Although the United States' infant mortality rate continues to decline, its rate is still higher than that of many other industrialized nations and grave inequalities exist in the rates of infant mortality between races. In an attempt to respond to the problem of infant mortality, many communities have initiated fetal and infant mortality review (FIMR). FIMR offers an opportunity for communities to identify unmet needs and shortcoming in the health care delivery system as well as to create means to respond to identified problems. FIMR has been endorsed by various groups including the American College of Obstetricians and has been incorporated into the federally-funded health Start projects. While FIMR shows promise as an innovative means to identify and respond to gaps in the health care system, there is little know regarding how FIMRs actually go about attempting to assess and amend the communities' health care systems. This study proposes to examine FIMR projects to assess how policy recommendations are created and what efforts are made towards their implementation. The study will use an embedded multiple case study approach that will include systematic data collectionin order to explore aspects associated with FIMR-related health policy development. The specific aims of the study are to explore: 1. What FIMRs do to produce policy recommendations; 2. How FIMRs implement policy recommendations, and; 3. Whether the processes identified fit existing models of health policy formulation. It is anticipated that this research will be of interest to those intereste in FIMR in general as well as those interested in quality assurance, health planning, policy and community development as well as decision making. Moreover, by gaining a better understanding of the FIMR process, actual FIMR projects may be better able to respond to the health needs of women and children within their communities.