RESEARCH FLASH: Urgent need for diversity of health promotion strategies around infant sleep position

Smylie J, Fell DB, Chalmers B, Sauve R, Royle C, Allan B, O’Campo P. Socioeconomic Position and Factors Associated With Use of a Nonsupine Infant Sleep Position: Findings From the Canadian Maternity Experiences Survey. American Journal of Public Health. 2013. Epub 2013 Apr 18.

Issue: Putting infants to sleep on their backs can help reduce the risk of Sudden Infant Death Syndrome (SIDS). Over the past 20 years, public health campaigns promoting “back to sleep” have been linked to dramatic reductions in SIDS rates in many countries. In Canada, SIDS rates dropped by 70% between 1985 and 2004. More recently, SIDS rates have stabilized in many countries, while remaining high among some groups facing barriers to achieving socio-economic equality.

What we did: We looked at health survey data from more than 6,000 Canadian women who had recently given birth, and analyzed how socio-economic position influences associations between factors like where mothers live, their life experiences, their health care service use and infant sleep position.

Findings: More than 22% of mothers reported putting their infant in a non-supine position (ie. not on their backs) during the first 4 months. Women with less than high school education were more than twice as likely to put their baby in a non-supine sleep position compared to women who had completed post-secondary education.

We found that different factors influenced women’s practices for putting their baby to sleep depending on their level of formal education. Here, we focus on the impacts of health care services.

  • Late initiation of pre-natal care had a negative impact for women with less than a high school education.
  • The absence of postpartum contact from a health provider had a negative impact for women who completed high school.
  • The absence of pre-natal classes and postpartum contact from a health provider had a negative impact for women who completed some post-secondary education.

Notably, self-reported sufficiency of postpartum information on SIDS was not found to have any impact on infant sleep practices for women from any educational background.

Policy and program implications: There is an urgent need for additional health promotion strategies to make sure mothers and families across socio-economic groups are aware of the importance of putting babies to sleep on their backs. In particular, it should be noted that postpartum health interventions seem to be tailored to women with higher socio-economic positions, and are not equally benefiting all new mothers. It should also be noted that rural residence was associated with non-supine sleep position for both women with some post-secondary education, and women who had not completed high school.

This paper can be found in the Li Ka Shing database

Contact: Janet Smylie (