Friday, November 18, 2011

Scare Tactics Won't Save Babies {Guest post}

I have a friend (who doesn't have a blog) posting what I feel is a very well thought out researched response to the appalling anti-co-sleeping ads the city if Milwaukee released. I have been on both sides of this debate using a crib with my first two and becoming a co-sleeper with my third. We were in a desperate state when we started co-sleeping. Seeing ads like these would have made a stressful time unnecessarily more stressful.

I'm sure I don't have to say this because my readers are awesome, but please keep the comments constructive to the conversation. Attacking comments and name calling will be moderated.

From Loralie:

Milwaukee’s infant mortality rate is a serious and growing issue. As a Milwaukee native and mother of two, the statistics are a punch in the gut.  According to the City of Milwaukee’s website, overall city rate for infant mortality in 2009 was 11.1 infant deaths per 1,000 births.  In the city’s Black community, that number was as high as 14.7 per 1000.  To put this in perspective, Milwaukee’s Black Community suffered at a rate comparable to El Salvador, Sri Lanka and Tunisia last year, according to a 2011 UN Inter-agency Group Report on Child Mortality.  

Aggressive tactics to combat these numbers are called for, but in the case of the new ad campaign unveiled by Milwaukee’s Mayor and Health Commissioner last week, their tactics not only miss the mark but are completely irresponsible.

By now you’ve seen the ads coming out of Milwaukee with the frightening image of a baby sleeping next to a butcher knife and the headline that reads, “Your Baby Sleeping With You Can Be Just As Dangerous.”  No matter where you stand on the topic of bed-sharing, the image is disturbing.  But the issue of infant death in Milwaukee is just not as simple as where baby sleeps.

The Facts on Bed-Sharing
The truth is sharing a bed with an infant can not only be safe but highly beneficial to both the mother and child and for reasons that go beyond cuddling.  It can lead to more restful sleep, a stable infant physiology, success in breastfeeding and other long-term benefits.  While not everyone may be interested in bed-sharing, for those families that meet the criteria, (i.e. non-smokers, sober, with access to a firm, large mattress free of extraneous bedding that is close to the ground) it is a wonderful option.  The benefits are no secret to the scientific community. In a review published in Paediatric Respiratory Reviews in 2005 titled "Why babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, bedsharing and breastfeeding," authors James McKenna and Thomas McDade specifically state “...the simplistic, scientifically inaccurate and misleading statement ‘never sleep with your baby’ needs to be rescinded, wherever and whenever it is published.”  For some reason, American culture, and Milwaukee in particular, have missed this memo.

A Number of Risk Factors
To make a blanket statement that bed-sharing is completely unsafe is an unreasonable leap. While media outlets such as the Milwaukee Journal-Sentinel continue to trumpet “Co-Sleeping Deaths!” a careful analysis shows the presence of other risk factors.  It is these risk factors that lead to accidents, not merely the act of sharing sleep in and of itself. Data from the City of Milwaukee itself published in their 2010 Fetal Infant Mortality Review (FIMR) Report shows that in most cases where the cause of death was accidental overlay or suffocation there are multiple risk factors. By labeling bed-sharing as the sole culprit in the recent infant deaths, the ads gloss over other real risk factors that make the environment unsafe for the child. How can other families prevent future tragedies without complete information on how to create safe sleep spaces for their own children, be it in a family bed or in a crib? Certainly, secondhand smoke, a caretaker under the influence of drugs or alcohol, or a sleep space filled with toys, pillows and blankets is just as dangerous in a crib as it is in a bed with an adult. Milwaukee officials have made the call to shortchange information in favor of scare tactics.

Bed-sharing More Common Than You Think
To make "No bed-sharing" a matter of public health policy is overly-simplifying a complex issue. Certainly there are families who can and do provide a safe family bed for their infants and who make the conscientious and sober decision to do so. These parents probably don’t need a billboard to validate that choice but this ad campaign completely alienates those families.

