How Cradle Cincinnati Helped Reduce Infant Mortality in Hamilton County
Research By: John Feister, MD, MS | Bin Huang, PhD | James Greenberg, MD
Post Date: September 17, 2026 | Publish Date: Sept. 17, 2026
Strong community collaboration across 16 years moved the region’s most populous area from above to below national averages for deaths occurring in the first year of life
Key Takeaways
- Hamilton County cut annual infant deaths from 120 in 2007 to 55 in 2023, bringing its infant mortality rate below the national average for the first time.
- A new Pediatrics study used a “synthetic control group” to show that interventions led by Cradle Cincinnati helped Hamilton County’s decline outpace expected improvements from other influences.
- The findings point to long-term, community-led collective impact—not a single intervention—as a model other regions may adapt to reduce infant mortality.
In 2007, families in Hamilton County mourned the deaths of 120 infants who never reached their first birthday.
The causes included complications of extreme preterm birth, sudden infant death syndrome, unsurvivable birth defects, and other factors. Regardless, more babies were dying in Hamilton County than in many other places in the United States.
In fact, the county’s 2007 infant mortality death rate (10.9 per 1,000 live births) sharply exceeded the national average at the time of 6.75 deaths per 1,000 live births. Worse, the local rate stayed high for another several years.
In looking more closely at these numbers the reason became clear. Hamilton County’s infant mortality rate was significantly higher than the national average because the infant mortality rate among Black infants in the county was several times higher than the rate for infants of other races.
Enter a novel organization – a “collective impact collaborative” – called Cradle Cincinnati.
This organization was co-founded in 2013 by James Greenberg, MD, co-director of Cincinnati Children’s Perinatal Institute, and Elizabeth Kelly, MD, MPH, Vice Chair of Clinical Obstetrics and Gynecology at the University of Cincinnati College of Medicine. Cradle Cincinnati was built to bring a wide variety of people together to address this complicated problem, including mothers with lived experiences, medical experts, community advocacy groups, governmental agencies and others.
Now, a study published Sept. 17, 2026, in Pediatrics documents how much of a difference the effort made.
In 2023, 55 infants died in Hamilton County, fewer than half the infant deaths compared to 2007. And for the first time, the county’s infant mortality rate (5.5 per 1,000 live births) fell below the national average, which had declined more slowly to 5.61.
How to measure the impact of one group among many?
While many celebrated the lives saved, a difficult question also emerged. How could experts tell what made the difference? Were changes at the federal or state levels more powerful than the changes at the local level? What about advances in high-tech medicine or lower-tech lifestyle changes or systemic changes in health benefits?
The reality was Hamilton County’s people could not be separated into study arms like people participating in a traditional clinical trial. Among other factors, Cradle Cincinnati itself regularly adjusted its multi-pronged approaches over the years.
The new study relied on an innovative research method that helped cut through the forest of variables to help find answers to these questions. Using statistical approaches spearheaded by Bin Huang, PhD, a member of the Division of Biostatistics and Epidemiology at Cincinnati Children’s, and doctoral student Shixuan Wang, MS, the research team compared the actual experience of Hamilton County to a “synthetic control group.”
The team drew from a “donor pool” of people from 15 other Ohio counties to build a digital control population that closely reflected the demographics of Hamilton County – based on factors including household income, Medicaid coverage, population density, tobacco use, numbers of infants with extremely low birth rates, and more. The reasoning: this synthetic group would be just as likely as people in Hamilton County to be influenced by national and state-level trends but would be much less likely to be affected by the work of Cradle Cincinnati.
The team ran the models and compared the outcomes. The team found that the real infant mortality rate for Hamilton County dropped significantly faster than the expected rate for the synthetic group, demonstrating that Cradle Cincinnati’s work had real impact.
“In the earlier years, we saw small declines in infant mortality compared to the synthetic populations of Hamilton County,” says the study’s lead author, John Feister, MD, MS. “Then, consistent with the iterative nature of Cradle Cincinnati’s work, we saw the largest reductions in infant mortality for the real county population, especially in 2021 and 2023.”
Multiple improvements over the years
The Cradle Cincinnati participants collaborated on three strategic plans that drove several changes in Hamilton County. Early steps included building a learning collaborative structure and launching a support program called Cradle Connections. Then in 2018, the group helped launch Queen’s Village.
Founded by Meredith Shockley-Smith, PhD, Queens Village is a supportive community network and advocacy initiative led by Black women. The women involved are organized around advisory boards that convene to direct interventions, funding, and strategic thinking, especially around systemic racism encountered by Black women as they experience reproductive health services.
In 2023, Cradle Cincinnati launched “Mama Certified,” a program that provides Black parents-to-be with tools to assess and understand how local maternity centers address equitable care. All the maternity provider hospitals in Hamilton County participate.
Each intervention built upon previous efforts to further drive down infant mortality rates.
“There has been no single magic bullet to this effort. This is all about collective impact,” Greenberg says. “It has been learning from each other, from mothers, prenatal care providers, neonatologists, our Hamilton County and Cincinnati Health Departments, the Cincinnati Metropolitan Housing Authority, Job and Family Services, and so on. Everybody has worked together to make things better.”
Can this approach be replicated?
The Queens Village concept has spread to Akron, Cleveland, Columbus, Dayton, Canton, and Butler County, Ohio, as well as Jacksonville, Miami, Tulsa and Atlanta. Meanwhile, leaders with Cradle Cincinnati have shared concepts with the Ohio Department of Children and Youth and have presented their experiences at conferences and in meetings with agencies in other states.
Greenberg stresses that each city has its own mix of community organizations and specific challenges, so the types of interventions needed to reduce infant mortality will likely vary. But this study provides two key models: a blueprint for building community collaboration and validation of the synthetic control group method for measuring the results.
Ongoing challenges
The Cradle Cincinnati researchers also stress that factors affecting infant mortality can change from year to year. Since 2023, the organization has seen an increase in county-level infant mortality that appears to be linked to an unexpected rise in deaths related to unsafe sleep. Collaborators are working to learn more.
“We still have work to do,” Greenberg says.
About the study
In addition to Feister, Huang and Greenberg, Cincinnati Children’s and University of Cincinnati co-authors included Shixuan Wang, MS, Dominique Walker, MPH, Rachel Webken, MPH, and Elizabeth Kelly, MD. Funding sources included grants from Bi3-Bethesda Inc. and the Ohio Department of Children and Youth.
March of Dimes (Ohio) Selects Greenberg as 2026 Medical Honoree
Cradle Cincinnati co-founder James Greenberg, MD, will be honored Nov. 12 for a career of helping ensure every baby has the healthiest possible start in life at this year’s March of Dimes Signature Chefs™ event.
The renowned neonatologist, researcher and Co-Director of the Perinatal Institute at Cincinnati Children’s has improved neonatal outcomes throughout the region and beyond through decades of clinical care, research and leadership.
| Original title: | A County-Level Collaboration to Reduce Infant Mortality: Cradle Cincinnati |
| Published in: | Pediatrics |
| Publish date: | Sept. 17, 2026 |
Research By
Throughout my career as a neonatologist and researcher, I’ve cared for infants with complex medical and surgical problems and led efforts to reduce preterm birth and infant mortality in our community.
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The Research Horizons blog features news and insights about the latest discoveries and innovations developed by the scientists of Cincinnati Children's. This blog does not provide medical advice, diagnosis, or treatment. Email researchnews@cchmc.org with questions or ideas.
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