Despite the 50 percent decline in the incidence of sudden infant death syndrome (SIDS) in the United States since the American Academy of Pediatrics first recommended that infants sleep on their backs in 1992, black infants remain twice as likely to die from SIDS as white infants. They are also about twice as likely to sleep on their stomachs (prone position) as other racial or ethnic groups. Two studies by researchers at Children's National Medical Center used focus groups or individual interviews with 83 mothers in the Washington, D.C., area to examine the factors affecting black mothers' choices about sleep position and location for their infants.
In the first article, the researchers investigate the factors contributing to the high incidence of the prone infant sleeping position in low- and higher-income African American families. The mothers in the focus groups were universally aware of the "Back to Sleep" recommendation. However, there was a common perception that the prone position was safer than the supine, especially because of the concern about aspiration when babies slept on their backs. Mothers who were not concerned about aspiration generally tended to initially place their infants on their backs, but many would later place them on their stomachs because they perceived that the infant did not sleep well or comfortably on their backs. Most mothers in the study did not understand why it is recommended that babies sleep on their backs and did not consider the link between sleep position and SIDS plausible.
In the second article, the researchers were concerned with the factors affecting sleep location, i.e., room sharing or bed sharing. Many mothers cited lack of adequate space for both room sharing and bed sharing. Unavailability of a crib was a factor contributing to bed sharing. Bed sharing was more common among families of low socioeconomic status. Breastfeeding did not seem to affect the decision to bed share.
Both room sharing and bed sharing were often chosen to make feeding and checking on the infant more convenient. Mothers who chose to bed share often cited the ability to maintain vigilance while asleep. Low-income mothers also used bed sharing as a defense against environmental dangers. Vermin and stray gunfire are not uncommon occurrences in low-income housing areas. The researchers conclude that efforts to encourage room sharing without bed sharing must address parental concerns about space for/availability of a crib, convenience, infant and parent comfort, and infant safety. Both studies were supported in part by the Agency for Healthcare Research and Quality (HS16892).
See "Factors influencing African American mothers' decisions about sleep position: A qualitative study," by Rosalind P. Oden, Brandi L. Joyner, B.S., Taiwo I. Ajao, M.P.H., and Rachel Y. Moon, M.D., in the October 2010 Journal of the National Medical Association 102(10), pp. 870-880. Also, "Where should my baby sleep: A qualitative study of African American infant sleep location decisions," by Brandi L. Joyner, B.S., Rosalind P. Oden, Taiwo I. Ajao, M.P.H., and Rachel Y. Moon, M.D. in the same issue, pp. 881-889.