Foundation for Delaware County and state partners. The department also plans to include evaluation metrics in the CHIP implementation plan and to request the state’s data for ongoing monitoring.