In a Pediatrics Perspective being early released in Pediatrics, Dr. Lori Bruce and colleagues from Yale University and Dartmouth College provide an overview of data, current laws, and preventative measures relative to infanticide and infant abandonment (10.1542/peds.2024-068991).
They review the benefits and drawbacks of the infant abandonment device (IAD), discuss confidential birth options within hospitals, and encourage pediatricians to become informed about safe haven laws so we can advocate for maternal and infant safety as new legislation is drafted.
►What are safe haven laws? Between 1999 and 2008, each of our 50 states ultimately adopted a safe haven infant surrender law that allows mothers (and in some states, fathers) to safely leave an unwanted infant in a designated place, such as a hospital, church, or fire station, without threat of criminal prosecution and without disclosing their identity.
►What exactly is an IAD? Infant abandonment devices, pictured in the manuscript, are metal receptacles built in the walls of fire stations and hospitals and equipped with alarms, video monitoring, mattress, bassinette, and temperature control.
However, IADs are not regulated by any federal agency, do not comply with the Indian Child Welfare Act (which upholds the child’s right to be raised in their tribe), and demonstrate worrisome safety data (given 2 associated deaths [one maternal, one infant] of 52 surrenders to date). Also, not all states have agreed to use IADs.
►What does confidential birth mean and who is eligible? Confidential birth permits a pregnant person to give birth in a hospital without disclosing their identity and has been associated with reduced abandonment in other countries. While no US hospitals have a confidential birth policy, many have “Jane Doe” policies that apply to victims of sexual assault, rape, and incest.
► What are situations leading to infant abandonment? The National Safe Haven Alliance, an advocacy group, lists “abuse, assault, trafficking, homelessness, substance abuse, pregnancy denial syndrome, post-partum depression, and mental health issues” as known etiologies.
Primary prevention of root causes, known as “upstream prevention,” is essential but challenging. Meanwhile, educating mothers early in pregnancy about their options through confidential conversation can be lifesaving for both mother and infant.
The authors focus here on IADs, and on confidential birth, as possible safe options for infant surrender. They challenge us to become part of the legislative process and aid in drafting laws that will operationalize safest and best practices. We owe it to those who are pregnant, marginalized, desperate, and stressed beyond words, and to their babies, to make this effort.
