Promising Practices for Eliminating Disparities in Sleep-Related Infant Deaths
Black babies born in the state with the lowest black infant mortality rate—those with the best chance at reaching their first birthday—die at a higher rate than white babies born in the state with the highest infant mortality rate, according to a 2018 report on infant mortality from the Centers for Disease Control and Prevention.
While overall infant mortality rates have gone down during the past decade, black infant mortality rates increased from 2014 to 2015. Sleep-related infant deaths—including accidental suffocation or strangulation in bed and those from unknown causes—contribute to these stark inequities, with black babies and American Indian/Alaskan Native babies dying at more than twice the rate of white babies.
These numbers are dire, but change is possible. And it is already happening in states and communities across the country.
Individuals, organizations and health departments have designed innovative community programs, grassroots initiatives, state and national campaigns, and educational materials tailored to high-risk and underserved populations that experience barriers to safe sleep practices. Eliminating preventable deaths is a significant opportunity to ensure healthy futures for all babies, regardless of their race or ethnicity.
Together, their work provides a vital road map for others seeking to drive community, state and national change. Below, we share nine promising practices. These practices are all highlighted in research NICHQ conducted to inform the Missouri Safe Sleep Coalition’s Strategic Plan to reduce infant unsafe sleep fatalities in Missouri.
Keeping the Faith: Church Peer Educators in Alameda County, California
This promising practice comes from the National Center for Cultural Competence and is available for free download on the website above. In an effort to reduce inequities in their county’s African American infant mortality rates, the Alameda County Health Department partnered with local African-American churches to implement a peer health educator program. Using flyers and church bulletins, they recruited women of reproductive age as peer health educators. After receiving a training on safe sleep education, the educators share safe sleep messages at church events and at caregiver service centers. By activating trusted, culturally concordant messengers, the initiative increased the delivery of safe sleep messages to their target population.
North Carolina Healthy Start Foundation: Culturally Competent Media Messages
North Carolina Healthy Start Foundation developed a series of print and broadcast media messages and training materials with a focus on all caregivers, including mothers, grandmothers and fathers. Safe sleep messaging was delivered through peer trainers, as well as through radio, television, and billboard advertising. The approach not only informed families about safe sleep practices but engaged all family members, specifically grandmothers, in supporting parents’ sense of self-efficacy. As trusted voices in the African-American community, grandparents are critical partners in spreading safe sleep messaging to high-risk populations.
Sisters United Initiative
State Health Department and African-American Sororities Work Together to Reduce Infant Mortality
Sisters United is a culturally sensitive, grassroots public health campaign aimed at raising awareness about infant mortality, associated risk factors, and prevention. Sisters United is comprised of four African-American sororities: Alpha Kappa Alpha, Delta Sigma Theta, Zeta Phi Beta, and Sigma Gamma Rho. The members serve as peer educators who share information about infant mortality inequities and train community members on prevention strategies. Promising outreach from sorority chapters include a series of educational YouTube videos, sponsoring public service announcements, promoting education at community public health fairs, sharing safe sleep information through Facebook accounts, and leveraging funding from NICHD grants to host 22 safety showers that provide safe sleep training for at-risk pregnant women.
Brothers United Initiative
Brothers United is an alliance of African-American fraternities including Alpha Phi Alpha, Kappa Alpha Psi, Omega Psi Phi, Phi Beta Sigma and Iota Phi Theta. Similar to Sisters United, the fraternities implement grass roots public education campaigns promoting safe sleep messages to men in their communities. Like the community safety showers of Sisters United, Brothers United host tailgate parties for new and expectant fathers.
B’more Babies for Healthy Babies
B'more for Healthy Babies is a city-wide initiative working to improve health outcomes for all of Baltimore’s babies. Led by the Baltimore City Health Department, with support from Family League of Baltimore and HealthCare Access Maryland, B’more brings individuals and organizations together around the shared goals to: reduce infant mortality and teen births, decrease racial disparities in both, and reduce sleep-related infant deaths. With mixed media and communications, the campaign reaches and educates all members of the community—parents, health care providers, family members, educators, community leaders—to support safe sleep and other infant mortality reduction strategies. Culturally competent messages and materials that target African-American parents and families, address cultural barriers to safe sleep behaviors include:
Baltimore B'more for Healthy Babies: Webpage with safe sleep lessons and Q&A: http://www.healthybabiesbaltimore.com/parents-and-caregivers/safe-sleep
B’more for Healthy Babies -- ‘SLEEP SAFE’ Campaign: https://www.youtube.com/watch?v=uJw8CrpI7bw
Baltimore B'more for Healthy Babies - Safe Sleep PSA for Fathers: https://www.youtube.com/watch?v=F194I4a5CLk
Baltimore B'more for Healthy Babies - Safe Sleep PSA for CareTakers: https://www.youtube.com/watch?v=iVMn1B87UGA
DE Thrives: A Quick Guide to Creating a Safe Sleeping Environment
This online and printable booklet from DE Thrives, Delaware Health and Social Services, provides clear language and multi-cultural images that help parents follow the steps for putting their babies to sleep safely. It includes a Q&A to directly address cultural behaviors or parenting concerns that may not be safe.
