Perinatal/Infant Health, Application Year FY26 

Priority: Support healthy pregnancies and infants to reach their first birthdays  

In 2023, 904 Ohio infants died before their first birthday for an infant mortality rate (IMR) of 7.1 per 1,000 live births.  There was no change in the IMR compared to 2022. Non-Hispanic Black infants were nearly 2 and a half times more likely to die than non-Hispanic White infants.  The non-Hispanic Black IMR was 13.7 compared to a non-Hispanic White rate of 5.7.  Ohio’s Hispanic IMR was 7.2 per 1,000 live births.

 

Ohio’s neonatal mortality rate (NMR) in 2023 was 4.8 per 1,000 live births.  From 2014 through 2023, there was no significant change in the overall NMR.  The non-Hispanic Black NMR was 8.4 compared to 3.9 for non-Hispanic White infants.  Despite an increase in 2023, there has been a general downward trend in the non-Hispanic Black NMR.  From 2014 through 2023, the rate decreased by an average of 3.2% per year.  The Hispanic neonatal mortality rate was 4.7.

 

Ohio’s postneonatal mortality rate (PMR) in 2023 was 2.4 per 1,000 live births.  From 2014 through 2023, there was no statistically significant change in the overall PMR. The non-Hispanic Black PMR was 5.3 compared to 1.9 for non-Hispanic white infants.  Despite seeing progress in 2023, the non-Hispanic Black PMR increased an average of 4.2% per year between 2014 and 2023. This increase largely offsets the progress we have seen in the non-Hispanic Black NMR. The Hispanic PMR was 1.2.

 

Measures:  

• NOM: Percent of preterm births.
• NOM: Infant mortality rate per 1,000 live births.
• SOM: Ratio of Non-Hispanic Black to Non-Hispanic White infant mortality rate
• SPM: Percent of women who smoke during pregnancy.
• NPM: A) Percent of infants who are ever breastfed B) Percent of infants breastfed exclusively through 6 months.
• NPM: A) Percent of infants placed to sleep on their backs B) Percent of infants placed to sleep on an approved sleep surface C) Percent of infants placed to sleep without soft objects or loose bedding D) Percent of infants room-sharing with an adult during sleep.
• ESM: Percent of high-risk women enrolled in evidence-based home visiting programs.
• ESM: Percent of birthing hospitals receiving recognition from Ohio First Steps for Healthy Babies.
• ESM: Percent of counties served by Cribs for Kids.

 

Objective 1: By 2030, reduce the proportion of women smoking during pregnancy by 4.3%.

 

1. Develop a plan to re-engage partnerships and identify strategies for addressing smoking use among women of reproductive age (including provider training through Reproductive Health and Wellness Program (RHWP), Women, Infants, and Children (WIC) Program, Ohio Comprehensive Home Visiting Integrated Data System (OCHIDS), and Tobacco Use Prevention and Cessation Program (TUCP).   

2. Increase collaboration among programs addressing tobacco use (e.g., ODH, DCY, MHAS).   

3. Identify and leverage cross-promotional/marketing opportunities (media, partner collaborations). 

4. Provide supports for pregnant women to quit smoking during pregnancy and improve birth outcomes.   

 

In partnership between ODH and DCY, FY26 programmatic efforts will continue to focus on addressing prenatal smoking cessation. At every Reproductive Health and Wellness Program (RHWP) Title X visit, tobacco use screening questions are asked. This includes reporting if the client is a current daily smoker, current some day smoker, former smoker, never smoker, and unknown. If needed, clients receive smoking cessation counseling. The RHWP will require clinics to provide informational sessions on preconception health topics, including smoking cessation.

  

Objective 2: By 2030, increase enrollment of high-risk populations in evidence-based home visiting programs by 2% each year.

 

1. Implement home visiting services for at risk pregnant and postpartum women.     

 

Both ODH and DCY support the implementation of four home visiting models: Family Connects Ohio (FCO), Healthy Families America (HFA), Nurse Family Partnership (NFP), and Parents as Teachers (PAT).  All models serve at-risk pregnant and post-partum women. ODH continues to work with home visiting providers to expand services to meet the needs of families in their communities, focusing attention on where there are waitlists and/or many at risk, eligible women/infants. An emphasis has been placed on expanding home visiting services to families that have not been able to access them previously. 

