CINCINNATI -- For babies born in Hamilton County, race and neighborhood play huge roles in whether they live long enough to celebrate their first birthday.
Understanding why has become a chief effort of Cradle Cincinnati, an Avondale-based nonprofit created to study and craft programs to address the county’s high infant death rate.
According to a report released Tuesday by the nonprofit, 97 babies died in Hamilton County in 2016 – down slightly from 100 deaths in 2015.
From 2012 through the end of last year, 123 fewer babies died compared to the previous five years. The nearly 20 percent drop marks a historically low infant mortality rate of 8.96 deaths for every 1,000 births in Hamilton County, according to the report.
Still, the local death rate remains higher than the national average of 5.82 deaths for every 1,000 births, according to the report. And African-American babies are more than twice as likely to die before their first birthday compared to Caucasian infants.
“Real change is happening, but we still have a long journey ahead of us,” said Ryan Adcock, executive director of Cradle Cincinnati. “We know this isn’t just one problem we’re trying to solve.”
As part of its work, Cradle Cincinnati has zeroed in on the three leading causes locally of infant deaths: Preterm births, sleep-related deaths and birth defects.
Working with neighborhood groups and leaders, the nonprofit has helped coordinate a host of community-based health programs aimed curbing the top causes of infant death.
“We have a lot of room to grow, but we know a lot of progress has been made by better connecting mothers with resources they need in their community,” Adcock said.
Making mothers the center of it all
In Avondale, where more than of the 90 percent of residents are African-American and 42 percent live below the poverty line, expectant mothers are being visited by home health workers and breaking bread with the local doctors and nurses overseeing their prenatal care.
It’s all part of the Start Strong program – an effort aimed at giving moms the care and resources they need to stay healthy during pregnancy and beyond.
“This is all about personalized prenatal care that focuses on what moms in Avondale need and what was lacking in their prenatal and early infancy care,” said Dr. James Greenberg, co-director of the Perinatal Institute and director of Neonatology at Cincinnati Children's Hospital Medical Center. “We did a lot of interviewing and what we learned was there were some missing connections between moms who are pregnant and the people who were caring for them.”
So the team set out “reinvent” prenatal care in Avondale by creating a model that “put mothers at the center of everything,” rather than doctors and nurses, Greenberg said.
“It sounds logical, but consumers of health care know it doesn’t always work that way,” he said.
Through the program, expectant mothers are connected with community health workers at health centers in Avondale who would help them coordinate doctor appointments, set up rides to see their doctor and assess their other needs.
“If you’re a mom, and you have to worry about where you’re going to sleep that night, it’s hard to worry about good prenatal care,” Greenberg said.
During their home health visits, mothers learn about the top causes of pregnancy complications and preterm births – including the risks of smoking and having children less than 24 months apart.
The team also worked with neighborhood health centers to provide “same-day access” to women coming in for pregnancy tests. Typically, when a doctor confirms a pregnancy, they then ask the mother-to-be to come back in a few weeks to start regular check ups, Greenberg said.
“That can be a problem for some moms who don’t have easy access to get to an appointment,” he said.
Now, physicians can see expectant mothers right away – something “that took a bit of culture change to get established in the doctor’s offices,” Greenberg said.
Connecting with moms outside of traditional health care settings has been central to the program, he added. Through regular “feasts” held at Gabriel’s Place – a neighborhood community garden and education center -- teams of doctors, nurses, community health workers and local mothers come together for dinners and conversation.
“I was skeptical about the dinners, but it was immediately obvious that they can have a real impact,” Greenberg said. “It’s all about creating meaningful and trusted relationships with caregivers.”
‘Dramatic change’ under way in Avondale
Since launching the Strong Start program three years ago, the results have been eye-opening.
It’s been nearly two years since a mother in Avondale lost a baby because of a extreme preterm birth – when a mother delivers before she’s hit her 28th week of pregnancy.
That’s huge, Cradle Cincinnati leaders say, considering the extreme preterm births are the largest driver of Hamilton County’s high infant death rate and Avondale has consistently had one of the highest rates of preterm births locally.
Across Hamilton County, preterm births were down 14 percent from 2012 to 2016, compared to the previous five years, according to Cradle Cincinnati. Preventing preterm births not only saves lives, it saves enormous amounts of money, Adock said.
"These are the most at-risk, expensive babies to care for," Adcock said, adding that the 14 percent drop equates to roughly $6.5 million in savings in health care costs for local families.
Now, as leaders work to expand programs that are curbing infant deaths, they hope to take Strong Start to other neighborhoods, starting with Price Hill.
“We’ve seen a dramatic change that we hope and believe can be sustained in Avondale,” Greenberg said. “We’ll mold and modify the program for each community but maintain those principals we’ve learned that keep mothers at the center.”