Category: Applied Anthropology

Cosleeping and Biological Imperatives: Why Human Babies Do Not and Should Not Sleep Alone

mother-and-childBy James J. McKenna Ph.D.
Edmund P. Joyce C.S.C. Chair in Anthropology
Director, Mother-Baby Behavioral Sleep Laboratory
University of Notre Dame
Author of Sleeping with Your Baby: A Parent’s Guide to Cosleeping

Where a baby sleeps is not as simple as current medical discourse and recommendations against cosleeping in some western societies want it to be. And there is good reason why. I write here to explain why the pediatric recommendations on forms of cosleeping such as bedsharing will and should remain mixed. I will also address why the majority of new parents practice intermittent bedsharing despite governmental and medical warnings against it.

Definitions are important here. The term cosleeping refers to any situation in which a committed adult caregiver, usually the mother, sleeps within close enough proximity to her infant so that each, the mother and infant, can respond to each other’s sensory signals and cues. Room sharing is a form of cosleeping, always considered safe and always considered protective. But it is not the room itself that it is protective. It is what goes on between the mother (or father) and the infant that is. Medical authorities seem to forget this fact. This form of cosleeping is not controversial and is recommended by all.

Unfortunately, the terms cosleeping, bedsharing and a well-known dangerous form of cosleeping, couch or sofa cosleeping, are mostly used interchangeably by medical authorities, even though these terms need to be kept separate. It is absolutely wrong to say, for example, that “cosleeping is dangerous” when roomsharing is a form of cosleeping and this form of cosleeping (as at least three epidemiological studies show) reduce an infant’s chances of dying by one half.

Bedsharing is another form of cosleeping which can be made either safe or unsafe, but it is not intrinsically one nor the other. Couch or sofa cosleeping is, however, intrinsically dangerous as babies can and do all too easily get pushed against the back of the couch by the adult, or flipped face down in the pillows, to suffocate.

Often news stories talk about “another baby dying while cosleeping” but they fail to distinguish between what type of cosleeping was involved and, worse, what specific dangerous factor might have actually been responsible for the baby dying. A specific example is whether the infant was sleeping prone next to their parent, which is an independent risk factor for death regardless of where the infant was sleeping. Such reports inappropriately suggest that all types of cosleeping are the same, dangerous, and all the practices around cosleeping carry the same high risks, and that no cosleeping environment can be made safe.

Nothing can be further from the truth. This is akin to suggesting that because some parents drive drunk with their infants in their cars, unstrapped into car seats, and because some of these babies die in car accidents that nobody can drive with babies in their cars because obviously car transportation for infants is fatal. You see the point.

One of the most important reasons why bedsharing occurs, and the reason why simple declarations against it will not eradicate it, is because sleeping next to one’s baby is biologically appropriate, unlike placing infants prone to sleep or putting an infant in a room to sleep by itself. This is particularly so when bedsharing is associated with breast feeding.

When done safely, mother-infant cosleeping saves infants lives and contributes to infant and maternal health and well being. Merely having an infant sleeping in a room with a committed adult caregiver (cosleeping) reduces the chances of an infant dying from SIDS or from an accident by one half!

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Social Programs That Work

That’s the name of this website – Social Programs That Work – run by the Coalition for Evidence-Based Policy. As they say, “U.S. social programs are often implemented with little regard to rigorous evidence, costing billions of dollars yet failing to address critical needs of our society — in areas such as education, crime and substance abuse, and poverty reduction. A key piece of the solution, we believe, is to provide policymakers and practitioners with clear, actionable information on what works, as demonstrated in scientifically-valid studies, that they can use to improve the lives of the people they serve.”

Thus, the site reports on “well-designed randomized controlled trials” across a range of important social issues. They also set out the criteria that they used for considering whether a study is worthy of inclusion on their site (they say only 40-50 studies meet these criteria). Partcularly important is their focus on outcomes:

-Reporting of the intervention’s effects on all outcomes that the study measured, not just those for which there are positive effects.
-For each claim of a positive effect, a reporting of (i) the size of the effect, and whether it is of policy or practical importance; and (ii) tests showing that the effect is statistically significant (i.e., unlikely to be due to chance). These tests should take into account key features of the study design, such as whether individuals or groups were randomized.
-If possible, corroboration of reported effects in more than one implementation site and/or population.