 

In FY25, ODH/DCY implemented the Family Connects (FC) program. The program offers a free home visit from a nurse to families with a new baby. Visits generally occur around three weeks after the child is born, and supports are tailored to meet a family's unique needs with a newborn baby. The nurse provides a physical exam for both mom and baby, assesses for maternal depression, intimate partner violence and many other environmental risk factors, answers questions about caring for the new baby, and provides referrals to other services and resources to support the family. Services will continue to be available in Erie, Huron, Fayette, Greene, Guernsey, Hamilton, Huron, Mahoning, Noble, Shelby, and Trumbull counties. Plans are being made to add additional counties to the FC Ohio program for FY26 with the long-term goal being to take the FC Ohio program statewide, ensuring that all families have access to a newborn nurse home visit and connecting families to long-term home visiting programs and the continuum of services provided by the DCY.

Objective 3: By 2030, increase the percent of infants who are ever breastfed to 83.2% and percent of infants who are breastfed exclusively through 6 months to 26.2%.

 

1. Continue implementation and expand promotion of 24/7 breastfeeding hotline and virtual lactation consultants. 

2. Continue breastfeeding initiatives in hospitals, worksites, and child care facilities.

3. Improve breastfeeding continuity of care.  
4. Address differences in lactation care and breastfeeding rates. 

 

In March 2021, Professional Data Analysts, Inc. (PDA) created two reports based on quantitative and qualitative data from focus groups detailing the breastfeeding experiences of Black or African American and Appalachian women in Ohio. As a result of the findings and identified strategies to improve breastfeeding initiation and duration in these populations, ODH released a competitive funding opportunity for FY23. Four organizations were funded for three years, and a competitive grant opportunity was released for FY26 to continue and expand this work. Determinations for organizations that will be funded are now occurring.  

 

ODH continues to contract with Appalachian Breastfeeding Network to offer 24/7 breastfeeding support by phone and text. Interpreters are available in most languages, and texting is available in English and Spanish. Eight International Board-Certified Lactation Consultants and two Mental Health Specialists are now available through the hotline as needed. Data will continue to be collected and reported monthly. ODH will release a competitive funding opportunity to continue 24/7 breastfeeding hotline support by phone and text for FY26. 

 

The Ohio First Steps for Healthy Babies hospital initiative will continue the optional Father/Partner Engagement Designation. Hospitals that apply are recognized for including fathers as they implement the Ten Steps to Successful Breastfeeding. First Steps will continue with quarterly application reviews and recognition. Continuing education webinars and updating current resources will also be planned.  

  

ODH has received the five-year CDC State Physical Activity and Nutrition (SPAN) Cooperative Agreement. Proposed activities include continuing to fund 12 counties that are currently educating local businesses and assisting with the development of lactation policies and accommodations, as well as expanding to other counties. Provider offices, schools, and hospitals will be specifically targeted for outreach and education. A yearly lactation training opportunity will be made available to community partners to increase access to lactation education and care across the state. The Breastfeeding Friendly Workplace Award will continue and be promoted by the funded counties. 

  

The Breastfeeding Friendly Child Care Award remains available for Early Childhood Education (ECE) providers who complete the required training and application depicting their implementation of breastfeeding-friendly practices. Outreach to all licensed childcare centers and family providers will continue, with plans to create new ECE breastfeeding resources and materials.  

 

ODH will continue work to improve breastfeeding continuity of care by working with local WIC staff through a work group setting to address each of the five goals presented in the Ohio WIC Breastfeeding Strategic Plan. The Coffective initiative, with the WIC program, will work with WIC projects through a local collaborative to create new connections and opportunities.

 

Objective 4: By 2030, increase the percent of infants placed on their backs to 88.9%, alone on separate approved sleep surface to 56.6%, and without soft objects or loose bedding to 75.6%. 

 

1. Continue implementation and expansion of the Cribs for Kids Program to provide safe sleep education and safety-approved cribs to all counties in Ohio.  

2. Continue implementation of the annual safe sleep campaign to provide consistent messaging on safe sleep practices to families.  

