The Need to Continue to Invest in Public Health Surveillance Systems to Reduce Infant Mortality

In this issue of Pediatrics, Holicky and colleagues describe findings from the 2016 to 2020 Illinois Pregnancy Risk Assessment Monitoring System (PRAMS), demonstrating important variations in maternal adherence to recommendations regarding infant sleep practices, breastfeeding, and smoking abstinence.1 Importantly, the report describes patterns of infant sleep and care practices instead of focusing on just 1 element.This report exemplifies how a population-based perinatal surveillance system can inform the development of interventions to improve safe infant care practices to reduce the risk for sudden unexpected infant death (SUID). As stated in this manuscript, the authors undertook this PRAMS analysis to understand the practices and experiences of mothers in the first year postpartum so that interventions could be developed in a targeted, data-informed manner. The study's finding regarding adherence to prone sleeping suggests that the "Back to Sleep" campaign of the 1980s was successful in increasing adherence to supine sleep positioning recommendations. Without state-specific PRAMS data, clinicians and other maternal and infant providers may have chosen to focus their engagement opportunities with parents on back sleeping with less attention to other safe sleep practices that have far lower adherence rates.Another valuable opportunity created by this analysis of state-specific, population-level data of infant care practices is the potential for ongoing monitoring of infant care practices as targeted interventions are developed and implemented across Illinois. For example, the Illinois Perinatal Quality Collaborative launched the Equity and Safe Sleep for Infants (ESSI), which seeks to engage all Illinois birthing and children's hospitals in increasing awareness of and readiness for parents and caregivers to practice safe infant sleep practices.2 Given the statewide reach of this effort, population-level data such as those collected by PRAMS will allow for ongoing evaluation of impact on improving maternal report of infant care practices that reduce SUID risk in Illinois. The current state of infant care practice has now been reported by Holicky, and, therefore, continued engagement with Illinois PRAMS will be critical for continued data-informed development and adaptations of SUID risk-reducing interventions.PRAMS also provides an important data set to monitor and improve health equity. By linking maternal responses to birth certificates, it provides reliable race and ethnicity data, allowing for population-level analyses regarding infant care practices and health outcomes. Given that non-Hispanic Black and American Indian/Native American groups experience disproportionate SUID rates in the United States,3 associated factors need to be analyzed within and across racial and ethnic groups. Data on the unique exposures and experiences among minoritized communities with accurate self-reported race and ethnicity categorization are essential to develop targeted interventions to support communities who have higher risks of SUID.PRAMS is the only national perinatal surveillance system that integrates birth certificate data with maternal experiential data, providing population-based estimates of maternal and infant dyadic health and well-being. In recent months, the Centers for Disease Control and Prevention's (CDC) Division of Reproductive Health, which oversees PRAMS, has been significantly reduced in size, scope, and resources. The reduction in the force of the CDC PRAMS team has created tremendous uncertainty regarding whether and how maternal and infant health experiences and outcomes will be monitored at the state and national levels. For many state maternal and child public health programs, PRAMS data are essential to identifying strategic focus areas for resource investment. Priority setting by these state entities is based on high-quality data, especially for developing programs and policies to optimize health for populations who experience a disproportionate burden of adverse perinatal health outcomes. Given that approximately 98% of all births occur in hospitals,4 and there are more than half a dozen recommended well-child visits for infants to their pediatric providers in the first year of life,5 the integration and collaboration of health care delivery with public health priorities for mothers, infants, and families are essential. The PRAMS analyses conducted by Holicky and colleagues provide robust data for perinatal health providers to develop, implement, and evaluate innovative safe infant sleep initiatives targeted to the array of practices reported by Illinois mothers to reduce SUID risk across their state. Ongoing resource investment, not withdrawal, in perinatal surveillance systems is critical to inform health care-based interventions to improve maternal and infant health and well-being.