We can't as a society wholly blow off all that co-sleeping and bed-sharing can provide, nor can we impugn those who practice it.   A 2003 report published in the Archives of Pediatrics & Adolescent Medicine indicated that in national survey 45% of infants spent some time in an adult bed and more than 90% of infants who "usually" slept on an adult bed shared it with their parents.  Whether folks admit this to their pediatrician or not, bed-sharing happens.  The Milwaukee ads not only vilify this choice, but go so far as to label bed-sharing parents as at the best neglectful and at the worst as murderers.  Stigma aside, by driving bed-sharing underground you block any sort of discussion on safety.  Sleep-deprived parents left with no alternative are left out in the cold and worse yet, risk the danger of falling asleep on a couch or in a recliner with their child - a space wrought with far more dangers than in a parent’s bed.

Car accidents are the leading cause of death in our country for children between the ages of 2 and 14. Besides the deaths, 250,000 children are inured each year in car accidents. Yet we do not say, "Do NOT drive with your children." Rather, we campaign for SAFE ways in which to drive with our children through the proper usage of car seats. (Melissa's Note: PhD in Parenting also commented on this, click to see her post)

A February 1992 Congressional Budget Office Staff Memo, discusses how in the US our infant mortality rate remains higher than many other developed countries.  The 2011 UN Inter-agency Group Report on Child Mortality lists the US as having 7 infant deaths per 1,000 births.  In Japan, where bed-sharing is widely practiced and culturally accepted, that number is 2 per 1,000.  And yet we continue to harp on bed-sharing as a killer?  

The Real Villain = Poverty
Those in favor of the ads, may feel desperate times call for desperate measures. They seek to remind us that the ad campaign targets low-income families in the inner city who lack education. A poster with a long list of do's and don’ts just doesn't create the same impact as a baby in bed with a knife. If it saves just one life who cares if some people's noses are rubbed the wrong way?  I’ll admit, the thought crossed my mind... Perhaps officials feel that the problem of infant mortality is so complex and so daunting, that they’d rather attack low-hanging fruit.  It’s easier to change where a baby sleeps than to uplift an entire population and attack the real issues of teen pregnancy, poverty and lack of resources.  The sad truth is, as much as we’d like to find an immediate solution to infant deaths, the solutions are not quick and not simple.  Most definitely, the solutions cannot be found in advertisements suggesting violence towards babies. Public officials have the obligation to offer all the facts not perpetuate myths in the name of a greater good.

One can say a 15-year old mother in the inner city, even with the best intentions, may not have the proper resources or ability to control the smoking, drug or alcohol habits of those around her. If we open the door to the possibility of bed sharing, does that open the door to other risk factors beyond the mother's control? It's a question worth asking, but are we in essence taking away her choice by not presenting her with all the information? If you really believe that inner-city parents are not smart enough to digest the facts, who is at fault there?  What’s at fault is a system that fails to provide education, job opportunities, income equality, and access to birth control.

So What Can Be Done?
There is in fact a direct correlation between level of education attained by the mother and infant mortality rates.  In data provided by the Robert Wood Johnson Foundation, rates of infant mortality are highest among babies born to mothers with less than 12 years of schooling.  The rates drop dramatically with each level of higher education attained.  In Wisconsin, the rate is 10.2 deaths per 1,000 births for mothers’ with less than 12 years of education and steadily declines down to 3.9 for mothers with 16 or more years of education.

Additionally, sex education and access to birth control has a direct affect on infant mortality rates.  According to an article from the Guttmacher Institute, as contraceptive use goes up, infant mortality goes down.  In countries where fewer than 10% of women use a modern contraceptive method, the average infant mortality rate is 100 deaths per 1,000 births, compared with 79 per 1,000 in countries where 10-29% of women use contraception and 52 per 1,000 in countries where 30% or more do so.  The issue simply isn’t less babies born mean less deaths, but when women are empowered to delay starting a family and have the ability to space their births the children are healthier.  Certainly, this lesson is applicable here when short intervals between pregnancies contributes to prematurity and SIDS.

