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The United States began tracking infant death by race in 1850, when 217 of every 1 000 White babies and 340 of every 1 000 Black babies did not reach their first birthday.1 While the overall US infant mortality rate (IMR, the number of infant deaths per 1 000 live births, a leading indicator in the health of a community2) has dropped dramatically since then, we still lag far behind other wealthy nations (55th overall, with an IMR of 5.83). These national statistics belie deep geographic, health care access, and, especially, racial disparities: the gap between White and Black IMR is worse now than it was in 1850.1 Ohio’s 2018 IMR was 6.9, but for Black Ohioans was 13.9.4 And in Cuyahoga County, where the overall 2018 IMR was among Ohio’s worst at 8.7, the White IMR was 4.5 (up from 2017 due to the opioid epidemic), and the Black IMR was 14.9.5 While we are seeing progress, Black babies in Cuyahoga County are still dying at 3.3 times the rate of White babies. ABSTRACT

Benefits of Understanding Systemic Racism in Forming Clinician-Patient Relationships to Reduce Black Infant Mortality