The risk of Sudden Infant Death Syndrome (SIDS) is one aspect of new parenthood that absolutely no one wants to think about, especially since there are still so few conclusive answers about why it occurs or how to prevent it. The fear surrounding the unexplained death of babies under the age of 1 year is the reason why parents are told, for example, to place their infants to sleep on their backs, or to not allow blankets or bumpers or stuffed toys in the crib, and there's good reason for it: according to the Centers for Disease Control, there were as many as 1,600 SIDS deaths in the United States in 2015. Which countries have the highest SIDS rates? Unfortunately, infant mortality is still a big problem throughout the world, but when it comes to SIDS specifically, there is still so much that isn't clear.
Part of the difficulty in analyzing SIDS rates around the world is that there isn't necessarily a standard way in which countries assess unexplained infant death. According to the the Georgetown University National Center for Education in Maternal and Child Health, countries differ, for example, in regards to how they determine an age range for SIDS deaths (some begin at birth, others at 1 week old), and available data regarding general infant mortality doesn't always specify the rate of SIDS death. What's more is that, according to a 2009 study in published in the New England Journal of Medicine, over the years, diagnoses other than SIDS (like accidental suffocation, or simply unknown causes) have become more common on death certificates, which may have affected the statistics that are available.
What is known for sure? According to the World Health Organization, babies born in Africa have the highest rate of dying before they turn 1 — the infant mortality rate is about 55 deaths per 1,000 live births on average. But when individual mortality rates are compared by country, it turns out that Afghanistan tops the list, with 112.8 infant deaths per 1,000 live births, according to the CIA World Factbook. Next on the list is Mali at 100 infant deaths, followed by Somalia (96.6), Central African Republic (88.4) and Guinea-Bissau with (87.5). The United States, on the other hand? 5.8 deaths per 1,000 live births.
But infant mortality statistics don't necessarily say much about the incidence of SIDS, especially in developing countries. That's because in countries where infant mortality is high, the causes are usually very specific (not to mention preventable). According to The Borgen Project, a Seattle-based non-profit focused on fighting global poverty, the most common causes of child mortality — especially in Sub-Saharan Africa and South Asia — are pneumonia, dehydration from diarrhea, and malaria.
Presumably since those causes are such a pressing issue, specific research into SIDS in those countries hasn't exactly been a priority. But in a 2016 study, Ikenna Kingsley Ndu from Enugu State University Teaching Hospital in Nigeria found that, while babies in developing countries are also at risk for SIDS, there are a number of major obstacles preventing researchers from even finding out how big of a problem it really is. Ndu noted, for example, that autopsies and death scene investigations are not routinely done in Nigeria, especially in cases of infant death, and that cultural beliefs in traditional communities in many developing countries mean that cases of SIDS could be explained away in other ways (like witchcraft, for example).
SIDS rates, on the other hand, are better researched in developed countries, and it's likely that the findings are at least somewhat applicable to all nations. According to Georgetown University National Center for Education in Maternal and Child Health, there are a number of countries reporting relatively low rates of SIDS — the Netherlands and Japan have the lowest reported rates of SIDS, with Sweden, England and Wales, and Norway following close behind. These countries also tend to be ones with very low rates of overall infant mortality (Japan, Sweden and Norway particularly, according to OECD Health Status data). So, what might be behind the encouraging numbers? According to the CDC, research has found that, while there is still no way to definitively prevent SIDS, certain factors can mitigate the risk, especially when it comes to safe sleep practices.
One of the most important preventable factors in reducing the incidence of SIDS is placing babies on their backs to sleep — in fact, that shift alone is thought to have led to a significant decrease in global SIDS deaths since the 1990s, according to the American Academy of Pediatrics. Other important sleeping safety measures include ensuring that babies sleep on firm mattresses, that there are no soft objects or loose bedding in the sleep area, and that they do not share a bed with anyone else, due to the risk of accidental suffocation, according to the CDC. Just as important? Not smoking during pregnancy, or around a baby, since second-hand smoke has been determined to be "a strong risk factor for SIDS."
Unexplained infant death is an incredibly upsetting topic, and is something that no parent should ever have to endure. The good news, at least, is that the rates of SIDS seem to have decreased significantly, and now parents know they can take steps to keep their children safe. The bad news? SIDS is still an issue, and one that doesn't have a definitive solution. And for parents in developing countries, the lack of resources and education surrounding SIDS puts them at an even greater disadvantage.