HRSA-supported team improves birth outcomes in U.S. South

U.S. Department of Health & Human Services
Health Resources and Services Administration
April 19, 2018

New research HRSA Exit Disclaimer published in the American Journal of Public Health found that HRSA-funded efforts to combat infant mortality in the South are improving multiple key indicators. The study, led by researchers from the Health Resources and Services Administration (HRSA), shows early elective delivery decreased by 22 percent in the South versus 14 percent in other regions. Alabama and Louisiana showed the largest reductions in the nation at more than 40 percent. Results in the South also showed that stopping smoking during pregnancy increased by 7 percent, infant back sleep position increased by 5 percent, and preterm birth fell by 4 percent; other regions only showed improvements of 2 percent for each of these outcomes measured.

Launched in 2012 at the request of southern state health officials, HRSA’s Infant Mortality Collaborative Improvement and Innovation Network (CoIIN) was the first multi-state public health quality improvement initiative to address infant mortality. The U.S. infant mortality rate continues to rank poorly among developed countries, with southern states having higher infant mortality rates than states in other U.S. regions. This study evaluated data from 2011-2014, comparing outcomes before and after the CoIIN’s original 18-24 month project period in the Department of Health and Human Services Regions IV/VI.

“HRSA aims to develop innovative solutions to address the diverse health needs of the people we serve,” said HRSA Administrator George Sigounas, MS, Ph.D. “This analysis demonstrates how data-driven collaboration among federal, state, and local leaders can lead to measurable results that may ultimately reduce infant mortality, one of the most concerning issues of our time.”

Preliminary data indicating CoIIN’s success in the South led to a national expansion to all states in 2014, which included additional strategies such as addressing the social determinants of health and progesterone therapy to prevent recurrent preterm birth. Further evaluation will be needed to assess whether other regions have achieved similar results, and whether additional strategies and sustained effort in the South have led to improvements in infant mortality rates. 

“Infant mortality is a sentinel measure of population health that reflects the underlying well-being of mothers and families,” said the study’s lead author and HRSA Senior Health Scientist Ashley Hirai, Ph.D. “HRSA’s Infant Mortality CoIIN exemplifies successful partnerships and what we can achieve if we provide a platform to leverage existing investments, share best practices, and track real-time results.  It shows promise for accelerating health improvement in the South and beyond.”

Using technology to remove geographic barriers to collaboration, HRSA CoIINs unite multidisciplinary teams to address common issues through collaborative learning, quality improvement, and new ideas. To learn more about HRSA’s CoIIN efforts, visit

Date Last Reviewed:  April 2018