How Do We Address Safe Sleep Disparities? Start by Building Trust
Every day across the country, families wake up to an unimaginable heartbreak. The healthy baby that they put to bed passed away during the night.
Healthy babies shouldn’t die in their sleep. But, despite decades of trying to reduce the number of sudden unexpected infant deaths (SUID) they still persist. And most often, their persistence affects families of color. SUID rates for American Indians, Alaskan Natives and Non-Hispanic black babies are more than twice those of white babies.
These statistics reflect an alarming lack of equity. Yet, they also illuminate a path of promising change. If, collectively, we address these disparities, we can drastically reduce sleep-related infant deaths in the U.S. This is why two NICHQ-led projects focused on addressing SUID, the Safe Sleep Collaborative Improvement and Innovation Network to Reduce Infant Mortality and the National Action Partnership to Promote Safe Sleep Improvement and Innovation Network, are placing disparities at the center of their improvement efforts.
Evidence-based research has shown us what needs to be done; the question now is how can we do more to address disparities in sleep-related infant deaths? And how do we build on the successes that already exist? The answers start with building trust, says Founder of the Global Infant Safe Sleep Center, Stacy Scott, PhD, MPA.
“Improving safe sleep practices means helping families understand the existing recommendations and why they matter. And helping them understand means having conversation built on mutual trust,” says Scott. “That trust isn’t something that just exists naturally, especially when working with underserved populations. We have to understand that these conversations are fraught with underlying tension, which stems from historic trauma and implicit bias.”
It won’t be easy to build that foundation of trust. But building it is what will make these conversations carry weight; it’s what will change perspectives and improve actions. And, as Scott explains, building that trust will start with developing authentic relationships with the communities we seek to help.
First, she explains, we need to shift the power, understanding that the most powerful way to promote a safe-sleep culture is through the mothers and members in underserved communities. Many of these mothers rely on the advice of family and fellow community members, those that share and understand their lived experience.
“Ask yourself,” says Scott, “Who am I empowering outside of my hospital or organization to have these conversations?”
Elevating their voices, rather than voices alien to their experience, facilitates trust. We do this best through community outreach that engages third parties already active within these communities. Community health workers, home visitors and doulas all serve as trusted third parties who can connect with and inspire safe sleep community champions.
Tapping into those community voices from the outset is especially important as we seek to uncover what has not worked, Scott notes.
“We need new solutions, but those solutions will only be equitable, and they will only be trusted, if underrepresented people help build them,” she says. “We need to remember that it’s much harder to take something apart that has already been constructed.”
Second, we need to practice sensitivity while engaging with existing barriers. Many of these families face significant socioeconomic challenges that influence their willingness to adopt safe sleep practices. “Being sensitive to these challenges means focusing on more than their economic status though,” explains Scott. “It means trying to understand their unique experience, and the specific barriers they face because of it.”
For example, many mothers believe that their bed is the safest place for their baby. These same mothers may live in communities where gun violence is common, and burglary expected. Other mothers may not be able to afford a separate bed for their baby. These are their experiences. These are the barriers productive safe sleep conversations would address. And, as Scott explains, when health professionals initiate conversations that stem from a sincere desire to understand these barriers, they come closer to achieving the authentic relationships needed for productive conversations.
“Practicing sensitivity also means suspending our bias about what the baby-caregiver dyad looks like,” explains Scott. Not all babies have or are cared for by mothers. In underserved communities, community members sometimes care for babies in lieu of an absent or deceased mother. These caregivers, not to mention single fathers and same-sex male partners, may feel alienated from safe sleep messaging that does not consider their perspective. Because of this, practicing inclusivity comes with any promise to practice sensitivity.
“These conversations can change outcomes,” says Scott. And having them means building trust by pausing to understand and empower those whose family’s health is at stake. When we do this, we can help stop healthy babes from dying and help spare more families from hurting.
Would you like to hear more from Stacy Scott? She led a recent NICHQ webinar on safe sleep. View a recording here and find actionable techniques for helping families from all backgrounds commit to safe sleep habits. .
Children’s Health Policy Update: Fall 2019
As 2019 draws to a close, we’re sharing an update on policies and public programs that impact children’s health outcomes. We’ve included breastfeeding legislation passed over the summer, important legislation to watch in the coming months, and insights on vital public programs and funding needs for fiscal year 2020.
How Co-Created Goals Support Social Emotional Development
Social emotional development, which begins in infancy, helps children learn to understand their emotions and sustain positive relationships with others. When pediatric providers partner with families to co-create goals to support their children’s social emotional development, in the same way they do to promote children’s overall health and wellness, children thrive.
National Action Teams Promote Safe Sleep and Breastfeeding Across the Country
Over the past decade, improvements in sleep-related infant deaths have stagnated. Now, four national action teams are working together to drive measurable change in four priority areas: Aligning National, State and Local Efforts; Promoting Conversation Modules; Supporting Early Child Care and Education; and Public Media and Media Relations.
Strengthening the Developmental Screening Process
Two counties in southeast Kansas are streamlining early childhood systems to ensure effective developmental screenings and referrals to supportive services to improve children’s developmental health outcomes.
Breastfeeding Takes a Village and, Too Often, Black Women Don’t Have One
Breastfeeding peer support networks run for and by Black women fill a gap in breastfeeding support for Black women—a gap largely created by historic and systemic inequities. Here, Khadija Garrison Adams, co-founder of Black Lactation Circle (BLaC) of Central Ohio, shares how their community is empowering black pregnant and nursing mothers to meet their breastfeeding goals.
Family Advocates Demand More from Their Government
An advocacy group led by and for parents and community members spearheaded a campaign for funding to address lead in the homes throughout their city. Their successes illustrates the vital impact families play in advocating for policy change on behalf of children. Here, two parent leaders share their experiences and advice for supporting family-led civic engagement.