Delaware County report finds rising Black–White gap in infant mortality; maternal health, prematurity identified as largest contributor

Delaware County health officials released a Perinatal Periods of Risk (PPOR) analysis on Jan. 20 showing that excess infant mortality among Black infants increased in the 2016–2020 period compared with earlier five‑year periods, and that the largest share of that excess was in the maternal health and prematurity period.

Victor, senior epidemiologist for the Delaware County Health Department, told the Board of Health that comparing three PPOR analyses (2008–2012, 2012–2016 and 2016–2020) “the risk of excess death increased” in the most recent period and that “the highest infant mortality rate was in the maternal health and prematurity area.” He said the PPOR method assigns deaths by birth weight and age at death to identify periods where prevention efforts could be targeted.

The PPOR method used in the county analysis was adapted for U.S. use by CityMatCH and the Centers for Disease Control and Prevention and has been employed in other counties and cities, Victor said. The county used births linked to death certificates for 2016–2020 to capture clinical and perinatal factors not always present in other vital statistics.

Health Department Director Laura said the report was released the same day and that maternal, parental and infant health is a formal strategic priority for the department. “This is that maternal, parental, and infant health is 1 of our strategic priorities for the department,” she said, and added the findings will be integrated into the department’s Community Health Improvement Plan and its maternal and child work group.

The PPOR categorizes deaths into four periods of risk—maternal health and prematurity, maternal care, newborn care and infant health—and maps recommended strategies onto each period. Officials identified preconceptional health, health behaviors and perinatal management as priority intervention areas for the county in response to the findings. Victor summarized recommended strategies from PPOR guidance that the county is considering, including increased access to preconception care, improved prenatal care quality, perinatal and neonatal management, and community-based supports such as doula programs.

Board members asked whether the analysis could be broken down geographically; Victor said detailed location data are available from the state on request and the health department can combine that with census data. He and Laura said they plan a March presentation to the maternal–child health committee and to incorporate evaluation measures into the Community Health Improvement Plan work group’s objectives.

The health department noted that prior local PPORs reached similar conclusions about the role of maternal health and prematurity; the county said it will use existing local partners, including the Foundation for Delaware County and its Healthy Start program, in planning interventions.

The report’s authors stressed the complexity of translating PPOR findings into interventions and the need for multi‑partner systems change, training and funding. Officials said they will continue PPOR analyses at five‑year intervals, now that the department has refined data requests to the state.

Votes at a glance: the meeting approved the board’s previous meeting minutes without a recorded roll-call vote.