By Julie Washington, cleveland.com

CLEVELAND, Ohio — As infant mortality and maternal morbidity rates cause concern locally and nationally, Cleveland’s Neighborhood Family Practice Medical Center aims to be part of the solution.

The health agency recently expanded its services to expectant moms, especially those from other cultures, as it seeks to break down cultural barriers to care and create supportive communities for new parents.

Pregnant women who don’t speak English can use the health center’s app to communicate with caregivers. NFP’s baby dance classes give new moms and dads a fun way to socialize and bond with their infants, and the health center is training additional lactation consultants to help all families across Cuyahoga County, regardless of race.

The new programs are meant to focus attention on infant mortality and maternal health, two important gauges of overall health in the United States.

Cuyahoga County’s latest Child Fatality Review Board report, released this month, found that the county’s infant mortality rate – defined as children who don’t live to see their first birthday – rose to 8.8 for every 1,000 live births, the highest it’s been in the last five years. The county’s infant mortality rate had previously been trending down and was reported to be 7.2 in 2022.

Being born prematurely was the cause of death in 40% of all infant deaths, according to the county report.

In Ohio, the infant death rate was 7 per 1,000 live births in 2022 — among the highest in the nation, according to federal data. In 2022, the overall infant mortality rate in the United States was 5.6 deaths per 1,000 live births, according to the U.S. Centers for Disease Control and Prevention.

Maternal death rates are also high in Ohio. The state has a rate of 24.5 maternal deaths per 100,000 births, according to the 2024 March of Dimes Report Card.

“We know that it’s a combination of things that have contributed to the poor outcomes we have here in Cleveland, Cuyahoga County and the state of Ohio,” said Neighborhood Family Practice CEO Domonic Hopson. “It didn’t take one thing to get us here, and there’s not one silver bullet that’s going to get us out of this.”

Neighborhood Family Practice’s approach to infant and maternal care is making a difference, Hopson said.

The health center pointed to data showing that its outcomes for Black births outperform state and local outcomes. NFP patients have lower percentages of preterm birth, low birth weight and delivery by Caesarean section than do Ohio, Cuyahoga County and Cleveland, according to 2020-2022 data from March of Dimes and the Ohio Department of Health.

Breastfeeding initiation is higher (92%) for NFP’s Black births than for Black births in Ohio (68.9%) and Cuyahoga County (77.1%), according to the same data.

The federally funded nonprofit health center has seven locations in Cleveland and Lakewood offering primary care, behavioral health, dental and pharmacy services, midwifery, lactation specialists and more. Neighborhood Family Practice served more than 22,000 patients in 2023, and about 300 pregnant patients annually.

“The question we’re asking ourselves is, can we do more?” Hopson said. “Do we have capacity to see more patients? What can we do to share what we’re doing with other practices across Cleveland and Cuyahoga County?”

Neighborhood Family Practice looked across Northeast Ohio and the United States to find programs that have enjoyed the best outcomes, he said.

The health center, with a $29 million annual budget, is paying for the increased services through fundraising and grants. While some programs are free for participants, others are offered on a sliding scale or covered by private health insurance.

“For us, it’s worth the investment, because our focus is on outcomes,” he said.

Centering groups, baby dance classes

In NFP’s centering groups, expectant women who are due to deliver about the same time can discuss postpartum depression, breastfeeding, safe sleep and other topics with caregivers, leading to improved outcomes for mothers and babies.

Centering groups are different from support groups. In centering groups, prenatal appointments focused on their specific issues are built into the sessions.

Neighborhood Family Practice has increased the number of centering groups it offers, so that more first-time parents, like Jill and Matt Allard of Cleveland, can be well prepared for labor and delivery.

After welcoming their newborn Lucas, the Allards continued to attend centering group meetings for camaraderie and education.

“It provided a sense of community and support in spades,” said Jill Allard, 36. “We highly recommend it. We felt more ready to welcome new life into the world.”

This year, Neighborhood Family Practice also ran a pilot program that created culturally focused centering groups for non-English-speakers. Women who spoke Swahili, for instance, were able to join a centering group with other Swahili speakers.

Although the funding grant ran out, the health center would like to bring back this type of centering group if another grant can be found, Hopson said.

The health center also introduced monthly baby dance classes to promote social interaction among new parents, help babies’ physical development and increase bonding.

Hopson and his wife welcomed a daughter, Vera, this year. His staff is clamoring to see him and his family moving to the rhythm at a baby dance class.

“We haven’t been able to make it yet, but I’m hoping to join one sooner than later,” Hopson said.

Translation app, doulas support moms and infants

Neighborhood Family Practice performs health screenings for a large segment of refugees arriving in Cuyahoga County, mostly from the Democratic Republic of Congo, Syria, and Afghanistan, Hopson said.

If the new arrivals are pregnant, they often use the health center’s midwifery services. But cultural differences can create barriers to care.

For instance, women from some cultures may not feel comfortable being examined by a male physician or having male caregivers in the delivery room, Hopson said.

NFP has introduced an education program for area health care workers on navigating cultural sensitivities during and after pregnancy.

“Our ultimate goal is that regardless of where a person receives care, (that caregivers) have these cultural competencies that are so important, especially for somebody who’s still trying to navigate a new country,” Hopson said.

Another barrier is language. If caregivers and a woman in labor don’t speak the same language, asking for a glass of water can mean waiting for an interpreter.

NFP developed an app called Mother Tongue that provides translations for a variety of languages, including Burmese, Swahili, Somali, Spanish and Ukrainian. The idea came from an NFP patient, Hopson said. It’s available on the health center’s website so that other healthcare organizations can use it as well.

In addition to these programs, Neighborhood Family Practice is recruiting more women’s health nurse practitioners and nurse midwives. It is partnering with Birthing Beautiful Communities, a nonprofit centered on doula care, to help women at high risk for infant mortality. The partnership will ensure that every one of NFP’s pregnant patients have access to a birth doula, to provide prenatal support and care through the baby’s first year.