Celebrating More

First Birthdays
2023 Hamilton County
Maternal and Infant
Health Report
 When our community
comes together, real
change is possible.

TA B L E OF CON T E N T S

From Our Executive Director................................... 4

By the Numbers.......................................................... 6
Racial Equity................................................................ 8
Safe Sleep................................................................... 12
Innovation in Action.................................................. 16
Supporting Data.......................................................20
Thank You................................................................... 22

2 Hamilton County Maternal and Infant Health Report Hamilton County Maternal and Infant Health Report 3

Making Historic
Strides Together
From Our Executive Director
As Executive Director of Cradle Cincinnati,
I have the honor of celebrating you.
Together, we just pushed Black infant
mortality into the single digits for the first
time in Hamilton County.
Our overall infant mortality
rate decreased from 8.7 to 5.5.*
The Black infant mortality rate
decreased from 13.7 to 9.0*
This year is a heartfelt acknowledgment
of the “We.” It’s a celebration of what
happens when diverse groups of people
support each other and apply persistent
and innovative approaches to solving
our shared challenge: infant mortality.
It’s rejoicing in the power of letting those
most impacted by the problem lead their
solutions: amplifying voices, listening, and
“The truth is, the smaller the numbers,
the harder the work. We’re going to
continue to focus on innovation.”
* 2022 vs. 2023 infant mortality rates
4 Hamilton County Maternal and Infant Health Report
Infant Mortality Rate
has decreased from 8.7 (2022) to 5.5
deaths per 1,000 live births in 2023
funding to test and learn what strategies
8.7 2022
5.5
are most effective.
Let’s keep going! While we revel in this
progress, we see that the disparity still
exists. Our preterm birth-related infant
deaths are steadily decreasing, but we
still have work to do on sleep-related
infant deaths. Based on our current 2023
success we know we can do better.
The truth is, the smaller the numbers, the
harder the work. This win means that we
have to keep going even harder. Thank
you for your support, hard work, and
dedication to this vital effort. Let’s come
Black Infant Mortality Rate
back next year with even better results. has decreased from 13.7 (2022) to
9 deaths per 1,000 live births in 2023
Dr. Meredith Smith
Executive Director, Cradle Cincinnati
13.7
2022
9.0
2023
Hamilton County Maternal and Infant Health Report 5
 The infant mortality rate in Hamilton 14%
County is now lower than the
national average.*
In 2013, Hamilton County set an aspirational We are motivated by our
23%
goal of achieving an infant mortality rate on
county’s progress. But there
par with the national average.
is much more work to be done
At that time, Hamilton County families were to ensure every baby born in Leading Causes
70% more likely to experience an infant loss
than the nation as a whole.
Hamilton County lives to see of Infant Death in
We’re pleased to announce the infant
their first birthday. Hamilton County
mortality rate has dropped below the national 2019-2023
average – a testament to what can be
achieved when a community comes together Preterm Birth-Related Deaths
around a common goal.
Birth Defect-Related Deaths

Sleep-Related Deaths
46%
Other Deaths 17%
10.2
Hamilton County

U.S. Average

9.0
8.1 Preterm Birth-
5.5 5.6
Complementary medical and community based
Infant Mortality Rate

Related Deaths interventions support the decline in Black infant death.

Sleep-Related
v

Sleep-related infant deaths continue to be a stubborn

problem. The data calls for innovative interventions.
Infant Deaths

Birth Defect- Birth defect data remains consistent with national

averages and shows no racial disparities.
Related Deaths

2008-2012 2013-2017 2018-2022 2023 2022 Other Deaths Includes homicides, infections, accidents and other causes.

Source: Hamilton County Fetal and Infant Mortality Review (FIMR), Centers for Disease Control and Prevention (CDC)

* United States Infant Mortality Average 5.6 (2022)

6 Hamilton County Maternal and Infant Health Report Hamilton County Maternal and Infant Health Report 7
 RACIAL EQUITY

We center Black
women by
listening to them
and co-creating
solutions to make
systems change
together.

