Abstract
The past decade has offered many excellent books that highlight how scientific motherhood—that is, the ideology that women need “scientific and medical expert advice to raise children healthfully” (Apple 1995:161)—continues to emerge under the guise of “best practices” or “evidence-based guidelines” that serve to undermine mothers, even when the evidence is unclear. Laura Harrison, Professor of Gender and Women’s Studies at Minnesota State University, Mankato, has offered a strong addition to this body of work. Her book Losing Sleep: Risk, Responsibility, and Infant Sleep Safety demonstrates convincingly how efforts to promote “sleep safety” reflect fundamental misunderstandings of risk and health that perpetuate racist and sexist assumptions about low-income families and families of color. Harrison’s book shows how the insistence on framing infant mortality as the result of parental failings to follow medical advice allows medical experts, public health practitioners, corporations, and state actors to ignore how infant death often arises, in fact, from structural inequality. Harrison adopts a reproductive justice lens, which, she argues, “underscores how the physical and mental health of an individual is inseparable from the community or social context and is not solely a matter of individual ‘choice’” (p. 193).
Sudden, unexpected infant death, some of which is diagnosed as sudden infant death syndrome (SIDS) and some of which is classified as having an unknown cause, affects about 3400 to 3600 infants each year. 2 These deaths mostly occur between two and four months of age, with 90 percent occurring before a baby is six months old. Being born male, premature, with a low birth weight, or to a mother who smoked cigarettes or consumed alcohol during pregnancy increases the risk of death. Whether babies sleep on their backs, with soft bedding, or in the same bed as an adult are also believed to be risk factors for infant death. Risk, as Harrison reminds us, is not causality. Yet, identifying calculable risk so that individuals can be persuaded to modify their behavior, rather than addressing public failures to ensure healthy communities, has become the focus of much of public health and medicine. Therefore, it is unsurprising that a coalition of pediatricians, public health organizations, and SIDS-prevention groups banded together in 1994 to launch a campaign to persuade parents to put their babies to sleep on their backs instead of their stomachs (known as the “Back to Sleep” campaign, which evolved into “Safe to Sleep”) and to later condemn co-sleeping, in which babies sleep in beds with adults.
The Back to Sleep campaign is credited with reducing infant mortality, a reduction which eventually plateaued. Even so, there continue to be significant racial disparities in infant mortality. Harrison highlights the many sources of institutional and structural violence that present risk to babies born to minoritized mothers, including environmental pollution, poverty, stress, violence, the weathering effects of racism, bias in health care, lack of health care, or poor family nutrition. Yet, she notes, “Parents, and especially mothers, are expected to be capable of providing a safe sleep environment for their children regardless of access to resources” (p. 18). From this perspective, experiences of structural inequality that cause health disparities are recast as parental failures.
Although there was seemingly little rejection of the Back to Sleep recommendations, the condemnation of co-sleeping was much more controversial. Co-sleeping is a tenet of attachment-based parenting philosophies that valorize parent-child bonding through physical contact, a perspective promoted by some experts who support “the family bed” to promote intimacy and increase breastfeeding. What emerges, as Harrison shows, is an informal acceptance that some mothers (who are generally white and wealthy) who intentionally choose to co-sleep as part of a parenting philosophy are able to do so safely. In contrast, brown and Black mothers are assumed to be co-sleeping reactively, without intention or conviction and with ignorance of the harms they may cause. Since babies from minoritized groups are more likely to die, these assumptions come to be supported by experts’ use of data—with Black babies’ deaths being more likely to be documented as smothering by adults than those of white babies. In short, experts accept that there are good and bad co-sleepers, and these assumptions layer on to existing racialized representations of good and bad mothers.
Harrison’s 200-page book is organized into five chapters surrounded by an informative introduction and conclusion. In many ways, each chapter stands alone, demonstrating some aspect of the problematic assumptions woven into infant sleep politics. The first chapter offers a historical perspective on the science of infant death, which has since its inception assumed that families of color and immigrant parents are to blame.
