Vignette: You are completing a clinical rotation in a small community agency that provides services to pregnant women or women with children under the age of 3. This agency is located in an urban area of the southern United States. The racial composition of the community is 78.1% white, 9.6% African American, 8.0% Hispanic, 0.3% American Indian/Alaska Native, 2.0% Asian, and 2.0% other. In 2009, 110,800 women of child-bearing age resided in the county with 5,300 total births.

Recently you and your fellow students learned that current statistics for the county reveal that from 2006 to 2008, the infant mortality (number of deaths per 1000 live births) rate was 8.2%; an increase from 6.5% in 2005-2007. For African Americans, the rates were 10.0% in 2005 to 2007 and increased to 14.4% in 2006 to 2008. The local Healthy Start agency confirms that these data are accurate for the community. In fact, based on a review of deaths by the coroner, in the last year, the major causes of neonatal and infant demise were low birth weight, babies sleeping in bed with an adult (roll over/unintentional deaths), and SIDS. SPSS