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Moving Beyond a Biomedical View of Co-Sleeping

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Written by Rickey Bower

The debate over parenting methods and beliefs are a hot topic in the media lately. The recent cover of TIME showing a Caucasian woman breast-feeding her 3-year-old son opened up discussion about breast-feeding practices; President Obama set off a firestorm of debate when he expressed his feelings that same-sex marriages do not weaken families and my fellow anthropologist Gia M. Hamilton recently blogged about being a single parent and her choice of "lifestyle design." All of these discourses on parenting caused me to stop and rethink my intended topic of discussion about co-sleeping practices in American culture. I ultimately reached the decision to continue with this topic, because I believe that few choices that a parent makes can have as profound of an effect on a child or family, and we as a culture desperately need to expand our knowledge of and discussions about this practice.

The concept of co-sleeping is not a new idea for humanity. The reality is that providing a separate sleep space for an infant is a new (and primarily Western) development in human history. Even today, co-sleeping is practiced globally on a larger scale than separate sleep spaces. The pressure not to co-sleep placed upon American parents is in many ways surprising, considering the diverse cultural heritage in America. Even the recent resurgence of co-sleeping advocacy in America seems to align more with "new age" belief systems than it does with cultural beliefs. Consider this CNN blog discussing the mother at the center of TIME's article on "attachment parenting," in which the author points out that the concern about co-sleeping in the TIME article was related to its effects on adult intimacy. Fortunately Ms. Grumet, the cover mom, provided parents around the world with some relief when she stated that intimacy was not affected.

Now I will admit that I do not believe that co-sleeping is the danger that medical and public health officials claim. I fully support co-sleeping practices, despite the fact my wife and I chose to use separate sleep spaces with our two children. In the past, colleagues of mine have questioned why I support co-sleeping, as the "evidence" overwhelmingly demonstrates it to be dangerous. One would think that I would be against co-sleeping because I have witnessed, as an EMS provider, the turmoil a family experiences following an infant's death where co-sleeping was a factor. In actuality, these experiences have only strengthened my support for co-sleeping practices.

The argument that in America, co-sleeping was practiced in the majority of sleep-related infant deaths is deceiving. Consider the data from Milwaukee, Wisconsin where infant mortality truly is a public health epidemic. Around 97% of all sleep-related infant deaths had multiple risk factors other than co-sleeping, and on average there were four risk factors present. Evaluating total infant mortality in the region shows that around 0.5% of deaths have co-sleeping as the only risk factor. Evidence actually suggests that an infant has a greater chance of being murdered (2.4% of cases) than die from strictly co-sleeping. It would be reasonable to conclude from this data that risk factors other than co-sleeping were the causative agent in infant deaths.

Asking why co-sleeping seems to remain a major point of concern when an infant is nearly five times more likely to be murdered (at least in Milwaukee) points to answers stemming from cultural beliefs. The implication is that co-sleeping deaths can be easily prevented when compared to murder. This argument is the result of biomedicine's impact on American culture and policy. The desire to collectively simplify the cause of death into objective pathologies has been the hallmark of biomedicine, and American culture has come to embrace this belief. Historically, the biomedical approach has struggled for answers when faced with subjective problems, and while changing the biomedical culture would be a strong step towards long term solutions for our infant mortality epidemic, the need to critique the impact that other cultural belief systems have on infant mortality is huge.

There is very little debate that cultural beliefs effect infant mortality, but how and to what level they do so is difficult to assess. Americans have difficulty integrating cultural beliefs with scientific evidence, as the interplay between religion and science has shown us over the years. This schism has increasingly impacted parenting and healthcare choices in American culture, and frequently forces individuals to make parenting decisions based on either relatively stable cultural traditions or changing scientific evidence. Alienation from groups is a very real risk parents face when selecting one body of knowledge over the other. Should they practice cultural traditions, such as co-sleeping, medical and public health officials admonish them as bad or uneducated parents. Deciding to follow parenting guidelines based upon scientific evidence can lead to discord between family generations, especially when childcare is performed by multiple generations. The concept of a compromising middle ground is not possible for many parents because of these competing cultural and biomedical values.

As a culture, Americans need to move beyond narrow and limited interpretations of parenting practices. Our attempts to force a single model of parenting, from cultural beliefs to biomedicine, places unnecessary stress on parents who already have enough to worry about. Instead we should, as a culture, focus on providing parents a comprehensive and diverse body of knowledge from which they can use to make educated choices. In the debate regarding co-sleeping both sides need to acknowledge the conflicting evidence. Biomedicine needs to realize that co-sleeping is safe when performed in a controlled environment without additional risk factors.

Culturally, Americans need to work towards changing cultural values that condone co-sleeping with other risk factors such as alcohol or drug abuse. Ultimately, undertaking the task to empower parents cannot be limited to either side of the co-sleeping argument.

Rickey Bower is a former fire fighter and EMT that has also worked in multiple healthcare arenas during the past 10 years. He obtained his B.A. in Anthropology from Marquette University, and is currently pursuing graduate education. His professional interests include the effects social inequality and cultural practices have on healthcare in America. Presently he operates his own healthcare consulting service that helps primary care clinics create culturally relevant outreach initiatives.