Chapter Two delves into how the guidelines developed by the American Academy of Pediatrics alienated many proponents of co-sleeping and created a space for corporations to market unproven and untested products that claim to protect against infant death, including a Fisher-Price “safe bed” that caused at least 50 infant deaths before being recalled. In this and subsequent chapters, we see clearly that the state regulates families much more aggressively and that families are more likely to be held responsible for infant death than are corporations.
Chapter Three closely examines a specific Milwaukee outreach campaign that aimed to eliminate all co-sleeping. The campaign notably likened parents to SUVs who roll over babies and included images of babies sleeping with knives and of beds with cemetery headstones for headboards to suggest parents’ presence is inherently dangerous, despite evidence that mothers and babies who co-sleep are aware of each other. Unsurprisingly, this campaign was ineffective and perpetuated mother-blame without addressing the real causes of infant death, which indisputably include prematurity, poverty, and racism. It also offered a clear example of the harms too often found in the marketing and outreach campaigns that public health agencies love to fund, often without community input or support.
In Chapter Four, Harrison examines cases in which caregivers were prosecuted for co-sleeping deaths, many of whom were using drugs or alcohol at the time of their babies’ deaths. The majority of the parents charged for co-sleeping deaths were of low socioeconomic status. This chapter illustrates how constructions of good mothers inform state responses, which match much of what researchers who have examined the growing trend of prosecuting pregnant women for fetal harm have found. Harrison identifies how there is often a lack of clear evidence to show why a baby died—with SIDS and smothering appearing indistinguishable. This scientific uncertainty raises important questions about what state action means. This ambiguity becomes most apparent in cases in which mothers had two babies die. On the one hand, this could seem a clear case of negligence. On the other hand, Harrison points to some research that suggests that having one child die of SIDS may lead to a four-fold risk of siblings suffering the same fate.
Chapter Five returns to the ways social and parental anxiety over infant death supports technologies that surveil infants, even without evidence that these data-collecting tools in any way prevent infant death. In a cultural landscape that encourages everyone to track all biometric rhythms and daily behaviors, it is not surprising that parents are encouraged to pay for surveillance technologies that promise to improve their children’s health, even as the corporations who collect their data offer little in terms of actual outcomes. Despite cultural tropes that “sleeping like a baby” is ideal, Harrison shows how these companies insist that sleep is inherently risky and that their products may help. Yet even they rely on mother blame to sell products. As one such product’s user agreement notes, “Never use our Products to replace good parenting, common sense, or appropriate medical care” (p. 172). This chapter powerfully shows how subtle cultural assumptions are mass marketed in ways that are seldom examined.
Harrison’s book is excellent because it inspires the reader to see how contestations over the meanings of infant sleep and infant death link to broad social phenomena. One does not need to care about babies or sleep to see the richness of this case. Throughout, we see how exploration of infant sleep offers a means to better understanding the policing of poor families, the racism and classism built into medical recommendations, the commercialization of parental fear, the promise of managing risk through consumption, the ways assumptions built into data lead to particular understandings of individual failure, the refusal of the state to address social and environmental determinants of health, and the need for a justice framework. The trade-off to these expansive linkages is that at times readers are introduced to many terms and authors that do not reappear. For those who are familiar with the ongoing discussions in these areas, these connections make sense. For those new to these topics or new to sociology, there may be too many concepts to learn with limited payoff. For example, novice readers may work to understand dense and important concepts like biomedicalization or maternal-fetal conflict, but will see it used in only one place in the text. I suspect fewer concepts that are more clearly threaded throughout the text and through each chapter would likely make this book easier to use in classes. Some chapters are more easily navigated than others, even as they all contain useful and thought-provoking information.
Overall, Harrison has written a compelling book that deeply engages with existing scholarship to elucidate how something as routine as infant sleep is politically fraught. The book offers readers an opportunity to understand the webs of meaning that tie risk, technology, surveillance, expert advice, social inequality, and mothering together. One is left hoping that as new parents inevitably discuss how their babies are (or are not) sleeping, they could recognize the ways their fears, anxieties, and decisions about expert recommendations reflect larger systems of inequality and corporate efforts to cash in on their fears.