The site provides detail on each study by its theme. So in education, one example is SMART – Start Making a Reader Today; for crime there is Multisystemic Therapy for Juvenile Offenders; in substance abuse DARE – Drug Abuse Resistance Education is shown to be ineffective despite the program’s popularity. On the employment/welfare side there is Riverside’s Greater Avenues for Independence (GAIN), showing a “sizable increase in employment rates and job earnings, reduction in welfare dependency, and savings to the government, especially for single parents.”

I definitely support this sort of research, given the insight it provides into what works and what doesn’t. So it’s great to find a site gathering this information together. However, as an anthropologist, I might also add some caveats. First, there is an almost exclusive US focus, and what works here doesn’t necessarily work elsewhere. Second, the focus is on techniques and outcomes, and not on context, relationships, resources and other things that can also make an enormous social difference. Third, this sort of research is about the workings of specific programs, and not radical change – these programs don’t address the root causes of social inequality or the ideologies that support some in favor of others.

Finally, outcome studies are no substitute for creative thinking, program development, and innovative work. These are still very much needed, so for some ideas there, see some previous posts on Cellphones Save the World; CeaseFire: Violence Prevention and Why Gary Slutkin Is An Anthropologist and Successful Weight Loss.

Habits to Help

Val Curtis
Val Curtis

Warning: Habits May Be Good For You highlights the anthropologist Val Curtis’ work to synthesize anthropology, public health, and consumer behavior. She has a simple problem, how to teach children in sub-Saharan Africa to habitually wash their hands, thus lowering significantly the risk of many diseases. As Charles Duhigg writes, Curtis turned to consumer-goods companies for insight into her work.

She knew that over the past decade, many companies had perfected the art of creating automatic behaviors — habits — among consumers. These habits have helped companies earn billions of dollars when customers eat snacks, apply lotions and wipe counters almost without thinking, often in response to a carefully designed set of daily cues.

“There are fundamental public health problems, like hand washing with soap, that remain killers only because we can’t figure out how to change people’s habits,” Dr. Curtis said. “We wanted to learn from private industry how to create new behaviors that happen automatically.”

The companies that Dr. Curtis turned to — Procter & Gamble, Colgate-Palmolive and Unilever — had invested hundreds of millions of dollars finding the subtle cues in consumers’ lives that corporations could use to introduce new routines.

If you look hard enough, you’ll find that many of the products we use every day — chewing gums, skin moisturizers, disinfecting wipes, air fresheners, water purifiers, health snacks, antiperspirants, colognes, teeth whiteners, fabric softeners, vitamins — are results of manufactured habits. A century ago, few people regularly brushed their teeth multiple times a day. Today, because of canny advertising and public health campaigns, many Americans habitually give their pearly whites a cavity-preventing scrub twice a day, often with Colgate, Crest or one of the other brands advertising that no morning is complete without a minty-fresh mouth…

“Our products succeed when they become part of daily or weekly patterns,” said Carol Berning, a consumer psychologist who recently retired from Procter & Gamble, the company that sold $76 billion of Tide, Crest and other products last year. “Creating positive habits is a huge part of improving our consumers’ lives, and it’s essential to making new products commercially viable.”

Habits

Habitual behavior is one topic that concerns brain science, psychology, economics and anthropology, each with disciplinary specific ways of trying to explain these everyday patterns. However, most of those explanations have two flaws: some variety of rationality as the way to understand habits, and some causal force (e.g., genetics, reward, subjective utility, culture) as forming the pattern. But things are not quite so simple, as “Habits May Be Good For You” shows:

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Anthropology and Social Design Round Up

John Sherry is an anthropologist who is also chair of the Department of Marketing at Notre Dame’s Mendoza School of Business. I had coffee the other day with John, and was struck by how similar some of our approaches are. What unites us is an interest in behavior, for me behavioral health and for John consumer behavior, and a belief that anthropology can help unite interdisciplinary understandings of behavior and experience.

John has several online papers that focus on experience, embodiment and context. First up is Speaking of Art as Embodied Imagination: A Multi-Sensory Approach to Understanding Sensory Experience (it’s a large pdf, give it a moment).

Another good one is Fruit Flies Like A Banana (Or, When Ripeness Is All): Meditation on Markets and Timescapes. And here’s a short piece on Sporting Sensation. For more, check out his online cv with pdf links.

I’ve also come across a new blog uiGarden, which is about “Weaving Usability and Cultures”. (I covered similar blogs on “anthropology, design, business” back in April). Several posts there at uiGarden caught my attention:

A View of the Future: Trends Research, Ethnography and Design
Why Do People Become Attached to Their Products
Story Telling
Design for Emotion: Ready for the Next Decade?

