With a new executive director and $4.9 million state grant, First Year Cleveland joins the Mandel School to continue its fight against infant mortality
As she entered the second trimester of an unplanned first pregnancy, 21-year-old Rachel Ashew was scared. She had no insurance and was unsure where to turn.
“I was thinking I wasn’t going to be able to do it,” said Ashew, of Cleveland.
As a Black woman in Cuyahoga County, Ashew faced a higher likelihood of risks to her pregnancy than a white woman, a trend that reaches back decades. In 2022, Black babies born in Cuyahoga County were three times more likely to die before their first birthdays than white babies, according to county data. Cleveland also had worst overall infant mortality rate in the United States in 2019, according to the Centers for Disease Control and Prevention.
At a family member’s suggestion, Ashew visited a mobile van operated by a nearby prenatal care center to receive her first ultrasound. There, she was linked to the Nurse-Family Partnership, a local nonprofit program based at The MetroHealth System, which provides home visitation and other resources to expectant and new mothers. The hospital system is one of nine community partners of First Year Cleveland (FYC), an umbrella organization housed at Case Western Reserve University focused on reducing the infant death rate in the county’s Black community.
Its new home represents a shift in focus for the organization toward a more community-centric approach that is rooted in social work-based research and interventions. This new approach will better position FYC to battle the structural racism that drives many of the health inequalities experienced by Black mothers and babies—not only in Cleveland, but across the U.S.
The experiences of mothers like Ashew suggest that a multipronged approach by a network of services can help create better health outcomes—and that progress can be made in the fight against infant mortality.
As Ashew’s pregnancy progressed, her Nurse-Family Partnership caseworker encouraged her to begin seeing a behavioral therapist.
“At first, I was very against going to see [a therapist] to talk about some of the experiences that I’ve been through. But it helped me and made my pregnancy easier,” said Ashew. Ashew’s caseworker, a nurse who offered support, advice and information throughout her pregnancy, maintained constant contact. “She talked to me almost every day, like a mother would,” said Ashew.
Ava Amore, Ashew’s daughter, turned 2 in March. “It’s one of the best feelings, taking care of my little girl,” she said. “My caseworker made sure, as a first-time mom, I was ready.”
Leading the change
For nearly two decades, Angela Newman-White has worked in public health and social services, advocating for racial equity and equality, including in maternal and infant health. In early 2023, she became FYC’s new executive director.
“The issue is not that Black women don’t want to have healthy babies—every woman wants that,” said Newman-White. “Whether or not a baby survives has so much to do with a woman’s life long before she ever gets pregnant. It’s much more than a medical issue.”
Pregnant women and mothers who participate in programs offered by FYC’s partners have healthier outcomes during pregnancy and lose far fewer babies than the county average, said Newman-White.
Still, multiple peer-reviewed studies have shown that Black women—regardless of their income or education—have higher rates of infant mortality compared to white women. A study published this year from the National Bureau of Economic Research analyzed 2 million births in California and showed that the poorest white women had lower infant mortality rates than the richest Black women.
While many factors contribute to infant mortality, more than half of infant deaths in the United States are attributed to premature birth. Early labor can be driven by heightened levels of stress hormones during pregnancy, among other factors.
The disparity in infant mortality between Black and white mothers is due, in part, to the perpetual toxic stress of racism, said Newman-White, as discrimination—in overt and covert ways—leaves few aspects of their lives untouched.
“Infant mortality is a symptom of the health and welfare of a community,” she added.
Empowering partners
When Newman-White took the helm of FYC in January, she found significant resources available to help the organization accomplish its work.
In summer 2022, FYC received a two-year, $4.9 million grant from the Ohio Department of Medicaid. FYC will distribute funds to nine designated community partner organizations, including the Nurse-Family Partnership, that provide services directly to expectant and new moms. These services are intended to address causes of infant mortality—such as unsafe sleeping conditions—and also to provide support often found in birthing classes and lactation consultation.
“No one entity can do this work alone. Each partner approaches solving issues in a unique way,” said Stacey Hren, who is managing FYC’s transition into the Mandel School, and works on CWRU’s campus with Newman-White and fellow FYC staff members Julie Hewitt and Tyler Nelson, who manage the organization’s operations.
In addition to public funds, FYC has attracted significant philanthropic support—from the George Gund Foundation, Mt. Sinai Health Foundation and others. A portion of these funds is distributed to develop or enhance services that emphasize “community-based solutions drawn from the communities they serve,” said Newman-White, “because we know health outcomes for Black patients have proven to be better if their provider looks like them and understands their experience.”
Though diverse in the ways they approach reducing infant mortality, FYC’s community partners share a common charge: to address the conditions that produce such unequal health outcomes for Black people in the first place, said Newman-White.
“What draws us to the work is social justice, equal rights,” she said. “Fixing a broken system that results in too many Black infants dying.”
In 2015, Newman-White—who worked for the Cuyahoga County Board of Health at the time—wrote the first successful Medicaid grant application that helped fund the creation of FYC. For years, infant mortality rates had remained stubbornly high. While “there were little pockets of activity,” she said, there was no overarching organization that coordinated and convened resources to try to lower the rate.