8 Hamilton County Maternal and Infant Health Report Hamilton County Maternal and Infant Health Report 9
Making History: Hamilton County reached
a single digit Black Infant Mortality rate of
9.0 for the first time on record. While the national Black infant mortality rate has
The decrease in Black infant mortality is a We changed the direction of our work toward been on a slow decline, we’ve seen a much faster
major contributor to the overall decrease in identification of the structural factors driving rate of change in Hamilton County. We are dedicated
Hamilton County infant mortality. When we the racial disparity of infant mortality in our
came together as a community to decrease community. Now our work to amplify the to continue that leadership so that we can sustain
infant mortality in 2013, the standard narrative voices of Black women in clinical settings and and grow this accelerated improvement.
focused on socioeconomic factors. However, collaborating with our regional maternal health
our scrutiny of infant mortality data revealed providers are showing meaningful signs of
social determinants of health did not explain improvement.
Black infant mortality. Instead, the data pointed
to racial discrimination as the key driver.

Black Infant Mortality Rate Black Infant Mortality

18 16.5 16.6 20
Number of Black infant deaths per 1,000 live births

number of infant deaths per 1,000 live births

16 18

14
11.8 Next
16
Hamilton County and

Infant Mortality Rate

Milestone 14 United States 2011-2023
12 12 • The racial disparity in
infant mortality still

6.4
10 10
exists in Hamilton
8
County
8
6
• In 2023, Black infants are
6 4
almost 2.5 times as likely
2 to die as white infants in
4 our community
0
2011 2013 2015 2017 2019 2021 2023
2

0 Hamilton County United States Hamilton County United States

2009-2013 2014-2018 2019-2023 Our Next Goal*
Black Black White White
*Visit our strategic plan at cradlecincinnati.org to learn more

10 Hamilton County Maternal and Infant Health Report Hamilton County Maternal and Infant Health Report 11
 SAFE SLEEP

Black families
continue to be
more likely to
experience a
sleep-related loss
than families of
other races
or ethnicities.

12 Hamilton County Maternal and Infant Health Report Hamilton County Maternal and Infant Health Report 13
 Let’s Talk About Sleep
Creating safe spaces for These listening circles are one of several ways
in which we continue to listen to the community
truths to be shared about safe sleep in order to guide our work.

Sleep-related infant deaths remain a stubborn

problem. Practicing safe sleep consistently
Join the conversation
can be difficult and exists at the crossroads of Cradle Cincinnati is drafting a more detailed
cultural beliefs and parental exhaustion. five-year safe sleep strategic plan for
Hamilton County. If you would like to be
Our community research team is committed to
involved by providing input or helping
understanding and addressing this issue. The
with implementation, please complete
six Queens Village board members* who make
this survey at bit.ly/hcsafesleepplan.
up the team have been trained as experts in
creating safe spaces for truths to be shared.
Last summer, they hosted safe sleep listening
circles where Black moms discussed challenges
to safe sleep and how families can be further
supported with their safe sleep goals.

* Lauren Brassfield, Brandi Colvin, Mia Crockett,

Shamika Karikara, Kiera Paddy, Dr. Fran Kazimierczuk

We’ve seen impressive decreases

in preterm birth-related deaths
but limited progress in sleep-
related infant deaths.
70 Our community research Postpartum Depression
Preterm birth-related

60 Sleep-related
team found familiar
themes around the hard
Number of Infant Deaths

Birth defect-related
Anxiety & Stress
50 reality of parenthood.
40
These centered around: Lack of Support
30
Exhaustion
20
Financial Struggles
10