3. Create, revise, and disseminate safe sleep educational materials to reflect infant safe sleep recommendation updates released by the American Academy of Pediatrics.    

4. Update and disseminate annual safe sleep training for providers, parents/grandparents, children’s services, Cribs for Kids partner agencies, etc.   

 

The Ohio Department of Children and Youth (DCY) will continue to provide funding to local organizations serving 71 counties to promote safe sleep practices and distribute safe sleep survival kits. Survival kits will continue to include a safety-approved portable crib, as well as supplemental items such as a fitted sheet and infant sleep sack. Survival kits will continue to be available to families at no cost. Safe sleep information will continue to be shared with families, including safe sleep recommendations from the American Academy of Pediatrics (AAP).

 

Ohio will continue to participate in the Child Injury Action Group (CIAG) Safe Sleep quarterly meetings. DCY will continue to facilitate quarterly Technical Assistance meetings for all funded Cribs for Kids/Safe Sleep partners.

 

Objective 5: By 2030, assess the need for and explore opportunities to improve infant outcomes through enhancing screenings and education provided during well-baby visits. 

 

1. Assess need for and explore opportunities to educate/train providers on enhanced screenings and education during a well-baby visit (Bright Futures, including lead, hearing, vision, oral health, immunizations, and safe sleep).   
2. Explore cross-program support opportunities through partnership with the State Immunization program.  

 

The Title V team will continue to engage partners and collaborate on identifying gaps in screening and education. In collaboration with the Ohio Chapter, American Academy of Pediatrics, a comprehensive resource linking providers to screening guidance by age to address developmental screening, community health factors, injury prevention, oral health, and improving immunization rates will be developed. They will also conduct quarterly webinars based on emergent topics in child health.  ODH participates in the Healthy Mom, Healthy Family quality improvement project to impact maternal and infant health. It is designed for postpartum women and their children with a special emphasis on non-Hispanic Black women and women who are eligible for or enrolled in Medicaid or are uninsured. Healthy Mom, Healthy Family seeks to improve interconception care for women of reproductive age to reduce risk factors that might impact future pregnancies and the long-term health of mothers in Ohio. The interconception health of birth mothers of patients in participating pediatric sites is assessed through a series of interventions during well-child visits from 0-18 months. Implementation of Healthy Mom, Healthy Family begins with the integration of the mother’s care with the baby’s well-child visit in a pediatric setting, if the accompanying caregiver is the biological mother.    

  

Ohio Title V coordinates with the Bureau of Infectious Diseases (BID) to promote immunizations.  The Title V director meets with the Vaccines for Children (VFC) Program Administrator at least quarterly, and the school nursing administrator meets with BID more frequently. Cross collaboration between both bureaus will remain in effect to support existing and future work. 

 

Objective 6: By 2030, reduce the ratio of the Non-Hispanic Black infant mortality rate to the Non-Hispanic White infant mortality rate to 2.0, with the ultimate goal of parity.

 

1. Increase access to clinical and social services through outreach and identification of Black pregnant women.    

2. Increase use of social support services among high-risk Black pregnant women to address factors influencing health.
3. Support local community-driven policy and practice change addressing factors influencing health that impact poor birth outcomes.
4. Improve access to basic needs resources for pregnant and postpartum women (e.g., Cribs for Kids).  
5. Leverage surveillance data, including Child Fatality Review, Fetal Infant Mortality Review, and Pregnancy-Associated Mortality Review, to inform the preventability of perinatal and infant deaths to inform data-to-action.  

 

The Maternal and Infant Vitality Initiative (MIVI) will continue to support the facilitation of local upstream (policy change addressing community health factors that impact poor birth outcomes) and downstream (clinical and social resource navigation for pregnant women) strategies in the ten Ohio counties who carry the greatest burden of Black infant deaths and the greatest disparities in birth outcomes.  Data will continue to be used to drive community-specific interventions.   

 

Queens Village, developed by Cradle Cincinnati to engage and empower Black women to reduce infant mortality rates and differences in local communities, will continue in eight of the ten Ohio OEI counties. The Queens Village model emphasizes community-driven solutions by placing the experiences and insights of people most affected by infant mortality at the core of its strategy. This approach has resulted in enhanced community-driven advocacy, sustainable local leadership development, and grassroots mobilization.

