The WHO CC UTS acknowledges use of key language from The WHO Global Strategic Directions for Nursing and Midwifery (2021–2025).
Sudden Unexpected Death in Infancy (SUDI) is a term used to describe the sudden and unexpected death of a baby (previously known as ‘cot death’). Most SUDI deaths occur as a result of either SIDS or a fatal sleep accident. Sudden infant death syndrome (SIDS), is the sudden, unexpected and unexplained death of an apparently well baby. In Australia in 2016, 94 babies died suddenly and unexpectedly; of these, 54 were identified as SIDS.(1)
Whilst working in the UK in the early 1990s as a newly graduated midwife, Janine Young witnessed first-hand the profound impact that a simple public health intervention had in reducing infant mortality caused by SIDs. The ‘Back to Sleep’ campaign, where babies slept on their backs resulted in a significant and sustained reduction in infant mortality. The program has been adopted across the world.
Every country that instigated the campaign, which simply involved changing the advice for newborns to be placed on their back to sleep rather than their front, saw a 50-85% reduction in infant death,
says Jeanine.
When she returned to her home state of Queensland, Jeanine discovered that, despite the introduction of the ‘Back to Sleep’ campaign, the rate of SUDI, was three to four times higher for Aboriginal and Torres Strait Islander babies than for the rest of the population[2]. Co-sleeping remains a cultural norm in many Indigenous communities, particularly for breastfeeding infants. While co-sleeping is, in itself, not necessarily a risky behaviour, when it is combined with other hazardous factors, such as drug, alcohol and tobacco use, there is an increased risk of SUDI. Aboriginal and Torres Strait Islander communities identified SUDI as a priority area for investigation in their own communities [3]. So, Jeanine looked to leadership across the Tasman and approached a Maori organisation that had achieved some traction with a culturally appropriate ‘safe sleeping’ initiative, the Pēpi-Pod Programme, which valued bed-sharing and co-sleeping. Working together with local Aboriginal and Torres Strait Islander communities, they adopted the novel New Zealand sleep initiative which had been successful in Maori communities.
In Maori, ‘pēpi’ means ‘baby’ and pod is ‘protector of new life’. The aim of Jeanine’s study was to determine the feasibility and acceptability of the Pēpi-Pod® Programme, a portable infant sleep space embedded within ‘safe sleep’ health promotion, amongst Aboriginal and Torres Strait Islander communities in Queensland, Australia. Since the initial study in 2012, the programme has been rolled out across remote, regional, and urban sites across the country. However, its impact has yet to be fully evaluated.
Janine partnered with the New Zealand organisation to trial the programme in Queensland in 2012. The program started with five communities and, through word-of-mouth, spread to about 20. The elders in the communities said the Pēpi-Pod cot itself was similar to the traditional woven baskets that had been used in their own communities, so they were happy to trial it. The program worked through partnering with local health services including Aboriginal Medical Services, as well as mainstream government services that had Aboriginal infant and child health. Most of the services were supported by a nursing and midwifery teams but the project was flexible in supporting indigenous health workers as they were the key contacts for families, in order to build local health workforce capacity in remote communities that are led by midwives and nurses [4].
Listening to parents has been key to Janine’s approach and the Aboriginal and Torres Strait Islander families she met told her, ‘We don’t want to be told not to bed-share, but we want to be shown how we can do so safely’.
We’ve been doing Safe Sleep health promotion since 1991, but what we lack is better resources that are co-designed with Aboriginal and Torres Strait Islanders at a local level because there are language and cultural differences between communities.
The Pēpi-Pod was the first safe sleep program – that enabled co-sleeping in a safe environment.
It’s not rocket science. While we can’t always impact the broader social determinants of health that are impacting on infant mortality rates – such as alcohol, drug and tobacco addiction, the impact of poverty and inadequate housing, but we can protect a newborn who has risk factors at birth in a culturally appropriate way.
[1] Health Direct, Sudden Infant Death Syndrome, Australia. Available https://www.healthdirect.gov.au/sudden-infant-death-syndrome-sids Accessed 28th July 2020
[2] Queensland Health, 2017, ‘Pēpi-Pods program promotes safe sleep for newborns’, Queensland Health Wesbsite: https://www.health.qld.gov.au/news-events/news/safe-sleep-for-newborns, accessed 14 July 2020.
[3] Young, Jeanine; Watson, Karen; Craigie, Leanne; Cowan, Stephanie; Kearney, Lauren, 2017,
[4] ‘UNITING CULTURALPRACTICES ANDSAFESLEEP ENVIRONMENTS FORVULNERABLEINDIGENOUS
[5] AUSTRALIAN INFANTS’, Australian Nursing and Midwifery Journal: ANJ;
[6] Melbourne Vol. 24, Iss. 9, (Apr 2017): 37.
[7] apunipima.org.au, Apunipima Pepi-pod Program Shortlisted for Nursing Award. 2019.