0 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023

14 Hamilton County Maternal and Infant Health Report Hamilton County Maternal and Infant Health Report 15
 As we work toward our goal of zero infant deaths,
Innovation in Action this is how our community is thinking, acting and
innovating in new ways.
Black Birth
Workers Support
Black Mamas
The positive impact doulas
have on the birthing experience
is extensive and includes fewer
negative childbirth experiences,
shorter labor time and better
communication between
pregnant people and their
healthcare providers. However,
access to doulas has been
financially out of reach for most
families, and the birth workers
who have the talent and
passion are not earning enough
to support themselves.
Cradle Cincinnati Connections
and Queens Village have been
working collectively to solve
both issues and have made
significant strides with the
following initiatives:
Providing Access to Free
Doula Care
This program offers a
year of free doula care to
Black birthing people in
our community, funded by
16 Hamilton County Maternal and Infant Health Report
CareSource and provided “The doula business
by Blaq Birth Circle. Moms program is essential in
are eligible for prenatal care, our community because
attending birth and two
it directly supports the
postpartum visits.
sustainability of doula
Building Doula Business
practices, helping both
Capacity
new and established
The demand for doulas is so
high that there is a real need doulas sustain their
to support them in building businesses while
their businesses. Our pilot doing what we love
program, co-developed with most: supporting the
the NOIR Collective and funded
by bi3 Fund, addresses this by
community. It also helps
equipping doulas with the tools remove barriers so that
women can more easily
they need to thrive. Over the
past four months, we’ve been access doula support.”
empowering them to navigate
complex areas like grant Sesheta Tafari, Me & She Doulas
and insurance applications,
optimizing their business
systems and conquering
the intricacies of Medicaid
reimbursement.
Hamilton County Maternal and Infant Health Report 17
INNOVATION IN ACTION INNOVATION IN ACTION

Moms and Healthcare Leaders Unite

for Maternal Health Equity
Three years ago, Black women
in Queens Village expressed
that they would value increased
visibility into how hospitals are
addressing racial inequities in
birth outcomes.
In response, Cradle Cincinnati,
Queens Village, The Health
Collaborative, local birthing
hospitals and Black mothers
came together to design and
implement Mama Certified, a
collaborative impact approach
to addressing these concerns.
Learn more at mamacertified.org
Mama Certified is a first-of-its-
kind program in which birthing
hospitals agreed to publicly
share data and partner with
Black women to improve the
hospital birthing experience.
Together, we are working
in partnership with hospitals
to maintain accountability
and trust with Black birthing
families while also celebrating
their progress in improving the
birthing experience.
“We know that Black
mothers experience
poorer maternal
and infant health
outcomes than their
white counterparts,
and we want to be a
part of bridging that
gap and changing that
narrative.”
Gina Hemenway, Mercy Health
Advocacy in Action
Collaboration is key to
continuing to ensure
system change remains
a statewide priority.
In 2023, a statewide
collaboration between
CelebrateOne, Cradle
Cincinnati, First Year Cleveland,
Groundwork Ohio, the Ohio
Collaborative to Prevent Infant
Mortality and Capitol Partners
resulted in the creation of
Infant Vitality Advocacy Day, an
event focused on advocating
for budget and policy priorities
to support better maternal and • Representative Andrea White
infant health outcomes.
• Representative Latyna M.
A key part of Infant Vitality Humphrey
Advocacy Day was creating
Stay tuned for our second
opportunities for lawmakers
and regional health advocates Infant Vitality Advocacy Day,
to meet in person. coming this September. Visit
cradlecincinnati.org to stay up-
Thank you to the following to-date and to get involved.
legislators for championing
moms and babies in Ohio:
• Senator Michele Reynolds
• Senator Catherine Ingram
• Senator Paula Hicks-Hudson

Mama Certified is powered by bi3 Fund and supported by Anthem Blue Cross and Blue Shield Foundation and CareSource .

