7 minute read
SUDI: MINISTRY REVIEW
AMELLIA KAPA COMMUNICATIONS ADVISOR
SUDI: MINISTRY REVIEW AFFIRMS POVERTY A MAJOR FACTOR
In 2020, the Ministry commissioned research to better understand the reasons behind the unacceptably high numbers of babies continuing to die from Sudden Unexpected Death in Infancy (SUDI) in Aotearoa. In May 2022, three reports detailing the findings were published.
The review was intended to identify how the Ministry-led National SUDI Prevention Programme (NSPP) - established in 2017 - could be improved. The NSPP evolved from the Sudden Infant Death Syndrome (SIDS) Prevention Programme of the 1990s, which saw an initial rapid decline of SUDI rates. Since then, rates have plateaued and there has been no substantial improvement since 2012.
More recently, since 2018, SUDI rates for whānau Māori have been rising and the review is a stark reminder of how inequitably the issue affects Aotearoa’s different populations. Despite the national programme and delivery of safe sleep devices such as wahakura and Pepi-Pod to whānau considered to be most at risk, pēpi Māori are currently nine times more likely, and Pasifika babies six times more likely to die of SUDI than non-Māori non-Pacific infants.
The first part of the Ministry’s review involved data analysis of the Coronial SUDI Liaison Reports of 64 infants who likely died of SUDI between September 2018 and June 2020. Professor Barry Taylor and midwife Anna Foaese found that previous correlations identified between SUDI and maternal smoking, bedsharing and infant sleep position were reiterated by the analysis, however some new insights added further context, highlighting the complex whānau circumstances foregrounding SUDI.
The findings of Taylor and Foaese’s (2022) analysis show: • Extreme parental tiredness was the most significant theme to emerge from the data, with maternal or paternal exhaustion directly impacting the infant’s sleep place and position. • A history of clinical unwellness and/or recent hospital admission was the second most common theme.
Parental decisions to change their infant’s usual sleep place or co-sleep were due to concerns about baby’s wellbeing, unsettledness or irritability, and whānau reported wanting to “keep an eye on their breathing”.
Pillows were another contributing factor, for the same reasons.
• Poverty and housing unaffordability are major contributing factors. Less than 20% of whānau from the dataset were living without considerable financial insecurity, meaning whānau of most SUDI cases were renting, boarding, living in shared accommodation, or squeezed into a single shared room, reducing capacity to create a separate/safe sleeping space for a baby. • Drug and/or alcohol addiction, as well as family violence contributed to household and whānau dysfunction, ultimately affecting sleep space and position.
The quantitative data showed safe sleep messages were received and understood by whānau/carers, with 75% having good or very good knowledge of key risk factors. Similarly,
the risks of smoking during pregnancy were understood by mothers, but smoking cessation opportunities were not taken up, the reasons for which were not elicited by the research.
As a result of the analysis, the Expert Advisory Group (EAG) on SUDI Prevention was established and in their report, Sudden Unexpected Death in Infancy Prevention in New Zealand: The Case for Hauora – a wellbeing approach, the group extends on Taylor & Foaese’s findings and makes recommendations.
The EAG reiterate that in general, parents of SUDI infants are aware of risk factors, but for one reason or another, act in a fashion contrary to best advice. They go on to point out that this is merely another symptom of living in desperate circumstances; that all findings point toward the significance of poverty, along with other social determinants of health, and the broader associated stresses impacting on the wellbeing of the whānau unit. These constant stresses impact parents’ abilities to make healthy decisions either for themselves, or their children, and it is suggested that a significant improvement in financial security is likely to affect all of the above positively.
The EAG also posits that the services/service providers are either failing to engage appropriately with whānau Māori, or simply do not suit the whānau in a socio-cultural sense. The distinct possibility that whānau are overly ill-equipped to recognise how they can take advantage of what is being offered by such services is also discussed.
The EAG emphasises the need to ensure the future development of any SUDI prevention initiatives consider the broader systemic, community and whānau contexts within which SUDI occurs. They strongly advocate for the development of systems run by Māori and Pacific women, which engage whānau and communities through a Hauora-wellbeing approach and move away from the previous didactic format.
Finally, a kaupapa Māori evaluation of the NSPP was also commissioned as part of the Ministry’s review, and Kia Puawai, the final report, outlines key recommendations to transform the NSPP into a programme that can more effectively redress health inequity and improve outcomes for whānau Māori, ‘āiga Pasifika and other priority populations.
A complete refresh of the NSPP programme, co-designed with Māori, Pasifika and health leadership is recommended, with emphasis placed on the overhaul being grounded in te Tiriti o Waitangi, kaupapa Māori, and Pasifika-based principles. Demonstration of meaningful partnership in the form of prioritising Māori and Pasifika leadership is recommended, alongside ensuring the SUDI-prevention workforce is culturally safe and therefore able to engage appropriately with priority groups.
WHAT DOES THIS MEAN FOR MIDWIVES IN PRACTICE? The findings of the Ministry’s review are simply another reminder of what midwives already know; that the social
determinants of health remain the most accurate predictors of outcomes for whānau, and events such as SUDI rarely occur in a vacuum.
This is not to say the findings are not worthy of ongoing reflection. The data show the breakdown for affected whānau has happened well before engagement with midwifery care; that the underlying issues are undoubtedly symptoms of colonisation and are clearly not resolved using a tickbox approach. Dropping off a wahakura, demonstrating how to position a baby face up and clear and hoping for the best is simply not working; not because midwives are underperforming, but because long after the midwife has left, the systemic inequities and complexities remain.
The dire circumstances many whānau are facing in the lead up to SUDI are multi-layered and stem from intergenerational mamae (pain/wounds). Midwives alone certainly cannot solve these issues, but engaging with whānau meaningfully, in ways that are culturally safe, may be more likely to lead to honest conversations about where and how babies are sleeping. Within safe partnerships, whānau may be more likely to open up about what stressors might be impacting their ability to make different choices, allowing midwives to see the fuller picture and offer safe solutions within that whānau’s capabilities.
As well as ongoing advocacy work to address the deep-seated societal inequities impacting SUDI outcomes at political and systemic levels, the College’s role is also to support individual midwives through education provision, practice guidance and other professional development processes. An obvious example of this is our safe sleep consensus statement, which is currently being updated. Ensuring te Tiriti underpins our updated strategic plan and following the recommendations of the cultural review currently in progress will further strengthen the College’s ability to respond to the inequitable SUDI burden experienced by particular groups. square
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