THE NEW ZEALAND MEDICAL JOURNAL

THE NEW ZEALAND MEDICAL JOURNAL Journal of the New Zealand Medical Association

SUDI prevention: a review of Māori safe sleep innovations for infants Sally Abel, David Tipene-Leach Abstract: Recent research and policy around sudden unexpected death in infancy (SUDI) have emphasised the place of safe sleeping practices within SUDI prevention strategies. Māori SUDI prevention workers have focussed on innovations around the safe sleep environment for some time now, as they have grappled with difficult to change and disproportionately high Māori SUDI rates. The wahakura (a flax bassinet modelled on a traditional Māori infant sleeping item) was developed in 2006 aiming to mitigate some of the risks of bedsharing with vulnerable infants, in particular infants exposed to maternal smoking in pregnancy. Early wahakura projects in Gisborne and Hawke’s Bay showed high acceptability, effectiveness as an infant health promotion vehicle but difficulty maintaining a low/no cost supply for vulnerable families. The Hawke’s Bay project revealed two pathways forward: the need for robust research to ensure the safety of the wahakura and the exploration of financially viable and more readily available alternatives. Work on both pathways is currently in progress around the country, signalling New Zealand’s ongoing contribution to SUDI prevention and its potential contribution to knowledge and practices applicable to indigenous and other marginalised communities worldwide. Recommendations by New Zealand coroners1 and recent publications in the New Zealand Medical Journal2,3 have highlighted the urgency of ensuring that strategies to prevent sudden unexpected death in infancy (SUDI) are well understood and effectively implemented by parents and caregivers of young babies. In addition, in June 2012, the Health Quality & Safety Commission (HQSC) wrote to all District Health Boards urging them to prioritise SUDI prevention strategies and making a number of recommendations in this regard.4 The issue of infant bedsharing has come in for particular attention, with recommendations to ensure consistent safe sleep messages are given and to provide safe sleep options where necessary to families with vulnerable babies. This focus on the infant safe sleep environment has been central to Māori SUDI prevention workers for the last seven years as they have grappled with difficult to change and disproportionately high Māori SUDI rates. In this viewpoint article we review the development of Māori initiated innovations for safer infant sleep environments, and suggest that these and other local safe sleep initiatives and research have the potential to keep New Zealand at the forefront of international SUDI prevention research and advice. Sudden infant death syndrome (SIDS) has been defined as “the sudden unexpected death of an infant