 

Building upon the success and lessons learned in SFY24-25, Queens Village will expand leadership development initiatives through specialized quarterly training and coaching to empower community leaders with expertise in fundraising, policy advocacy, leadership, communication, program evaluation, and stakeholder engagement. Additionally, Queens Village will provide technical assistance to local Queens Village Community Advisory Boards to co-create and implement local interventions to improve maternal and infant health. Finally, to increase collective reach and visibility, marketing campaigns with multimedia content to amplify the community stories will be launched. To share resources and enhance collaboration and communication, a Queens Village, Ohio Learning Collaborative platform will be launched. To improve access to basic needs resources for pregnant and postpartum women, the Ohio Safe Sleep/Cribs for Kids program will continue to distribute cribs to prevent sleep-related deaths in Ohio’s 71 participating counties. Through a partnership with Cribs for Kids, Inc., Ohio will distribute 11,000 cribs. Approximately forty percent (40%) of families receiving cribs will be African American participants. 

  

The Disparities in Maternal Health Community Grant Program funds community-identified solutions addressing unmet needs through the lens of improving health outcomes. From FY24-FY25, three grantees will implement initiatives to tackle ethnic and geographic health differences in Ohio. The Birthing Beautiful Communities’ community-based doula program will explore expanding behavioral health outreach, offering one-on-one counseling, grief recovery workshops, and emergency support for expectant Black mothers in Northeast Ohio. Also launching a pilot program to improve early detection and management of hypertensive disorders in pregnancy through education, blood pressure monitoring, and collaboration with local health partners in Akron. Hospital Council of Northwest Ohio will expand care coordination and access to doula services through the Pathways Community HUB model to address maternal health differences and improve outcomes for medically at-risk women in Lucas County.

 

Support was provided to Healthy Beginnings at Home, which offers rental assistance, housing stabilization, maternal and child health care, and social support to unstably housed pregnant women. For SFY25, the program aimed to provide rental assistance and services to 75 families in Akron, Cleveland, and Dayton, aiming for long-term economic stability.

 

During FY26, ODH will continue to fund local agencies through the Services for Homelessness Youth and Homeless Pregnant Youth grant. This project is predominantly funded through General Revenue Fund and leverages Title V for staff time. The goal for this project is to provide housing and support services to youths ages 14-24 experiencing homelessness in Ohio. In addition to providing support to these agencies, ODH will work with the Coalition on Homelessness and Housing in Ohio (COHHIO) to expand and improve youth homelessness data collection. In partnership with other state agencies and programs focused on pregnant and parenting youth, ODH will analyze data that currently collected related to parental health, birth outcomes, and infants and engage with these programs to learn, collaborate, and identify overlapping goals. ODH plans to hold a project director’s meeting focused on pregnant and parenting youth who are experiencing homelessness.

 

DCY continues to release an annual infant mortality report. This report highlights drivers of infant mortality, neonatal and post-neonatal mortality rates, and causes of death.  A fetal mortality report with 2023 data has been drafted with plans to make it available publicly in the near future. Additionally, a Quarterly Infant Mortality Scorecard was developed on the DataOhio portal (Ohio Infant Mortality Scorecard | DataOhio).  The scorecard provides the most current data available to stakeholders and the public and includes mortality rates, rates of prematurity and low birth weight, and select other indicators (e.g., prenatal care, prenatal smoking, interpregnancy interval, etc.).  DCY continues to look for outlets to share timely data related to infant and fetal mortality, including presentations, social media, and fact sheets.

 

ODH Child Fatality Review (CFR) and Fetal Infant Mortality Review (FIMR) program plans for the upcoming year include continuing to review recommendations generated by local CFR and FIMR Boards to determine areas of alignment for future prevention initiatives, increased data quality training and consistency checks, and providing ongoing technical assistance webinars and trainings for local CFR and FIMR Board members. The ODH BMCFH CFR Program has established regular meetings with both ODH BHIW Violence & Injury Prevention Section and DCY staff to discuss opportunities for collaboration related to the review of child deaths. DCY conducts reviews of child deaths due to abuse and neglect and continues to explore ways to work together to enhance our fatality prevention activities.