18 Hamilton County Maternal and Infant Health Report Hamilton County Maternal and Infant Health Report 19
Supporting Data Green = better compared to 2018-2022. Red = worse compared
to 2018-2022. All numbers are percentages unless otherwise
indicated. To read definitions of each indicator, download our Hamilton Hamilton
Hamilton Hamilton
HamiltonHamilton
Hamilton Hamilton
Hamilton Hamilton
Hamilton Hamilton
data dictionary at cradlecincinnati.org. County County
County County County,
County, County, County,
County, County,
County, County,
2018-2022 2023
2018-2022 White
2023 Black White Hispanic
Black AsianHispanic Asian
2023 2023 2023 20232023 20232023 2023

Preterm Birth Rate Preterm Birth Rate

Hamilton Hamilton
Hamilton Hamilton
HamiltonHamilton
Hamilton Hamilton
Hamilton Hamilton
Hamilton Hamilton <37 Weeks (total preterm
<37 Weeks
births) (total preterm births) 10.9 11 10.9 9.7 11 14.1 9.7 9.7 14.1 9.3 9.7 9.3
County County
County County County,
County, County, County,
County, County,
County, County,
<28 Weeks (extreme preterm
<28 Weeksbirths)
(extreme preterm births) 0.8 0.70.8 0.6 0.7 1.2 0.6 0.2 1.2 0.3 0.2 0.3
2018-2022 2023
2018-2022 White
2023 Black White Hispanic
Black AsianHispanic Asian
2023 2023 2023 20232023 20232023 2023 <23 Weeks (periviable<23
births)
Weeks (periviable births) 0.2 0.10.2 0.1 0.1 0.3 0.1 0.0 0.3 0.0 0.0 0.0

Prenatal Care Prenatal Care

Breastfeeding Rates Breastfeeding Rates 75.9 77.5
75.9 80.5 77.5 71.2 80.5 77.4 71.2 85.4 77.4 85.4 (among women who had
(among
live births)
women who had live births)
(upon hospital discharge)
(upon hospital discharge)
Accessed Care in the Accessed
1st Trimester
Care in the 1st Trimester 67.6 68.3
67.6 76.8 68.3 64.9 76.8 43.7 64.9 66.2 43.7 66.2
Multiple Births (twins,Multiple
triplets,Births
etc.) (twins, triplets, etc.)
3.8 3.83.8 4.1 3.8 4.3 4.1 1.4 4.3 3.5 1.4 3.5
(among women who had (among women who had live births)
live births) Accessed Care in the Accessed
3rd Trimester
Care in the 3rd Trimester 4.0 5.24.0 2.5 5.2 5.4 2.5 14.9 5.4 7 14.9 7

Birth
Birth Defect/Congenital Defect/Congenital
Anomaly Rates Anomaly Rates 0.9 0.80.9 0.8 0.8 0.8 0.8 0.5 0.8 0.0 0.5 0.0 No Prenatal Care No Prenatal Care 2.3 2.02.3 1.4 2.0 2.4 1.4 2.5 2.4 2.3 2.5 2.3

Birth
Birth Defect/Congenital Defect/Congenital
Anomaly Deaths Anomaly Deaths Maternal Cigarette Smoking
Maternal Cigarette Smoking
1.6 (2018-2022) 1.6
0.9(2018-2022) 0.4 0.9 1.6 0.4 1.6 1.6 -- 1.6 -- (during 2nd or 3rd trimester)
(during 2nd or 3rd trimester) 6.6 4.06.6 5.0 4.0 3.9 5.0 0.4 3.9 0.3 0.4 0.3
(deaths per 1,000 live(deaths
births) per 1,000 live births)

Sleep-Related Infant Sleep-Related

Deaths Infant Deaths Drug Exposure During
Drug
Pregnancy
Exposure During Pregnancy
1.7 (2018-2022) 1.7
1.5(2018-2022) 0.6 1.5 3.8 0.6 -- 3.8 -- -- --
(deaths per 1,000 live(deaths
births) per 1,000 live births) (Among regional women
(Among
who had
regional
live births)
women who had live births)

Reported
Reported consistently consistently
placing infant placing infant on his or
on his or Drug Exposure DuringDrug
Pregnancy
Exposure During Pregnancy 7.1 10.57.1 -- 10.5 -- -- -- -- -- -- --
her back for sleep her back for sleep 87.9 (2021) 87.9
86.9 (2022)
(2021) 93 (2022)
86.9 (2022) 76.1 (2022)
93 (2022) 87.5 (2022)
76.1 (2022) --87.5 (2022) --
Opioid Exposure During
Opioid
Pregnancy
Exposure During Pregnancy 2.3 2.22.3 -- 2.2 -- -- -- -- -- -- --
(among women who had(among women who had live births)
live births)

