Janiyah was one of the 99 babies who died before their first birthdays in Hamilton County in 2015. Her death is one of the most horrific examples of the county's infant mortality problem. And it's a prime reason why, way in the back of Cradle Cincinnati's latest report, there is a data table that includes information about women's mental health.
Cradle Cincinnati is the initiative working to reduce the infant mortality rate in Cincinnati and Hamilton County.
And while the mental health problems that plagued Janiyah's mom were extreme, the latest Cradle Cincinnati report shows it's not at all uncommon for women in the Tri-State to experience poor mental health or depression.
More than one in five women in Greater Cincinnati — 22.6 percent — reported eight or more days with "poor mental health" in the past 30 days, according to Cradle Cincinnati's report. And one in four — 25.1 percent — reported having depression diagnosed by a health care provider.
"We get so busy taking care of the physical being that we don't always take care of the psycho-emotional being," said Ruby Crawford-Hemphill, assistant chief nursing officer for UC Health. "Pregnant women who have depression are more prone to deliver prematurely and are more likely to have low birth-weight babies."
And women suffering from post-partum depression have a much more difficult time being the kind of nurturing, attentive caregivers that babies need in that first year of life, said Robert Ammerman, the scientific director of Every Child Succeeds. Every Child Succeeds delivers home visitation services to young moms throughout the region. The agency developed a program called Moving Beyond Depression to provide what Ammerman calls "in-home cognitive behavioral therapy."
Thankfully, it's rare for parents to kill their babies.
But studies have shown that when moms are depressed, they are less likely to use safety devices, such as car seats, Ammerman said.
'These Things Matter'
"There are other ways in which providing a consistent, safe environment for the child becomes more difficult when you're the primary caregiver," he said.
The mental health of the region's moms is not a focus of Cradle Cincinnati at this point.
The leaders of the initiative knew they had to be strategic in deciding which problems to tackle, said Cradle Cincinnati Executive Director Ryan Adcock. So they have been working to communicate three key messages:
• Spacing. The goal here is to encourage women to increase the amount of time between pregnancies to reduce the chances of premature birth.
• Smoking. Studies have shown that tobacco use increases the likelihood of premature births and birth defects. So the goal is to get moms to quit or smoke less.
• Safe sleeping. Babies sleep safest when they are alone, on their backs and in cribs.
But Adcock said the data on women's mental health is included in the report along with data about many other factors that the doctors and community activists involved in Cradle Cincinnati believe play a role in the county's high infant mortality rate.
"These things matter," he said.
As Cradle Cincinnati's work continues, the initiative will try to figure out how to tackle more of those factors.
For now, though, Every Child Succeeds' Moving Beyond Depression and the programs available at University Hospital Medical Center are tackling the problem through their own programs.
Every Child Succeeds treats as many women as it can through Moving Beyond Depression. But the agency only has two therapists who can provide the in-home therapy that moms in the program need, Ammerman said.
"The need is greater than what we can attend to right now," he said. "Our moms are experiencing more financial hardship. When that happens, their risk for developing post-partum depression increases."
That means all these problems tend to be magnified for women living in poverty.
"If they're a mom that already has two or three kids and is now having a fourth that's not planned. She's thinking, 'How do I get through it? How do I provide for my family?'" Crawford-Hemphill said. "If you're a single parent, that puts a lot of stress on women."
Asking The Right Questions
Crawford-Hemphill won a grant from the March of Dimes in 2014 to help support a UC Health program that screens pregnant women for depression during their first pre-natal visit.
Women can then take part in UC Health's Centering Pregnancy program, which groups them based on their due dates. The groups then meet regularly with a facilitator to talk about their stresses, worries and what is going on with their pregnancies.
"It has proven to be an effective way to reduce the infant mortality rate," Crawford-Hemphill said. "They have that peer support, and they come to the meetings because they look forward to seeing each other."
Often the women's partners get involved, too, she said.
"Men get depressed, too," Crawford-Hemphill said.
The Centering Pregnancy meetings encourage women to keep their appointments, take their pre-natal vitamins and to keep themselves healthy for the sake of their babies.
The program also teaches moms about shaken baby syndrome and advises them on healthy ways to cope with the stresses a new baby can bring.
The first hurdle can be getting a pregnant mom to talk about it if she is feeling anxious or depressed.
"Everybody tells them, 'You should be happy. This is God's way. This is how life is.' But no one's really asking this woman, 'Was this your dream? Was this the journey you wanted to be on at 15 or 12 or 40,'" Crawford-Hemphill said.
They're important questions to ask.
If we as a community can figure out a way to make sure more women are having those discussions, it might help ensure more Hamilton County babies live until their first birthdays and beyond.
For more information about Cradle Cincinnati, click here.
For more information about Moving Beyond Depression, click here.
For more information about Centering Pregnancy, click here or call (513) 584-LADY.
Lucy May writes about the people, places and issues that define our region – to celebrate what makes the Tri-State great and also shine a spotlight on issues we need to address. Childhood poverty is an important focus for her and for WCPO.