'A terrible injustice': Sleep-related infant deaths in Manitoba inequitably impact Indigenous families: report

Sleep-related infant deaths are largely preventable but there has been "a complete lack of progress" over the past 13 years in reducing them, says a new report by the Manitoba Advocate for Children and Youth.

The report released on Thursday by Sherry Gott also says Indigenous and socio-economically disadvantaged families are disproportionately impacted, "revealing the unjust and unequal nature of this problem."

The prevention of sleep-related infant deaths will require a fundamental shift in how they are understood and addressed, and the government needs to play a much larger role, Gott said in the report Shifting the Lens: Understanding and Confronting Inequities in Sleep-Related Infant Deaths in Manitoba.

She calls it "an important confirmation that social and structural factors are powerful determinants of health."

The report examined the circumstances around 48 infants who died unexpectedly in their sleep or in a sleep environment in Manitoba from 2019 to 2021.

The report says:

• 81 per cent of infants who died were Indigenous. The overwhelming majority of incidents occurred in socio-economically disadvantaged areas, and 27 per cent occurred in First Nations communities.
• 64 per cent of the infants' homes were considered overcrowded, with nearly two-thirds having six or more occupants. Serious environmental health concerns were identified in 40 per cent of the incident households.
• 70 per cent of the infants' biological mothers were known to have been victims of intimate partner violence.
• 69 per cent of the families had degrees of involvement with Child and Family Services at the time of or in the year prior to the infants' deaths.
• 50 per cent of the mothers had experienced some form of maltreatment as children, including emotional/ psychological abuse, neglect, physical abuse and sexual abuse.
• 33 per cent of the households did not have a safe sleep surface available for the infant.

"This is a terrible injustice and a clear indication that things need to fundamentally change in our province … if a society cannot protect and provide for its most vulnerable members, no matter who they are, where they live," Gott said during the news conference for the report.

MACY has examined trends related to these types of deaths since 2009. It issued a report in 2020, Safe and Sound, which focused on individual and household-level risk factors — sleep surface, bed-sharing, position found, swaddling, tobacco smoke exposure, overheating and objects in the sleep environment.

"Regrettably, in the three years following the release of that report, between 2019 and 2021, 48 additional infant lives were lost unexpectedly in their sleep or in a sleep environment," the latest report says.

Of the 48 deaths, 17 occurred in Winnipeg, 13 in First Nations communities, and 18 in other provincial cities, towns, and municipalities.

That prompted MACY to re-examine the issue through a wider lens.

The Shifting the Lens report demonstrates that risks for sleep-related infant deaths are more vast than individual practices, the report says. They are largely determined by the conditions of people's daily lives "and the wider set of factors and systems that shape them," the report says.

"These are known as the social determinants of health and are factors over which caregivers and families have very little control," such as poverty, social exclusion, living conditions, discrimination and colonization.

"Therefore, it is wildly unfair and ineffective to place the burden of prevention onto their shoulders by focusing efforts solely on modifying individual behaviours and practices."

Inuit, Métis and First Nations families in Manitoba face unique and significant challenges when attempting to access services, shaped by cultural differences, geographical isolation and the legacy of colonialism, the report says.

That can include limited access to health care, education and social support, compounded by language barriers and the need to travel long distances to urban centres for specialized care, and a history of marginalization that creates mistrust in public institutions.

The impacts of intergenerational trauma from residential schools add further complexity, affecting mental health, substance abuse and poverty, the report says.

Focusing solely on changing individual practices absolves the government of its role and obligations under international human rights law, it says.

Interventions and policies to address these deaths must include public education on individual and household-level risk factors, as well as concrete measures to address the inequality by improving the underlying conditions in which families live and raise their babies, the report says.

"This will require strong political will and bold commitments from government. Anything less will continue to deliver the same horrific results: beloved, disproportionately Indigenous infants dying from preventable causes — and this is wholly unacceptable."

Gott said a "whole government" approach is required, involving the minister of families, minister of health, minister of housing, addictions and homelessness and minister of mental health to address "the larger social issues" that contribute to the risk factors for the deaths.

"We are urging the government to address the social determinants of health. It is a legally binding children's right obligation, so we hope that they will respond to this," she said.

Families Minister Nahanni Fontaine told reporters Wednesday the government has already done work to address the social determinants of infant death outlined in the report, including doubling the prenatal benefit to more than $160 a month, and re-establishing the healthy child committee of cabinet, which looks into policies impacting children in the province.

"I think that this report highlights several things. One of them is that this is something that no family, no Manitoba family should go through," the minister said.

Asked if there was a timeline for the government to respond, Gott said MACY conducts compliance reports once a year, measuring government action on recommendations.

"So hopefully, within six months we will review this to see if they've responded. I will report and call [them] out publicly if they haven't," she said.