Partnering to Reduce Infant Mortality in Cincinnati

By Tiffani Kigenyi, MPH, Public Health Analyst, ODPHP and Susan Pagani, MFA, Health Writer, CommunicateHealth, Inc.

Here are some troubling facts: babies born in the United States are about 3 times more likely to die in their first year than babies born in Finland or Japan — and the United States ranks last among 26 developed countries for infant mortality. In 2014, more than 23,000 U.S. babies died before their first birthday.

Ryan Adcock, Executive Director of Cradle Cincinnati

Infant mortality takes a greater toll in some communities. Until recently, Hamilton County in Cincinnati, Ohio, had the 5th highest rate of infant mortality in the Nation. In 2011, an average of more than 10 babies in Hamilton County died for every 1,000 born. That means Hamilton County was losing 122 babies a year — which, for its population, was twice the national average.

Cradle Cincinnati, a program designed to reduce infant mortality in Hamilton County, launched in 2012 as a response to numbers like these. Ryan Adcock, Executive Director of Cradle Cincinnati, describes it as a “collaborative of partners.” The program brings together everyone from traditional health care and faith leaders to high school principals and families to set common goals and find solutions. And it has been remarkably successful: since its founding, infant deaths are down 20% in Hamilton County.

Focusing Efforts on Key Areas of Intervention
Adcock attributes Cradle Cincinnati’s success to its focused approach. “Infant mortality is an enormous problem,” he says, “So there’s an impulse to want to map out and solve every issue. But we try to be as focused as our work will allow. So, instead of taking on 20 issues and addressing them in really small ways, we try to focus on a few that will impact the community in really big ways.”

With that in mind, Cradle Cincinnati’s work focuses on 3 core areas of intervention that reduce the risk of infant mortality:

  • Birth spacing: waiting at least 12 months between pregnancies
  • Safe sleeping: putting babies to sleep on their back, alone, and in a crib
  • Smoking abstinence: giving up smoking during pregnancy

Creating Connections to Maximize Impact
Cradle Cincinnati addresses its core areas of intervention with a few different strategies. One of these is a learning collaborative, which brings together 28 prenatal care teams that serve Medicaid-insured moms. Health care providers in the learning collaborative use quality improvement tools to share data and create measurable goals for improving the way they deliver care during pregnancy.

The group also works with neighborhood leaders and families who have first-hand experience with the problems that the program is trying to solve. Adcock calls this a “co-creation strategy.” He says, “Because there’s such great economic and racial disparity on this issue, we’re working hard to involve the community. The families that experience the deaths and the pre-term births can help us learn how to prevent these issues for other families.”

Collaborating to Promote Safe Sleep Practices
Adcock says he’s particularly proud of the results of Cradle Cincinnati’s efforts to reduce the rate of sleep-related infant deaths in Hamilton County.

From 2007 to 2011, Hamilton County lost an average of 17 babies a year to sleep-related causes of death — the majority of which were related to babies sharing sleep space with their parents, or co-sleeping. So Cradle Cincinnati created what Adcock calls a “collaborative swarm” of partners to get information about safe sleep practices into the community.

Here’s just some of what they did: Local grocery stores put information about safe sleep practices in baby food and diaper aisles. Hospitals made safe sleep education part of the check-out process for new mothers. Churches posted safe sleep advice in their lobbies, and Fortune 500 companies added it to their health and wellness programs. And the Cincinnati Health Department gave away hundreds of free cribs and play yards to new and expecting mothers.

In just 5 years, these coordinated efforts helped to reduce sleep-related infant deaths in Hamilton County by an impressive 24%. “In public health, people often take a divide and conquer approach to complex issues,” Adcock says. “But our approach is to get everyone on board and running after the same thing. We’ve seen these changes in sleep-related deaths because so many players from the community are working on it.”

Success by the numbers:
From 2012 to 2016, Hamilton County saw a:

  • 12% drop in short pregnancy timing (pregnancies less than 12 months apart)
  • 19% drop in smoking during pregnancy
  • 24% drop in sleep-related infant deaths

Additionally, there were:

  • 123 fewer infant deaths overall
  • 92 fewer extremely preterm babies

The Future of Cradle Cincinnati
This summer, Cradle Cincinnati will begin work on their second 5-year strategic plan, which will launch in June 2018. While the program will continue to focus on birth spacing, safe sleep, and smoking abstinence, Adcock says they’ll also try to help address the basic needs of women and families, like housing and food.

“Many of the families we work with live in poverty,” Adcock says. “So even though we’re focused on things that impact birth outcomes, those things are sometimes way down on the family’s list of priorities. We have to address basic needs so folks have the bandwidth to learn new ways they can help their babies be healthy.”

In the meantime, the “collaborative swarm” approach is catching on — professionals in Hamilton County are applying Cradle Cincinnati’s approach to other public health issues, like addiction. “We’re helping them think about how they can build their own collaborative of partners,” Adcock says. “It’s really encouraging.”

Sharing what works is one of the things Adcock enjoys most about his work with Cradle Cincinnati. “We have the biggest successes when we’re sharing solutions and approaches that work — when we’re growing together,” he says. “I see so much possibility in these partnerships.”