Rocking the cradle: Local experts disagree on the best way to reduce rates of infant mortality

CINCINNATI - Infant mortality is a complicated problem. It can’t be solved in the sense of being eradicated, like smallpox.

In Ohio--especially in Hamilton County and Cincinnati--the infant mortality rate has been well above the national average for years.

About ten babies die in Hamilton County for every 1,000 births every year; the U.S. rate is a fraction more than six deaths for every 1,000 births. The rate among African-Americans in Hamilton County has for years been more than double the national average.

The rates in Northern Kentucky are also alarming:

  • Boone County: 4.8 deaths for every 1,000 births
  • Campbell County: 8.3 for every 1,000
  • Kenton County: 9.8 for every 1,000

The newest local push to drive down infant mortality, Cradle Cincinnati , unveils its strategy Feb. 18 at the Community Action Agency in Bond Hill. There, at a meeting that is open to the public, the organization will present findings and propose a fresh campaign to educate women and men on making pregnancy, birth and the first year safer for a child.

This time, "it's different"

Cradle Cincinnati was created last year with a former City Hall figure as executive director and $250,000 a year for five years from UC Health . Ryan Adcock, legislative affairs director in the Mallory administration, took the job leading the nonprofit because of his love for Cincinnati. His father was the longtime city public health director.

“When I read about these numbers and really started understanding what was going on, I just thought, ‘This is my town. This can’t be happening here,’” Adcock said.

Hamilton County Commissioner Todd Portune helped obtain the funding to create Cradle Cincinnati as part of the county’s deal to sell Drake Hospital to UC Health . He said the year-old nonprofit is unique, not just in the nation, but in the history of local and regional efforts to combat infant mortality, which often run out of money and motivation.

“We have every major healthcare system in the region, the city and county health departments, working on this,” Portune said. “We were just in Baltimore meeting with people at Johns Hopkins (University) on this topic, and they were astounded that we had been able to get everybody to come together and sign off and not go rogue.”

Dr. Jim Greenberg is a professor of pediatrics at University of Cincinnati’s College of Medicine and director of neonatology at Cincinnati Children’s Medical Center. 

“I’ve been involved in those previous efforts to reduce infant mortality, and there’s one novel thing about this effort: We’ve got the kind of expertise that’s never really been engaged around this problem before," Greenberg said. "In the past, the efforts have been underfunded. This time, we’ve locked in participation from key stakeholders. That’s what’s different about this.”

The message for parents

Adcock said at the Feb. 18 meeting, Cradle Cincinnati will describe a three-point approach to improve the infant mortality rate:

  1. Spacing. A woman needs about 18 months to recover from pregnancy and birth. Less rest for the mother can more than triple the chance of death for the next infant.
  2. Smoking. Tobacco use during pregnancy increases the risk for premature birth and defects. Two-thirds of infant deaths in the city and Hamilton County are related to premature birth.
  3. Sleeping. To sleep safely, a baby must be alone, on its back in a crib--not in bed with parents and not swaddled in bed linens or surrounded with toys. The area’s rate of sleep-related deaths is triple the national average.

The broader social goals for Cradle Cincinnati are to reach more women with easy-to-understand messages about healthier choices; to guide doctors to provide care without judgment, and to reach out to communities so that women and their families are getting quality health information from people they trust.

The approach gives Cradle Cincinnati a focus, Adcock said. For his part, Portune aims to get more financial commitments from Cradle Cincinnati participants to fund outreach. But everyone involved acknowledges that infant mortality is an important indicator of women’s health, which is a larger social function.

Not the solution

Kay Brogle worries that Cradle Cincinnati’s conclusions don’t go far enough. She is executive director of the nonprofit Healthy Moms and Babes. For 27 years, the organization has sent vans with health workers into lower-income city and county neighborhoods to offer counseling and testing for pregnancy and sexually transmitted diseases.

While she applauds Cradle Cincinnati’s overall purpose, she said the new group is going over old ground. Infant mortality, she said, often has more

to do with a mother’s economic standing and the struggle to provide shelter, food or even a bed for her children.

“Safe sleep? We’ve been teaching that for years. Stop smoking? That’s the first thing we ask a woman when she comes to us: ‘Do you need help to quit smoking?’ Spacing? We talk about that all the time,” Brogle said. “Give us money to supply cribs. Don’t start another campaign. That’s where my frustrations come from. How do we get cribs in all these people’s houses?”

Dr. Elizabeth Kelly, like Greenberg a professor at the UC College of Medicine, is director of maternal health at the Cincinnati Health Department and of the perinatal institute at Cincinnati Children’s. She has spent her career caring for women of child-bearing age in poverty. Infant mortality, she says, is a woman’s issue.

“Think of all the factors: How is a woman entering a pregnancy? Is this unplanned? Is there smoking, drugs, infection? There are the interactions with genetic and environmental issues. It’s very complicated,” Kelly said. “That’s what keeps me up at night, thinking about this complex issue and really continuing in an evolution of thought. There’s no textbook or handbook to do this.”

In July, the Ohio Department of Health issued a comprehensive examination of infant mortality that shows that Ohio’s rate, while always higher than the U.S. rate, had been coming down in a parallel track until 1996. The rate has barely budged since.

Resources for pregnancy and birth:

Thursday > A baby and a book: How two Cincinnati doctors are spreading the word about "safe sleep"

Connect with WCPO Contributor Anne Saker on Twitter: @apsaker

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