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Healthy Women Healthy Baby Zones: Strategies to Address the Social Determinants of Health


The Infant Mortality Rate (IMR) is a public health indicator of a complex societal problem.  Numerous frameworks have been used to understand the complexities of infant mortality. The social determinants of health (SDOH) are often defined as the circumstances in which people are born, grow up, live, work and age that play an important role in shaping health outcomes.

Lifestyle or behavioral risk factors such as smoking, poor nutrition, excessive or risky alcohol intake, physical inactivity and psychosocial conditions such as isolation, low self-esteem and abuse, environmental conditions affect one’s health. For pregnant women, infants and young children such exposure to these risk factors and toxic stress can result in life threatening conditions, as well as infant deaths. Research and experience shows that women, children and families do better and thrive when they live in strong and supportive communities.

Building on research and evidence gathered through large, multiyear studies, DPH is proposing that in order to influence driving down the state’s infant mortality rate, that there be a concentrated effort to implement non-medical community-based interventions to address the social determinants of health. Delaware’s infant mortality rate of 7.5 deaths per 1000 births is higher than the U.S. rate of 5.9 deaths per 1000 (2011-2015). In spite of significant improvements over the past decade, a racial disparity stubbornly persists in birth outcomes. The average infant mortality rate among black s in Delaware is 12.5 1000 in 2012-2016, compared to 5.1/1000 for whites.


The aim of Healthy Women Healthy Baby Zones: Strategies to Address the Social Determinants of Health is to build state and local capacity and test small scale innovative strategies to shift the impact of social determinants of health tied to root causes related to infant mortality.

The primary focus is to spread evidence-based programs and place-based strategies to improve social determinants of health an equity in birth outcomes. Communities with high risk indicators such as high infant mortality, high premature birth rates, poverty and/ or other risk factors will be the focus of this program.


The awarded contractor for this grant will provide project management for 3-6 subcontractor organizations to implement interventions to address SDOH driving poor birth outcomes. The contractor will provide operational oversight to the subcontractor projects on behalf of the Division of Public Health and the Community Health Workers that will be placed within the high-risk communities.


The RFP process leading to grant awards was near completion in June of 2019.