Infant Mortality Finally Improves

The secret? Asking new and expecting mothers what they need, not telling them.
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Illustration by Chiara Ghigliazza

After a decade of concerted effort by the Cradle Cincinnati nonprofit and local health care professionals, Hamilton County’s alarmingly high infant mortality rate has finally improved. The credit goes to “We,” says the organization’s executive director, Meredith Smith. “It’s rejoicing in the power of letting those most impacted by the problem lead their solutions: amplifying voices, listening, and funding to test and learn what strategies are most effective,” she shared in Cradle Cincinnati’s 2023 annual report.

James Greenberg, M.D., a neonatologist at Cincinnati Children’s who cofounded Cradle Cincinnati in 2013, says the organization has focused on addressing preterm birth, congenital malformations, and sleep-related deaths, the top causes of infant mortality in Hamilton County. In 2022, 8.7 Hamilton County babies died per 1,000 live births; the number decreased to 5.5 babies in 2023. The Black infant mortality rate decreased from 13.7 to 9.0.

“Our rate of sleep-related deaths here is much higher than the national average,” says Greenberg. This tragedy occurs most often due to asphyxiation, often from an adult laying with the baby and rolling over on them, he says, what’s called “co-bedding.” One of the culprits is exhaustion, which partly results from social isolation when there isn’t enough community or help for new mothers.

The average U.S parent gets four weeks of maternity leave, often unpaid. Other reports show the average is 10 weeks, with only 22 days paid or covered by workplace PTO—leaving many with the choice between going back to work exhausted and still recovering from childbirth or not being able to afford necessities.

For decades, physicians and advocates have promoted the “Safe to Sleep” campaign to help prevent Sudden Infant Death Syndrome (SIDS) and other sleep-related deaths. Safe sleep practices including the ABCs for infant sleep: Alone, with no other people, bedding, pillows, or objects; Back, as babies are safest from sleep-related deaths on their backs; and Crib, a firm, flat surface instead of a reclined swing or baby chair. “The ABCs work,” Greenberg says.

To further improve infant mortality, Greenberg says experts had to take the community’s needs into account. “Racial disparities and infant mortality are a primary focus for us,” he says.

One of the major new programs introduced by Cradle Cincinnati has been Queens Village, a virtual and in-person community of around 3,000 Black women united around the cause of decreasing infant mortality. Smith says the most common response from women involved in Queens Village was, I don’t feel valued, I’m overwhelmed and stressed in my body, and I feel lonely. “The answer for them was gathering together,” she says, and so new programming created community through yoga, painting, and walks in the park in neighborhoods where mortality is especially high.

Queens Village also encouraged women to tell their own stories and to pursue on concrete steps like affordable access to postpartum doulas, rides to and from medical appointments, car seats, housing, and other essentials.

Hamilton County’s model of proactive coaching and support instead of focusing on medical interventions has garnered national attention, and the Queens Village program (blackwomenforthewin.com) has already scaled to 11 other cities.

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