And now for a more traditional round-up:

Irene Guijt, An “Aha” Moment in the Development Sector
Stories and practical examples, not grand narratives, as making the difference

Jason Palmer, Interview: The Cellphone Anthropology
Interview with Jan Chipchase, bringing anthropology to cellphones everywhere (for more on Chipchase, see our own Cellphones Save the World.)

Dori Tunstall, Design Anthropology: What Can It Add to Your Design Practice?
“Anthropology is engaged with issues of the global flows of people and goods, human rights and social justice, global feminism, technology adoption, the social effects of the environmental degradation, and local sustainability practices—all issues that have become important to designers.”

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Maurice Bloch and Everyday, Relevant Anthropology

Maximilian Forte over at Open Anthropology recently covered an interview with Maurice Bloch that appeared in Eurozine. In his summary, Forte highlights certain parts of the interview in a way which struck me as quite relevant to neuroanthropology. Interestingly, Forte had a similarly positive reaction to Bloch’s statements, even though his Open Anthropology project is focused on a different sort of public engagement and synthetic approach than what we do here.

Here’s why, captured in one of the more striking lines from Bloch: “I would consider that all human beings are anthropologists: all are concerned with the general theoretical questions about the nature of human beings, about explanations of diversity and similarity. Of course I’m not worried about the continuation of this form of anthropology.”

What about anthropology in its present, institutional form? There, things are not so clear. Bloch makes this provocative statement, “anthropologists have not been addressing those questions that are burning questions for human beings. Other people have done it and have not made use of what anthropologists have learned… I think we should engage with the general questions that people are ask, rather than spending our time navel gazing.”

On the applied side, particularly with regards to development and anthropology, Bloch tells us that the anthropologists’ “role is one of caution. Because we have learned that easy answers don’t work. So we anthropologists will always have a negative role [in public debates] and I think that’s right.” In contrast, however, the development and conservation experts who come in with big money, big ideologies and big power do not necessarily want to hear the “it’s complicated” anthropology message.

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Call for Change in HIV Prevention in Africa

Daniel Halperin, a medical anthropologist at Harvard, is leading the call for a change in HIV prevention. As a recent BBC article reports, “Substantial investment in condom promotion, HIV testing and vaccine research has had limited success in Africa, [Halperin and others] argue in Science. Instead male circumcision and reducing multiple sexual partners should become the ‘cornerstone’ of prevention.”

Their overall argument actually takes aim at one of the biggest sacred cows in current anthropology—the role of inequality. In Reassessing HIV Prevention, Potts, Halperin et al. write, “Such devastating epidemics [of HIV/AIDS] have frequently been attributed to poverty, limited health services, illiteracy, war, and gender inequity. Although these grave problems demand an effective response in their own right, they do not appear to be the immediate causes of generalized epidemics.”

The immediate causes, and thus the immediate foci for prevention, are more concrete:

Where multiple sexual partnerships, especially concurrent ones, are uncommon, and particularly where male circumcision (MC) is common, HIV infection has remained concentrated in high-risk populations (7). Niger, a Muslim country where sexual behavior is relatively constrained and MC is universal, has an adult HIV prevalence of 0.7% (1), despite being the lowest ranking country in the Human Development Index. Botswana, the second wealthiest country in Sub-Saharan Africa, has high levels of multiple concurrent partnerships among both sexes and lack of MC (8), with an HIV prevalence of 25%.

I would also add mother-to-child prevention, given work I help guide in Lesotho. That research, in affiliation with the Touching Tiny Lives project which helps children, shows the importance of access to preventive drugs during pregnancy and breastfeeding, while also addressing the stigmas and sociocultural limitations that often keep women from having access to these drugs.

And for those larger causes? Halperin wrote a powerful editorial back in January, Putting A Plague in Perspective. There he wrote:

Many other public health needs in developing countries are being ignored. The fact is, spending $50 billion or more on foreign health assistance does make sense, but only if it is not limited to H.I.V.-AIDS programs… Many millions of African children and adults die of malnutrition, pneumonia, motor vehicle accidents and other largely preventable, if not headline-grabbing, conditions. One-fifth of all global deaths from diarrhea occur in just three African countries — Congo, Ethiopia and Nigeria — that have relatively low H.I.V. prevalence. Yet this condition, which is not particularly difficult to cure or prevent, gets scant attention from the donors that invest nearly $1 billion annually on AIDS programs in those countries.