Reported
Reported always placing a baby always
in cribplacing a baby in crib Previous Preterm Birth
Previous Preterm Birth
(among women with previous
(among women
births) with previous births) 7.8 7.77.8 6.0 7.7 11.2 6.0 6.1 11.2 6.4 6.1 6.4
for sleep for sleep 94.2 (2021) 94.2
94.2
(2022)
(2021) 97.5 (2022)
94.2 (2022) 88.7 97.5
(2022) (2022) 93.6 (2022)
88.7 (2022) --93.6 (2022) --
(among
(among women who had women who had live births)
live births)
Chronic Illness DuringChronic
Pregnancy
Illness During Pregnancy
Reported
Reported receiving paid receiving
leave from paid leave from employer
employer (among women who had (among
live births)
women who had live births)
after baby was born after baby was born 46.4 (2021) 46.4
45.3 (2022)
(2021) 53.8 (2022)
45.3 (2022) 31.1 (2022)
53.8 (2022) -- 31.1 (2022) -- -- --
(among women who had(among women who had live births)
live births) Gestational Diabetes Gestational Diabetes 10.7 11.110.7 10.7 11.1 10.9 10.7 10.6 10.9 23.3 10.6 23.3

Hypertension Hypertension 17.6 19.917.6 18.8 19.9 26.2 18.8 12.3 26.2 12 12.3 12

Stillbirth rate Stillbirth rate

(per 1,000 births) (per 1,000 births) 6.5 7.86.5 -- 7.8 -- -- -- -- -- -- --

Pre-Pregnancy Body Pre-Pregnancy

Mass Index Body Mass Index
(among women who had
(among
live births)
women who had live births) Stress Stress
(among women who had
(among
live births)
women who had live births)
Underweight (BMI < 18.5)
Underweight (BMI < 18.5) 2.9 2.62.9 2.3 2.6 3.6 2.3 1.9 3.6 2.9 1.9 2.9

Obese (BMI ≥ 30) Obese (BMI ≥ 30) 28.3 30.1

28.3 26.9 30.1 40.5 26.9 22.7 40.5 12 22.7 12 Reported having someone
Reported
to talk
having someone to talk
to about problems during
to about
pregnancy
problems during pregnancy 82.5 (2021) 82.5
82.7 (2022)
(2021) 90.7 (2022)
82.7 (2022) 75.7 90.7
(2022) (2022) 59.4 (2022)
75.7 (2022) --59.4 (2022) --

Sexually TransmittedSexually
InfectionTransmitted Infection
(among women who had(among
live births)
women who had live births)

Syphillis Syphillis 0.5 0.60.5 0.3 0.6 1.4 0.3 0.6 1.4 0.3 0.6 0.3

Gonorrhea Gonorrhea 1.3 1.1 1.3 0.3 1.1 3 0.3 0.2 3 0.3 0.2 0.3
Housing Housing
Chlamydia Chlamydia 4.4 4.74.4 1.1 4.7 9.2 1.1 8.2 9.2 3.8 8.2 3.8 Renters Renters 41.5 (2018-2022) 41.5(2022)
39.8 (2018-2022) -- 39.8 (2022) -- -- -- -- -- -- --

Vacancy Rate Vacancy Rate 9.3 (2018-2022) 6.8

9.3(2022)
(2018-2022) -- 6.8 (2022) -- -- -- -- -- -- --
Unintentional Pregnancy
Unintentional Pregnancy
47.7 (2021) 47.7
42.3 (2022)
(2021) 27.7
42.3 (2022) 69.6 (2022)
27.7 37.4 (2022)
69.6 (2022) --37.4 (2022) --
(among women who had(among
live births)
women who had live births) Reported difficulty paying
Reported difficulty paying
rent before pregnancyrent before pregnancy 14.9 (2021) 16.214.9
(2022)
(2021) 11.3 (2022)
16.2 (2022) 24.9 (2022)
11.3 (2022) --24.9 (2022) -- -- --
Inadequately SpacedInadequately
Pregnancy Spaced Pregnancy (among women who had (among
live births)
women who had live births)
(among non-first time(among
moms who
non-first
had live
timebirths)
moms who had live births)

