Sudden infant death syndrome (SIDS) is a scary-sounding name for an equally scary phenomenon — it's the name given to the unexpected death of babies less than 1 year old, who usually seem to die in their sleep. The encouraging news though is the rate of SIDS deaths have declined significantly since the 1990s, and there are well-researched ways all parents can reduce the risk. But other associated risk factors are much harder to address. One example? Some studies have shown that babies born into low-income families may be at a higher risk for SIDS. As with many aspects of the SIDS discussion, the reason behind that isn't entirely understood. But one thing that is clear? The connection between SIDS and poverty doesn't even sort of mean that it's acceptable to shame low-income mothers.
According to the Centers for Disease Control, about 1,600 infants died of SIDS in the United States in 2015, comprising 43 percent of total yearly cases of sudden unexpected infant death (SUID), which also includes infant deaths caused by accidental suffocation and strangulation in bed, or those contributed to "unknown causes." That's still a higher number than any parent is surely comfortable with, but according to the American Academy of Family Physicians, new guidelines introduced in the '90s that encouraged safe infant sleeping habits (like putting babies to sleep on their backs, on firm mattresses, without any loose bedding, soft toys or bumpers in the sleep area) helped reduce the incidence of SIDS by 50 percent.
That seems to clearly indicate that the guidelines were a success, but the fact that SIDS cases continue to occur suggests that there's more to the picture. Again, experts still don't know all the answers, but research has suggested that societal factors seem to play a role. A 2007 study in the Southern Medical Journal found "a significant association between poverty and SIDS" in metropolitan counties in the United States, and in a 2004 review in the Journal of Epidemiology and Community Health, socioeconomic status was found to be "independently associated with sudden unexpected infant death in all but one" of the studies that were analyzed, once adjustments were made for birth weight and sleeping position.
Conversely, Brown University economist Professor Emily Oster recently explained to BBC News, that while the United States lags behind other developed nations in terms of infant mortality, American women with a college degree (and thus, who tend to have higher incomes) actually have infant mortality risk rates similar to college-educated women in countries like Finland and Austria, where infant mortality rates are low overall. The difference then, Oster suggested, is that, while women in a country like Finland appear to have similar infant mortality profiles regardless of income level, in the United States, low-income women seem to be at a higher risk than their higher-income counterparts.
That's important to note, not because it suggests that low-income parents aren't doing a good enough job keeping their children safe, but because it suggests that there is a greater need among low-income populations to provide the type of support that can help mitigate the added infant mortality risk they face. And since other countries with low infant mortality rates have clearly shown that it is at least possible to take socioeconomic factors out of the equation, it also means that in the United States, the role that poverty may play in regards to infant death is something that needs to be addressed.
What's also important though is that income or education level doesn't seem to exist independently as a risk factor for infant mortality. Ethnicity, particularly among specific groups, also increases the risk for SIDS in the United States, and furthermore, all of those elements appear to work together. For example, while the Southern Medical Journal study found that poverty was associated with SIDS, it also found that the association only actually existed among non-Hispanic white and non-Hispanic black communities. And according to the CDC, Native and non-Hispanic black infants have more than twice the rate of sudden unexpected infant death as non-Hispanic white infants.
Why does income level and ethnicity seem to make such a difference? It's not entirely clear. But according to the National Institute of Child Health and Development, studies have found that it might come down to awareness and education. Compared to other ethnic groups, for example, African-American parents were found less likely to have been informed by a health care worker to place their babies to sleep on their backs, and according to NPR. And, while about one-quarter of all parents in the United States reported that they don't put their babies on their backs to sleep, the percentage of African-American parents who don't is closer to 50 percent. When you then take into account that, according to a 2015 Pew Research study, black children were more likely to live in poverty in America than any other racial group, it seems that race and income level are absolutely linked when it comes to discussions about infant mortality.
That still doesn't mean though, that any parent who falls into this category of higher risk should be judged, or that they should feel as though they've been unfairly targeted. After all, what the data seems to actually be showing is that greater support of those in these higher risk categories may be the key to bringing down the number of SIDS cases, especially if lack of information is a big reason behind the statistics.
One way to get the message through? According to Pat Tackitt, a pediatric mortality investigator in Wayne County, Michigan, a good place to start is by getting very specific about the most common causes of unexplained infant death in the United States. Though Tackitt told NPR that it's not uncommon for an infant death to be assumed to be SIDS, her own experience has shown her that "in almost all of the cases" she has investigated, babies were in unsafe sleep environments that suggested the cause was really accidental suffocation. Although it's difficult to know for sure, the fact that safe sleep seems to be such an important factor in reducing SIDS, coupled with the fact that many parents report that they don't actually follow the recommended infant sleep guidelines, suggests that outreach to high-risk communities could be valuable.
But there are other initiatives too: according to BBC News, Finland — now a country with low infant mortality — once had a higher rate of infant mortality than its neighboring countries. As a result, the government began targeting low-income mothers for outreach and assistance, in part with the introduction of it's now-well-known "baby box" program (which eventually became available to all Finnish mothers), but also by providing government-funded prenatal care, and later, a universal health insurance program.
In other words, by providing mothers with the care and support they require during their pregnancies and the postpartum period, it seems as though they would inevitably be in a better position to ensure that their infants have the best possible start — regardless of ethnicity or income level. On the other hand, making a mother feel bad or guilty about her ability to care for her child, or by making it even harder for her to access medical care or social support, will almost certainly make things worse.