  

Other Efforts Supported by Title V MCH 

 

Ohio Connection for Children with Special Needs – Birth Defects Surveillance Program    

One in 33 children is born with a birth defect. Birth defects, or congenital anomalies, are the second leading cause of infant mortality, accounting for approximately 16 percent of infant deaths in Ohio. For those who survive, birth defects are a major cause of morbidity and mortality throughout childhood. Ohio Connections for Children with Special Needs (OCCSN) is Ohio’s statewide population-based birth defects surveillance program. The Ohio Revised Code 3705.30 authorizes the Director of Health to require hospitals, physicians, and freestanding birthing centers to report children from birth to five years of age with certain reportable birth defects to the Ohio Department of Health (ODH).     

     

The OCCSN data system utilizes passive case ascertainment whereby hospitals report data to the online database after a child has an encounter at that facility. Genetic counselors at the eight state-funded genetic centers across the state conduct case reviews on selected birth defects to provide data validation. Approximately 130hospitals, including birthing and children’s hospitals, report cases to ODH through the OCCSN data system. Contact information for children under the age of three years confirmed with certain birth defects is sent via automatic email to the Help Me Grow Central Intake & Referral Coordination for referral to early intervention services. The OCCSN program includes activities in four major areas: surveillance of birth defects, analysis of surveillance data, referrals to early intervention services, and awareness and prevention activities.    

    

Comprehensive Genetics Services Program    

The Genetics Services Program funds a network of eight genetic centers that provide comprehensive care and services to people affected by, or at risk for, genetic disorders. The program aims to ensure availability of quality, comprehensive genetic services in Ohio. Genetic services include but are not limited to genetic counseling, education, diagnosis, and treatment for genetic conditions and congenital abnormalities. The goals of the Comprehensive Genetic Centers (CGCs) are to ensure that children and adults with, or at risk for, birth defects or genetic disorders and their families receive quality, comprehensive genetic services that are available, accessible and meet their unique needs; and providers, the public and policymakers, are aware and knowledgeable about birth defects, genetic conditions, and genetic disease related services in Ohio.     

     

The Comprehensive Genetics Services Program also provides newborn screening follow up for bloodspot screening for genetic disorders. In SFY24, a total of 50,448 encounters occurred for genetic counseling. A total of 1,364 were a result of newborn screening follow up. A total of 466 educational events were provided, with 51 of those events focused on preconception and birth defects prevention topics, 112 on newborn screening, and 135 on the importance of family health history.    

    

Infant Hearing Program

The Ohio Department of Health Infant Hearing Program (IHP) is the state Early Hearing Detection and Intervention (EHDI) Program. The national EHDI guidelines provided by the Joint Committee on Infant Hearing (JCIH) recommend newborns receive screening for risk of hearing loss by one month of age, receive a diagnosis for suspected hearing loss by three months of age after a non-pass screening, and children identified through diagnosis begin provisions of early intervention by six months of age. National averages indicate that approximately three infants per 1,000 births are identified with hearing loss. The IHP has several goals that align with the national EHDI principles. These include ensuring that all infants who do not pass their hospital hearing screening receive no more than two screenings before hospital discharge. The IHP also ensures that all newborns receive universal newborn hearing screenings in the hospital setting and before one month of age and that babies with non-pass screening results receive follow-up coordination for tracking and monitoring. In addition, the IHP refers families when a child is identified with hearing loss to home-based early intervention services to support the development of communication and language acquisition for infants and toddlers with hearing loss, to establish essential communication skills through the early developmental stages of life. 

 

Newborn Screening for Critical Congenital Heart Disease    

Congenital heart defects are the most common type of birth defect and occur in nearly 1% of births each year in the United States. Critical congenital heart defects (CCHD) are a group of heart conditions that are present at birth and require intervention in the first year of life.  About 1 in 4 babies in the United States with a heart defect has a critical congenital heart defect.  CCHD screening, using pulse oximetry, a painless test that measures the amount of oxygen in a baby’s blood, can lead to early diagnosis and treatment for critical congenital heart defects and may provide better health outcomes and save newborns’ lives. The Ohio Department of Health (ODH) CCHD newborn screening program partners with Ohio hospitals and birthing centers to ensure newborns are screened for critical congenital heart disease, and those that fail the screening receive timely and appropriate medical intervention.