Yet, despite this evidence, earlier this month Wisconsin advanced a sex-ed abstinence proposal which would require public schools to push abstinence as the only reliable means to prevent pregnancy.  The legislation would in fact strip requirements that student receive instruction on the use of contraceptives.  Without delving too deeply into a political discussion, it would seem politicians not just in Milwaukee, but elsewhere in the state, have got things mixed up.

Certainly the money funnelled into this offensive ad campaign could be better put to use with more home visits, better and more widely available prenatal care and education, and the donation of cribs to families in need. (Melissa's note: The Feminist Breeder did a great piece on Milwaukee's donation of Pack N Play's in response to these ads)  Education needs to include teaching safe bed-sharing habits. When bed-sharing is not possible or not desired, the program of crib donation should be continued and expanded.  

In terms of further advertisements, Milwaukee needs to put greater muscle behind promoting positive parenting practices with just as much fervor (such as breastfeeding,) rather than focus on the one action of bed sharing which cannot legitimately be singled out as the sole perpetrator in infant deaths. It's also worth noting that breastfeeding itself has been shown to reduce incidences of SIDS.

Do the Right Thing Milwaukee
The uproar caused by this campaign shouldn’t be about whose sleeping choice is better. The choice should always be where the child will be safest regardless if that is in a parent's bed or crib. My point is the campaign does precious little to educate on safe sleep other than make an incorrect generalization in a sensationalized and graphic manner. It is very easy to be on the bandwagon to save children's lives, but without an honest presentation of facts all you are left with is fear mongering.

Milwaukee public officials have an obligation to offer full disclosure and to share truths with all their constituents, regardless of socio-economic status. The conversation simply cannot end with "Just Don't Do it" or even worse, what these ads suggest, that to share sleep with your infant is akin to stabbing them. It is irresponsible and offensive.  Milwaukee’s babies deserve better than that.

Loralie Thomas
Milwaukee Native, Co-Sleeper and first and foremost a Mom


Maegan Beishline said...

Thank you for these well researched thoughts on co-cleeping. I have seen the ads and each time, my heart breaks a little more. In fact, I was thinking of these exact ads as I was falling asleep last to my 2.5 year old who has been sleeping next to me (safely) every night of her life. You're so right about what the actual issues are here and I think what saddens me the most is people in power giving backing to one-dimensional beliefs...very much like how you'll find more support for bottle feeding than breast these days. These ads dissapoint me on so many levels. Thank you for being a strong and well articulated voice of reason on this matter!

This Heavenly Life said...

Excellent, excellent post. I don't co-sleep in general (just for my own sanity, it hasn't worked well in our family) but I HAVE slept with all three of my babies at different points in their infanthood. There are times when it just makes sense, and to scare already-tired parents into NOT sleeping with their children, when they could be promoting safety in doing so -- sad.

Wouldn't it be nice if our pediatricians, instead of warning us that 'sleeping with your baby raises the risk of SIDS', told us how to do it safely? How to remove the actual risk factors from the situation? What if they encouraged and educated instead of frightened?

...what a wonderful world :)

Stephanie said...

Ok, I didn't read your whole article yet, but I just have to say = who in the world thinks to lay their sleeping baby next to a butcher's knife??? Because that's surely what all co sleeping parents do??? Seriously! We still co-sleep with our two and three year old on nights when they crawl into our bed or can't fall asleep at night. I was afraid of co-sleeping until my daughter spent almost two weeks in the NICU. When we got home, I couldn't bear to leave her in her basinet all alone and, honestly, she was happier and slept better in my arms. When my son came along, I had no doubts we would co sleep as long as he needed. There's something so sweet and wonderful about waking up with a sleeping baby next to you. I will be reading the rest of this and sharing it too. Thank you!

Stephanie said...

Ok, now that I've read this through, I just want to say THANK YOU for putting a voice to the truth. This is a well written article. I am still in shock at the bullying tactics used in that ad. It kind of reminds me of the babywearing scare - when babies died from unsafe babywearing suddenly babywearing was condemned. There is an unsafe...and a SAFE way to co sleep and the benefits far outweigh the risks, in my opinion. Thank you so much for sharing this.