When the overall annual county rate jumped by nearly 30% in 2015, the data proved alarming enough to instigate new urgency among leaders of Northeast Ohio’s hospital systems, foundations and local governments—all of which pledged funds for a new organization to serve as a hub for reducing the infant mortality rate.
Newman-White has remained active as a volunteer in the organization ever since.
“Now, it’s come full circle,” said Newman-White. “I feel great energy around our work. We’re ready to get our hands dirty.”
Imperfect progress
Newman-White assumed leadership at FYC at a critical time.
While infant mortality rates in Cuyahoga County have declined in recent years, with the gap shrinking between Black and white infant deaths, overall county figures are still much higher than rates found elsewhere in Ohio and the U.S.
According to preliminary data from the county, 2022’s infant mortality rate appears to be its lowest on record for the third consecutive year.
However, for every 1,000 births, 13 Black infants died, compared to four white babies.
“We still have an unacceptably high disparity,” said Richard Stacklin, a data analyst in epidemiology, surveillance and informatics for the Cuyahoga County Board of Health, who provides infant mortality data to FYC. “While we are moving in the right direction, it’s just not as fast or substantial as we’d like.”
Alumni action
Already, Mandel School alumni have been deeply involved, shaping the organization in its first half-decade.
Among them is Megan Walsh (SAS ‘05), who credits her time at the Mandel School for focusing her drive to help others—setting in motion a social work career that’s seen her address infant mortality at many levels.
“As a community, we need to create better options for moms if we want different outcomes. We are responsible for each other. Each of us has a role, big or small, in making things better.”
— Megan Walsh (SAS '05)
As a community health worker in Cleveland, Walsh worked directly with under-resourced moms. Now, as deputy project director at MomsFirst, a FYC community partner, she coordinates efforts to help mothers at both individual and structural levels.
“As a community, we need to create better options for moms if we want different outcomes,” said Walsh. “We are responsible for each other. Each of us has a role, big or small, in making things better.”
Last year, Talisa Norman was five months pregnant when a social worker from MomsFirst approached her in the grocery store. MomsFirst went on to match Norman with a doula, a specially trained coach providing counsel through pregnancy and labor.
Norman’s doula persuaded her to stop her occasional smoking and offered guidance on nutrition and breastfeeding—and helped build her confidence.
“My doula made me realize I couldn’t help my family unless I had myself together,” said Norman, who delivered a healthy baby boy in October. “She talked to me like a woman, about personal things. She felt like part of the family.”
Doula boon
In recent years, doulas in Cuyahoga County—through organizations like Birthing Beautiful Communities, another community partner of FYC—have been an essential component in the many concurrent initiatives to address aspects of infant mortality.
Multiple peer-reviewed studies have shown that doula-assisted mothers have better health outcomes—including a lower likelihood for birth complications and low-birth weights—and are more likely to breastfeed, and for longer.
“Moms have powerful experiences with their doulas,” said Jazmin Long (MNO ’15, SAS ‘15), CEO and president of Birthing Beautiful Communities, an adjunct instructor at the Mandel School and a certified doula. “They empower moms to make the right choices for their bodies and babies, each step of the way.”
Since starting as a pilot project in Cleveland’s Hough neighborhood in 2015, Birthing Beautiful Communities has expanded its reach—so far training more than 100 doulas and serving more than 1,000 mothers in Northeast Ohio. Its services are provided to mothers free of charge.
“Moms have powerful experiences with their doulas. They empower moms to make the right choices for their bodies and babies, each step of the way.”
— Jazmin Long (MNO ’15, SAS ‘15)
Doulas are paired with moms as early as eight weeks into a pregnancy, and remain involved until the child turns 1. They help develop birth plans and attend medical appointments to “ensure moms understand what doctors are saying,” said Long, and are also present for labor and delivery.
“We know we make a difference. We see it every day,” said Long, who is also a member of FYC’s steering committee—a group of health, government and nonprofit leaders who guide the organization’s policy and projects. “There’s a lot of joy in the work we do.”
A model in a movement
As FYC has grown in size and impact, so has its scope—and goals.
FYC’s first years were marked by an emphasis on improving access to medical care and critical treatment for moms and babies. When its approach widened to include interventions from community-based organizations, “it became clear that the Mandel School was the appropriate home,” said Dexter R. Voisin, PhD, the Jack, Joseph and Morton Mandel Dean in Applied Social Sciences.
Mandel School faculty are getting involved, too. This spring, the first grants from a fund established by university Provost Ben Vinson III are supporting research, evaluation or other faculty projects with FYC.
“We are deeply committed to this work,” said Voisin. “The work of addressing high infant mortality rates is a marathon, not a sprint. With FYC embedded within the Mandel School, together we are committed to working on this important issue, alongside our broad coalition partners.”
Voisin believes that FYC and its partners are well-positioned to become strong, significant voices in advocating for policy changes at the local and state levels, a sentiment echoed by Newman-White, Long
and others.
There is also confidence among FYC’s leadership that the organization—and its coalition of partners, including the Mandel School, community providers, foundations, and the city and state—will eventually serve as a national model for making headway in reducing infant mortality.
“We have a chance to leverage our collective strength to take on an issue that has taken root over hundreds of years,” said Newman-White. “No woman ever deserves to lose her baby. So, we have a lot more work to do.”
By Daniel Robison
Read more stories like this in the Spring 2023 edition of Action.