Are safe sleep messages supportive of breastfeeding? An examination of campaign materials from major U.S. metropolitan areas

Background: NICHD’s Back To Sleep campaign was successful in significantly reducing sleep-related infant mortality by discouraging prone infant sleep. In line with new AAP recommendations, the Safe to Sleep campaign targeted additional risk factors like bedsharing, unsafe sleep environments and exposure to cigarette smoke. Both breastfeeding and room sharing are recommended as protective. However, breastfeeding proponents argue that many locally adapted campaigns use an “abstinence only” approach to mother-infant bedsharing that acts to discourage breastfeeding. This is a particularly critical issue for African American communities that are characterized by both high SIDS/SUID rates and low breastfeeding rates.

 Methods: We examined safe sleep campaign materials from 18 U.S. cities that met our inclusion criteria for size and large African American population, evaluating a variety of characteristics including the extent of emphasis on the full range of AAP recommendations including the importance of breastfeeding.  We noted evidence of any evaluations of reach or effectiveness.

Results:  Of 27 documents examined, most focused primarily on an “ABC” message (Alone, Back, Crib).  Only a third (9 of 27) mentioned breastfeeding as protective.  Over half (15 of 27) encouraged room sharing, but in most cases these messages were not prominent.  We found no evidence that any of the campaigns were systematically evaluated.

Conclusions: Results of our scan support the assertion that safe sleep campaigns tend to focus on simple “ABC” messages at the expense of more complex messages that address the full range of Safe to Sleep recommendations, including the importance of room sharing and breastfeeding.