Safe to Sleep® Public Education Campaign
This website from the Eunice Kennedy Shriver National Institute of Child Health and Human Development provides safe sleep education basics and messaging for all caregiver audiences including parents, grandparents, aunts, uncles, babysitters, childcare providers and all other potential caregivers. It includes printable documents and materials that help support safe sleep behaviors. The campaign includes culturally specific campaign materials, messages, and training.
text4baby Parent Support and Education Texting Program
A free service of Wellpass © 2017. All rights reserved
Text4baby promotes maternal and child health through text messaging. Parents who sign up receive three free weekly text messages that are timed to their due date or their baby's birth date, through pregnancy and until the baby's first birthday. A number of states provide text4baby messages with local phone numbers. The service is available in both English and Spanish. Messages cover a wide breadth of information on prenatal and post-natal care and parenting, including messages and education on safe sleep practices.
First Candle: Straight Talk for Infant Sleep
Through education, research and awareness building, First Candle works to eliminate SIDS and other sleep-related infant deaths while supporting families who have experienced this unimaginable loss. Their evidence-based program, Straight Talk for Infant Sleep, is for nurses, community health providers, social service agencies and faith groups closely aligned with families. The program covers the AAP safe sleep guidelines, addresses individual implicit biases and the importance of judgement-free encouragement, and explores how socioeconomic and cultural beliefs influence families.
Looking for more safe sleep resources? Access NICHQ's safe sleep video quiz and use it to improve conversations with families about safe sleep and breastfeeding.
Supporting Children’s Health During the COVID-19 Pandemic
While most children may be unlikely to have adverse health effects from the illness, COVID-19’s overall impact on children’s health outcomes will likely be far reaching.
Promoting Fathers’ Mental Health During Children's Early Childhood
Father involvement has significant benefits for everyone involved. But too often, social expectations about masculinity and structural barriers make it difficult for fathers to get involved, especially during the early years of life.
Addressing Black Maternal Mortality Rates Starts with Listening to Black Women
In New York State (NYS), Black women are more than three times as likely to die from pregnancy or giving birth as white women. This disparity has persisted alongside the U.S.’s rising maternal mortality rate, which has doubled in the past 15 years. Recognizing the urgent need for change both within their state and across the nation, NYS launched an initiative to engage women of color in identifying sustainable solutions for improvement.
Four Steps to Address Racism’s Impact on Maternal and Child Health
Racism has been baked into U.S. systems and structures since enslavement, and Black families and other people of color are still suffering its consequences. As health professionals, it’s vital to acknowledge that all forms of racism—institutional, personally mediated and internalized—are real, are present in health systems, and are adversely affecting the health of Black families. One person can’t solve a systemic problem, but there are impactful steps everyone can take to help address it.
Using an Equity Lens to Reduce Maternal Mortality in Louisiana
Louisiana has one of the highest maternal mortality rates in the country. And troublingly, Black women are dying from pregnancy-related deaths at over four times the rate of white women. According to a recent report, more than half of these deaths could have been prevented by making a system change, either at the patient, community, or hospital level. These findings illustrate the enormous potential that quality improvement initiatives have for reducing maternal mortality in Louisiana and eliminating the Black-white disparity in maternal deaths.. Here, the Louisiana Perinatal Quality Collaborative shares seven opportunities for improvement.
Building Agency and Self-Efficacy: A Vital Opportunity to Reduce Sleep-Related Infant Deaths
Understanding how to support agency can help health care professionals transform their conversations with families and tap new and innovative approaches. Below, Milt Kotelchuck, PhD, MPH, provides six practical opportunities, drawing on more than three decades of experience working in maternal and child health quality improvement.