    

Sickle Cell Services Program    

The Ohio Department of Health (ODH) funds two grant initiatives under the Sickle Cell Services Program related to sickle cell disease, sickle cell trait, and other hemoglobinopathies. These initiatives are the Sickle Cell Initiative and the Statewide Family Support Initiative. As a public health program, the Sickle Cell Services Program works to ensure and enhance the availability and accessibility of quality, comprehensive sickle cell services and care for newborns, children, and adults; promote public/patient/consumer/family/professional education to increase awareness and knowledge about sickle cell disease, sickle cell trait, and other hemoglobinopathies; and, increase strategies to maximize collaboration, coordination and utilization of all sickle cell-related services and resources in Ohio. The Sickle Cell program provides newborn screening follow-up for disease and trait cases as a result of newborn screening in the hospital setting. Families are provided counseling and education regarding sickle cell trait and sickle cell disease.    

  

Child Fatality Review (CFR)  

Child deaths are often regarded as indicators of the health of a community. While mortality data from Vital Statistics provides us with an overall picture of child deaths by number and cause, it is from a careful study of each child’s death that we can learn how best to prevent future deaths. Recognizing the need to better understand why children die, Governor Bob Taft signed a bill in July 2000 mandating CFR boards in each of Ohio’s counties to review the deaths of children under 18 years of age. For the complete law and administrative rules about CFR, refer to the Ohio Department of Health website at https://odh.ohio.gov/know-our-programs/child-fatality-review/resources/cfr-rules.   

   

To accomplish this, it is expected that local review teams will: promote cooperation, collaboration, and communication among all groups that serve families and children; maintain a database of all child deaths to develop an understanding of the causes and incidence of those deaths; recommend and develop plans for implementing local service and program changes, and advise ODH of data, trends, and patterns found in child deaths.  

   

Local CFR boards must meet at least once a year to review all deaths of child residents of that county. The basic review process includes the presentation of relevant information, the identification of contributing factors, and the development of data-driven recommendations. At the state level, we take these data-driven recommendations to fuel ongoing collaborative efforts both within the agency and across agencies. The CFR Program’s ultimate goal is to identify trends and system responses to child deaths and prevent future child deaths in Ohio.

  

Fetal/Infant Mortality Review   

Fetal Infant Mortality Review (FIMR) is a multi-disciplinary, multi-agency, community-based program that identifies local infant mortality issues through the review of fetal and infant deaths and develops recommendations and initiatives to reduce infant deaths. Currently, there are active FIMR programs in all ten Maternal and Infant Vitality Initiative (MIVI) counties.   

   

The FIMR process includes:   

•       Identification of cases based on the infant mortality issues of the community.   

•       Collection of appropriate records from medical, social service, and other providers.   
•       Maternal interview.   
•       Abstraction of available records to produce a de-identified case summary.   
•       Presentation of de-identified case summary to review team.   
•       Development of data-driven recommendations.   

•       Implementation of recommendations to prevent future deaths.   
•       Case Review Team reviews case summaries and develops recommendations.   
•       Case Action Team reviews recommendations from Case Review Team and develops a plan to implement interventions.   

 

Infant Oral Health

The Oral Health Program (OHP) continues to distribute guidelines on managing oral health care during pregnancy and infant oral health to prenatal and dental care providers through the Integration of Oral Health into Prenatal Care Grant. This work will continue in FY26 with three subrecipients. Subrecipients have been provided educational resources to deliver to both providers and patients. 

 

An online continuing education module for early education professionals, nurses, and registered dietitians/registered dietitian nutritionists has been developed on oral health for infants and young children and is available to MCH programs, such as WIC and Home Visiting. This module is part of Help Me Smile—Ensuring the Oral Health of Young Children. The training is available on OhioTrain and is Ohio-approved through the Ohio Child Care Resource and Referral Association. Nursing and registered dietitian continuation education credits are available.