Sudden infant death and social justice: A syndemics approach

Abstract

Sudden unexpected infant death (SUID) and sudden infant death syndrome (SIDS) prevention has focused on modifying individual behavioural risk factors, especially bedsharing. Yet these deaths are most common among poor and marginalized people in wealthy countries, including U.S. Blacks, American Indians/Alaskan Natives, New Zealand Māori, Australian Aborigines, indigenous Canadians, and low-income British people. The United States now has the world's highest prevalence of SUID/SIDS, where even Whites' SIDS prevalence now approaches that of the Māori. Using public databases and the literature, we examine SUID/SIDS prevalence and the following risk factors in selected world populations: maternal smoking, preterm birth, alcohol use, poor prenatal care, sleep position, bedsharing, and formula feeding. Our findings suggest that risk factors cluster in high-prevalence populations, many are linked to poverty and discrimination and have independent effects on perinatal outcomes. Moreover, populations with the world's lowest rates of SUID/SIDS have low-income inequality or high relative wealth, yet have high to moderate rates of bedsharing. Employing syndemics theory, we suggest that disproportionately high prevalence of SUID/SIDS is primarily the result of socially driven, co-occurring epidemics that may act synergistically to amplify risk. SUID must be examined through the lens of structural inequity and the legacy of historical trauma. Emphasis on bedsharing may divert attention from risk reduction from structural interventions, breastfeeding, prenatal care, and tobacco cessation. Medical organizations play an important role in advocating for policies that address the root causes of infant mortality via poverty and discrimination interventions, tobacco control, and culturally appropriate support to families.

Bedsharing and Breastfeeding: The Academy of Breastfeeding Medicine Protocol #6, Revision 2019

“…be provided even to those parents for whom bedsharing should be discouraged (those with hazardous conditions or circumstances), as one must assume that parents may bedshare anyway, even if unintentionally (level 1). 33 See Table 3 for risk minimization strategies. a.…”

“…Structural societal interventions are essential interventions regardless of counseling on sleeping arrangements. As many parents will have limited contact with the health care system, 33 advocating for structural changes is critical. Policymakers should address the following strategies that may lower infant mortality:…”

“…American Indians/Alaskan Natives (combined) and non-Hispanic blacks, New Zealand M aori, Australian Aboriginal and Torres Strait Islander peoples, and indigenous Canadians. 33 Bedsharing is often common and culturally valued in these marginalized communities. However, there are also many populations with high bedsharing rates that have low rates of SIDS, 33,111 including Swedes, 33 U.S. Asians, and U.S. Hispanics (Fig.…”

“…These conflicting observations may be explained by the presence or absence of a variety of attendant hazardous risk factors. 33 The overlap of many of the hazardous circumstances with conditions of poverty, structural racism, and legacies of historical trauma must be noted, including antenatal smoking, alcohol use, preterm birth, poor prenatal care, and lack of breastfeeding (feeding human milk substitutes). In the United States, fewer than half of the mothers of infants who died of SIDS received timely prenatal care, 33 which has been demonstrated as associated with SIDS elsewhere.…”

What Is “Normal” Infant Sleep? Why We Still Do Not Know

“…Around the world, many sudden unexpected infant deaths (SUID) occur in marginalized populations in rich countries (Bartick & Tomori, 2019). Although cosleeping is high in these populations, it cannot be the main reason for these SUIDs because countries with low SUIDs have high cosleeping rates (c.f., Baddock et al., 2019; Bartick & Tomori, 2019). Given the low SUID rates with cosleeping in other cultures (especially across Asia), it is convenient but irresponsible to claim it is cosleeping and not other factors that are responsible.…”