What Is “Safe Sleeping”?

It was with great disappointment that I saw the new Albany County advertising campaign on “safe sleeping” for infants, which discourages bedsharing and repeat the old, inaccurate canard that “babies sleep safest alone.”

There are few things that are more emotional than an accidental infant death. I’m quite sure that all the people involved in this campaign are sincerely wanting to do what’s right and safe lives.

But that’s no excuse for an inaccurate campaign that is likely to harm more babies than it helps.

I wrote about this issue, and the problem with identical campaigns, in some detail in Metroland a few years back.

In quick summary, bedsharing is safe when a few key safety precautions are followed. Crib sleeping requires just as many precautions to be safe, and if done alone in a room separate from parents, is actually dangerous, dramatically increasing the risk of SIDS. Unfortunately, the data collection is skewed: any infant death in an adult bed is attributed to the location and not the specific cause, while any infant death in a crib is attributed to either the particular safety hazard at play or SIDS, and not the location. Public health agencies have, by incorporating their own biases into their recording mechanisms, manufactured an apparent crisis that belies both evolution and the actual facts.

As many of the more than 50 people who showed up to comment on the county’s Facebook photo albums of the ads and the news conference pointed out, such ads create a dangerous environment. Most parents will fall asleep with their babies sometimes, even if they are not intentional co-sleepers. By making parents terrified of taking their baby into the bed with them, said many health practitioners, you are increasing the chances they will sleep with them on sofas and recliners, which is in fact risky.

By not sharing the guidelines for both safe cosleeping and safe crib sleeping (which includes being in-room) and instead focusing on fighting bedsharing itself, campaigns like this put babies in danger—from SIDS, from recalled cribs, from unsafe cosleeping practices. And that’s before you even get into the health problems and infant deaths caused by reduced breastfeeding rates, since ease of breastfeeding and increased supply are one of the most common reasons for cosleeping.

As of Tuesday, Albany County Executive Dan McCoy had not made any public response to any of the outpouring of critiques.

Public health messages have a longish history of being based on emotion, culturally tone deaf, and off base when it comes to the facts. This round strikes me as akin to abstinence-only sex-ed, with its attendant problems of leaving teens who are not actually going to abstain unequipped to have sex safely and ignorant of how both pregnancy and STD transmission actually work.

In a way the anti-bedsharing ads are worse, since if achieved, abstinence wouldn’t actually present a health problem, whereas unsafe crib sleeping is quite a bit more dangerous than safe bedsharing. (Countries with high rates of cosleeping and low rates of smoking have much much lower rates of SIDS than we do. Those infant deaths matter too.)

Public health messages also have a long history of trying to operate based on shaming and fear rather than provision of useful information. Right now there is a stunning series of ads in New York City that feature babies telling their parents all the awful things that are more likely to happen to them because they were born to teen parents. As if teenagers are mostly getting pregnant because they have thought through the consequences and made a rational decision.

I don’t think those ads are necessarily reporting wrong science, but they sure seem to be largely destined to isolate teen parents or pregnant teens and make them less likely or slower to seek help. Access to birth control, abortion, and respectful adoption services, along with campaigns that support a culture of consent about sex would go so much further toward reducing unwanted pregnancies.

In that way, some of the Albany ads do a little better than they might. Saying “You don’t have to sleep with your baby to keep them close” is at least a positive spin, and it’s even true. A safe crib with no risk factors in the room with you can be one safe choice that does keep your baby close. But the implication is still clear, especially with “even one child’s death is too many” underneath, and other ads that repeat the “babies sleep safest alone” hooey.

It is completely not ok to put babies in danger by playing up misleading fears on the part of well-meaning parents. Public health messages need to be based on the whole picture, not misleading anecdotes.

(This column was originally published in Metroland, the Capital Region of New York’s former alt-weekly, on March 14, 2013.)

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