Addressing Racial Equity in Infant Mortality

Blue baby bootiesHow Everyday Democracy Helped Raise the Volume on a Quiet Crisis

One critical gauge of the overall health and well-being of a nation is the number of babies that die each year before reaching the age of one. This number, represented by the Infant Mortality Rate, gives crucial insight into important associated factors, such as the quality and availability of healthcare, public health practices, and socioeconomic conditions within a country.

According to a report released by the Center for Disease Control and Prevention in 2014, American babies fare worse than babies in Europe and most other highly developed countries. In fact, infants in America are more likely to die than the infants of 25 other countries. The reasons for the stark differences in outcome are complicated, but experts cite a continued legacy of racial and ethnic inequity as playing a central role. Healthcare disparities affect the well-being of infants, and as a result, black parents are less likely to see their children start the first day of school.

It’s a crisis we tend not to hear enough about, but the numbers are startling. Comparatively, the mortality rate for white infants in Ohio was 6.0 in 2013 and 5.3 in 2014, whereas the rate of black infant death is even higher – 13.8 in 2013.  And by 2014 that number had grown to 14.3. Not only do black babies born in Ohio continue to die at more than twice the rate of white babies, the divide is getting wider.

Although funding ceased in 2015, three cities continue to use Everyday Democracy’s Dialogue to Change approach in addressing infant mortality. More than 75 facilitators have been trained and are continuing to assist the work in Akron, Toledo and Youngstown, and actions havine included partnerships with hospitals, schools and other community organizations.


Background of the Initiative

Following a call to action by Ohio Governor John Kasich, the Ohio Department of Health instituted several initiatives to address the alarming rates of Black Infant Mortality in Ohio, collaborating with national organization CityMatCH to launch the Ohio Equity Institute. Comprised of nine participating cities experiencing the highest black infant mortality rates in Ohio, the initiative incorporated the existing framework of the W.F. Kellogg-funded Institute for Equity in Birth Outcomes.

In the spring of 2015, Everyday Democracy was asked to join the initiative. Complementing the work of the community partners involved in the project, we are strengthening the work through the development of community engagement strategies to bring the voices of diverse community members to this critical issue and especially those members most impacted by the loss of a child before their first birthday. With recognition that racism is a social determinant of health, we are working with local partners to implement community-wide dialogues on racism. The goal of these dialogues is to develop strategies and actions that are owned by individuals and community institutions as well as identifying local and state-based actions that can reduce or eliminate health disparities in birth outcomes for African American babies.

Everyday Democracy worked side-by-side with teams from the nine urban cities across Ohio, supporting these sites in raising awareness, knowledge, understanding and effecting change on black infant mortality. While the state initiative has ended, Everyday Democracy is still training organizers and supporting dialogues.


Community Dialogues for Action and Change

We see community dialogue as the starting point for building on public understanding, support, and demand for change in order to improve birth outcomes for all infants and especially black infants. By organizing and facilitating a dialogue to change initiative in each of the nine participating cities, we are providing a space for all voices to be heard, raising public awareness and increasing knowledge of the connections between racial inequity and black infant mortality outcomes.

Engaging parents, young people, the health service community and others across all backgrounds and ethnicities in authentic conversations about racism and its effects upon black infant mortality provides an opportunity for community members to imagine a different future, develop deeper connections, brainstorm ways to address the problem on many levels and create a pathway to make their vision a reality.

In each of the partner cities, Everyday Democracy also assisted community leaders and Ohio Equity coalition members with ongoing training and supportive coaching. In addition to hosting pilot dialogues and orientations within the framework of racial equity, we are providing in-depth organizing, facilitation and action planning trainings based on the appropriateness for each site.



In order to observe the effects of place and racism on birth outcomes and better understand factors that may contribute to black infant mortality, a research component was incorporated into the project. Focus groups to surveyed mothers and fathers who may have experienced the death of a child younger than one-year-old, as well as pregnant women and birth mothers who have experienced barriers to healthcare access and may have discontinued care as a result.

The voices of those most impacted are invaluable to help us understand their experiences with health care access and delivery systems. The research outcomes will be used to augment the dialogues on racism as a social determinant of health and its effect on black infant mortality.

Dialogue to Change

Our ultimate goal is to create positive community change that includes everyone, and our tools, advice, and resources foster that kind of change. Whether you’re grappling with a divisive community issue, or simply want to include residents’ voices in city government, Everyday Democracy's Dialogue to Change process, using a racial equity lens, can help.