By Tracy G. Cassels
Many of you know the name Dr. Helen Ball, but for those of you who don’t, let me give you a brief introduction. A professor of anthropology at Durham University (in the United Kingdom), Dr. Ball has spent most of her career examining issues surrounding infant sleep and breastfeeding (though you’ll see here that it was not what she intended to do). Her work has been featured in top journals, magazines (including Mothering), scholarly books, policy reports, and I have cited a fair chunk of it myself. Dr. Ball’s work includes findings pertaining to how sleep location affects the frequency of breastfeeding in the first few days post-partum, cultural differences in sleeping behaviour in the UK, anthropological discussions of the role of breastfeeding in sleeping behaviour across mammals, along with much more. Furthermore, her work has helped change the official stance in the UK from a blanket one against co-sleeping to a more moderate approach focusing on safety, one of the first Western countries to make such a change. Most recently, she has created the Infant Sleep Information Source, an online database of sleep-related information for parents and healthcare professionals. I am grateful that she kindly agreed to answer five questions pertaining to her research and parenting in general. Enjoy
What lead you to be interested in dedicating your career to breastfeeding and sleeping issues from an anthropological point of view?
I got into this field partly by accident and partly out of personal interest. I began with a degree in Human Biology, but was frustrated with the emphasis on microscope and test-tube science, and insufficient opportunity to study whole human beings. That’s when, via the opportunity to take electives, I discovered biological and evolutionary anthropology, which I just loved. So after finishing my undergrad degree I went to the US to do an MA and PhD in Anthropology. At that time I wanted to be a primatologist (Jane Goodall and Diane Fossey have a lot to answer for!) so I spent several years studying monkeys in Puerto Rico. When I got offered a permanent faculty position at Durham University I was still intent on primatology, but now my fieldsite was several thousand more miles away, and I had a one-year-old daughter. It became increasingly difficult to spend the number of hours conducting fieldwork that are needed to do adequate primate behavior studies, so I decided I needed to switch my research to something I could study closer to home and looked around for an area relevant to anthropology that I was suitably trained to do, and that was not crowded with other researchers. I already knew about the mother-baby co-sleeping research conducted by Jim McKennna (having read his work when I was pregnant with my first daughter, and having heard him speak at conferences) and so I began exploring questions that remained to be answered that I might be able to tackle in Durham, UK. By the time my second daughter was born I had secured some research grants to begin video studies of parents and babies sleeping in their natural habitats, and began together with a PhD student studying the nocturnal lives of babies. My second daughter was born at just the right time for she and I to be our first guinea-pig while we figured out how to film in the dark, where to position cameras, and developed our coding schemes. After 5 years of research the University built me the Parent-Infant Sleep Lab, and with a team of 10 PhD students over the past few years, we have been able to embark on all sorts of interesting studies – each one opening up a whole new bunch of questions!
Breastfeeding rates have been found to be negatively affected by the availability of formula in hospitals and birthing centers, places that should know better than to promote a subpar form of nutrition for newborn infants. What do you think led to this current state of affairs and how long do you think it will be before we see most hospitals make a change?
Well in the UK most hospitals have already made this change. Two thirds of UK hospitals are signed up to the UNICEF Baby-friendly Initiative, and this is one of the criteria for becoming Baby-friendly. People are working on this in both Canada and the US – but I think it will be a tough thing to crack in the US particularly because formula companies fund many hospital and research programmes. Where we have nationalized healthcare systems the situation is easier to tackle. Formula companies have utilized the same tactics as Pharmaceutical companies in ‘buying’ the recommendations of health care staff and clinicians with gifts, ‘training’ events and other treats that are thinly disguised marketing campaigns to build brand awareness and loyalty in their recipients. You would hope individuals in health care professions would see accepting these gifts and free dinners etc. for the unethical practice that it is, but unfortunately there is a lot of resistance in US hospitals to getting rid of the ‘freebies’. With the US Surgeon General’s emphasis on Baby-friendly accreditation of maternity units in US, however, there is now an external incentive for hospitals to make these changes, so hopefully things will begin to change as this initiative becomes more widespread.
You have published quite a bit on factors pertaining to safe and unsafe co-sleeping environments and yet many policy makers (especially in North America) are insistent upon ignoring this work when making public recommendations or setting policy guidelines. Why do you think they’ve taken this approach of selectively picking which research to follow? How do you think we can get them to listen, as you’ve been able to do in the UK?
Well, I’ve just written a big article on this topic (appearing sometime later this year in a special issue of Social Science and Medicine on Sleep and Health) so I could probably go on here for pages and pages. I think the biggest factor is the legacy of the worldwide ‘Back to Sleep’ campaigns in reducing SIDS rates. This was an easily modifiable infant care practice that had a huge impact on infant deaths (although no-one still knows why). With bed-sharing public health policy makers are trying to find another magic bullet with another simple campaign that can be delivered with a single message via a snappy slogan. They are failing to understand that bed-sharing isn’t a simple modifiable practice, and a single message is inappropriate (even naïve to those of us who study infant sleep as opposed to infant deaths). The position babies slept in was a recent historical change (parents were advised to sleep their babies prone beginning in the fifties), so was not culturally embedded, is not related to parenting paradigm regarding the nature of infancy and the role of parents, and has little influence on other aspects of night-time infant care. Bed-sharing involves all of these things and therefore will not be easily modified by repetition of instructions to parents. This is a behavior that can be variably safe and unsafe according to context, and so it is much more appropriate to provide parents with information on these issues than to simply stifle conversation by advising against it.
You are working on an Infant Sleep Information Source for parents and health professionals, which I think is fantastic. What gave you the idea to do this? What is the one main goal you hope it will accomplish?
ISIS goes live this week (www.isisonline.org.uk), and I wrote the opening blog today about why we created the site. There’s actually a bit of a selfish element to it – but one that was a reflection of the need for a single evidence-based source for infant sleep information – and that is that I was (and still am) regularly overwhelmed by email requests (from HCPs, parents, researchers, students) for all sorts of information about infant sleep. I hoped that by having a web-based resource summarizing much of the commonly requested information, I could remove some of the email traffic from my inbox! More seriously, though, there is a need for a consolidated source of infant sleep information that explains what the wealth of infant sleep research can shed light on, and which topics still require clarification. Much myth and misinterpretation exists in popular ‘wisdom’ regarding infant sleep. I hope that what it will accomplish Is to provide people (particularly in the UK) who want to know more about the evidence upon which to base decisions about infant sleep with the information they need from a source they will hopefully trust.
If you had carte blanche to come up with one worldwide policy change to help families, what would it be?
I have spent almost 20 years researching the effects of mother infant sleep contact and separation. If I had carte blanche to create one worldwide policy change to help families, it would be a policy change that provided for adequate clean water, sanitation and access to healthcare in countries where such basic human needs are not available to all families. The goal of this policy would be to reduce child and maternal mortality. All mothers and babies should be able to have unrestricted access to one another – but both have to be alive to be together. In the 21st century mothers and babies should not lose one another due to lack of things that those of us who live very privileged lives often take for granted.