Reimagining Safe Sleep: What Ohio Can Learn from Dreaming Safe Sleep Futures™
By Stacy Scott, PhD, MPA, CSJ, Vice President
National Institute for Children's Health Quality (NICHQ)
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Every year, Ohio loses Black infants to Sudden Unexpected Infant Death (SUID) at a rate no amount of good intentions has managed to close. In 2024, the Ohio Department of Health reported that non-Hispanic Black infants were 2.5 times more likely to die before their first birthday than non-Hispanic white infants, a disparity that has held steady, and even widened, for more than a decade. Groundwork Ohio's own research has been clear about what that number represents: not a knowledge gap, but a policy failure.
That is exactly the argument at the heart of my book, Dreaming Safe Sleep Futures™: Transforming Infant Sleep Interventions for Black Families. I wrote it for the people doing this work in Ohio and beyond, early childhood professionals, home visitors, doulas, and maternal and child health leaders, because I believe our field needs more than another awareness campaign. We need a practical framework for turning a hard truth into action.
A Story I Already Knew By Heart
Ohio, like many states, has invested real resources in safe sleep education. Families across the state have heard the ABCs of safe sleep, alone, on their back, in a crib, for years. Yet the disparity has not closed, and in some communities it has grown worse.
My central claim is that this is not because families do not know the guidance. It is because education alone cannot fix a problem rooted in housing instability, lack of overnight support, inconsistent access to cribs and sleep sacks, and health systems that too often treat Black families as noncompliant rather than under-resourced.
From “Risk Behavior” to “Risk Conditions”
The reframe I ask our field to adopt is this: move from describing “risk behaviors” to naming “risk conditions.” Instead of asking what a parent did wrong, the question becomes what conditions made safety difficult to achieve, and what it would take to remove them.
A caregiver who falls asleep feeding on the couch is not making a poor choice. She is often exhausted, unsupported, and doing her best at 2 am with no safe alternative in reach.
A family without a crib is not uninformed. They are waiting on a resource that should have reached them before the baby came home.
Afrofuturism as a Practical Method
In my book, I use Afrofuturism not as an aesthetic, but as a disciplined design method built on four verbs: Remember, Refuse, Reimagine, and Rebuild. Each verb is meant to produce something concrete, whether that is documented insight from families, revised intake language, a written future statement, or a new referral pathway. If a verb does not produce an output, I argue, it remains philosophy rather than practice.
Four Mechanisms Ohio Programs Can Put to Work
I translate that method into four mechanisms that map directly onto the work already happening across Ohio's home visiting, WIC, and maternal health programs:
Narrative repair: replacing deficit language like “noncompliant” with language that names real barriers to feasibility.
Design justice: giving families and frontline staff, doulas, community health workers, home visitors, real decision-making power over how services are designed.
Material support: treating safe sleep supplies as a standard part of care, not a reward for families who ask the right way.
Clinical practice transformation: shifting from “Here's what you must do” to “Let's design what's possible in your home.”
A Tool for Tonight: The Real Nights Plan
Perhaps the most immediately useful piece of my book for Ohio practitioners is the Real Nights Safe Sleep Checklist and Plan. Rather than walking families through an idealized routine, it asks about the nights they actually have: Where does your baby usually sleep? Who helps you overnight? What happens when you're too exhausted to stay awake? The goal is not a compliance score. It is one honest answer and one feasible change, activated with real support before the family leaves.
Why This Matters for Ohio Right Now
Ohio's infant mortality rate has reached a record low overall, and Franklin and Hamilton counties have both reported historic lows in Black infant mortality. But statewide, the Black/white disparity ratio still has not moved. As Groundwork Ohio has said in its own infant mortality reporting, the state has reached a point where incremental progress is no longer enough. I wrote this book to give our field language and tools to match that urgency, and to offer a reminder I hold onto in my own work: Black babies are not risk profiles to manage. They are future holders we are obligated to protect.
Take Action
Review your own program's documentation language for words that blame rather than describe conditions.
Ask your team where families have real decision-making power, and where they are only being consulted.
Learn more about my work and the Real Nights Plan at Books.by/stacy-d-scott.
Explore Groundwork Ohio's advocacy on infant and maternal health at groundworkohio.org.
