Date of Conferral



Doctor of Public Health (DrPH)


Public Health


German Gonzalez


This study addressed whether race and ethnicity, birthing location, the month the mother begins prenatal care, and pregnancy risk level impact fetal/infant mortality. Infant mortality is a gauge by which the efficacy of the healthcare system and the overall health of the country is measured. The United States falls behind most other developed countries in terms of infant mortality rates. The ecological perspective was used as the theoretical framework. The study design was a cross-sectional cohort design using a sample of births and infant deaths from U.S. Vital Statistics data. Binomial logistic regression analyses were carried out to calculate odds ratios. Results of this analysis showed non-Hispanic Black (only) mothers are more likely than non-Hispanic White (only) mothers to have a pregnancy result in fetal/infant death. In terms of prenatal care initiation, beginning care by Month 5 of a pregnancy confers a protective effect. Analyses on birthing location safety resulted in a substantial increased risk for births in freestanding birth centers and births at home that were intended to be at home, when compared to hospital births. Furthermore, women who were high-risk were more likely to have a negative birth outcome compared to low-risk women. Addressing each of these risks can help health care professionals contribute to positive social change by decreasing the incidence of fetal/infant mortality.