<6 month Interpregnancy

<6 month
Interval
Interpregnancy Interval 5.8 5.55.8 4.6 5.5 7.3 4.6 4.8 7.3 5.6 4.8 5.6
Transportation (among
Transportation
all adults) (among all adults)
<12 month Interpregnancy
<12 month
Interval
Interpregnancy Interval 18.6 18.518.6 18.4 18.5 20.1 18.4 16 20.1 12.9 16 12.9 Reported no vehicle availability 11 (2018-2022) 10.9
11 (2018-2022)
(2022) -- 10.9 (2022) -- -- -- -- -- -- --
Reported no in household
vehicle availability in household
<18 month Interpregnancy
<18 month
Interval
Interpregnancy Interval 33.9 33.9
33.9 38.4 33.9 31.3 38.4 24 31.3 28.7 24 28.7

Postpartum Depression
Postpartum Depression
7.8 (2021) 8.2 7.8
(2022)
(2021) 6.6 (2022)
8.2 (2022) 9.5 (2022)
6.6 (2022) -- 9.5 (2022) -- -- --
(among women who had
(among
live births)
women who had live births)

See Data Dictionary atSee

cradlecincinnati.org
Data Dictionary atfor
cradlecincinnati.org
confidence intervals
forfor
confidence
these proportions
intervals for these proportions

20 Hamilton County Maternal and Infant Health Report Hamilton County Maternal and Infant Health Report 21
Thank you to the
funders who make
Cradle Cincinnati possible.
bi3 Fund FrontStream Workplace Paramount Advantage
Philanthropy
Buckeye Health Plan Sisters of Charity of Cincinnati
The Greater Cincinnati
CareSource Foundation TriHealth
Cincinnati Children’s Hospital Hamilton County UC Health
Medical Center
Interact for Health United Healthcare  
The de Caval Family SIDS
Foundation/eat. play. give.   Robert N. Kirch United Way of Greater
Cincinnati
Crane Fund for Widows and Mercy Health  
Children U.S. Health Resources &
Molina Healthcare Services Administration
Crowley’s Inc.
Ohio Department of Health Lothar F. Witt
Day of Pentecost Celebration
Foundation Ohio Department of Medicaid

Deskey Procter & Gamble

Cradle Cincinnati is a network of community members and

Mission organizations working across sectors to measurably improve
Hamilton County, Ohio’s infant mortality rate and to eliminate
racial inequities in the health of moms and babies. We aim
to do this by transforming systems, supporting families and
amplifying Black women’s voices while empowering their
ideas and actions.

Vision Every child born in Hamilton County lives to

see his or her first birthday.

No single organization can tackle the issue of infant mortality.

Philosophy We need partners throughout Hamilton County to come
together under a common goal — helping our babies live to
their first birthday — and common objectives. We embrace a
model of collective impact.

22 Hamilton County Maternal and Infant Health Report Hamilton County Maternal and Infant Health Report 23
This report was developed by the Cradle Cincinnati
team in partnership with Cincinnati Health
Department and Hamilton County Public Health. It
was produced by our partners at Deskey Branding.
Photography by Knack Photo + Video

Contributors include Lauren Everett, Jessica

Seeberger, Melissa Burroughs, Meredith Smith
and Dominique Walker.

Learn more
about our work at
cradlecincinnati.org
blackwomenforthewin.com

Follow us on social
@cradlecincinnati
@queensvillagecincinnati

@cradlecincy
@queensvillagecincinnati

@cradle-cincinnati

@cradlecincy
@qvcincy