We all want babies to be safe. I am relieved to see the faxes that come every week from the Consumer Product Safety Commission (CPSC) announcing recalls of infant products. I'm happy there's a government organization that oversees product safety. I'm not pleased, however, about the recent forays of CPSC into the area of infant sleep customs. The CPSC has been laudable in announcing the dangers to infants from soft bedding, and the staff works diligently to recall unsafe products. However, in September 1999 and May of this year, the CPSC moved into territory over which they have questionable authority. On May 6 during an international tradeshow of the Juvenile Products Marketing Association (JPMA), the CPSC issued a press release that stated, "Don't place a baby to sleep in an adult bed." The press release equates the danger of a baby in an adult bed to the danger of soft bedding or prone sleeping. The evidence, however, does not support this. 
While I disagree with these statements of the CPSC, it is also dangerous advice. By prescribing safe behavior rather than describing safe sleep environments, the CPSC fails to reach those most at risk for infant death and provides an unprecedented opportunity for the marketing of cribs, playpens, and cosleepers. Most of the deaths the CPSC analyzed occurred in poor neighborhoods, among families who likely cannot afford a crib. These are not the families who will be reached by announcements in retail establishments. By failing to provide information on safe sleep in any setting, the CPSC has ignored the needs of the most at-risk population. 
Protecting people at risk is just what CPSC was founded to do. In the 1960s, consumer activists educated the public about the dangers of unsafe products and assigned the responsibility for product safety to government. In 1970, the National Commission on Product Safety, a bipartisan commission, found that many common household products were unnecessarily hazardous. The commission reported that 20 million people were injured in their homes each year by these products. Thirty thousand were killed and 110,000 permanently disabled at a cost to the federal government of $5.5 billion each year. 
This report prompted Congress to create a new product safety agency, the Consumer Product Safety Commission, established in 1972 by the Consumer Product Safety Act (CPSA). The act was passed soon after the enactment of new strict automobile legislation prompted by Ralph Nader's exposé of the auto industry, Unsafe at Any Speed. It was a time when consumer rights were at a high point, and no one argued with the legitimacy of consumer protection. Despite its great promise and noble mission, the CPSC has been continually plagued by budget limitations and political wrangling since its inception in 1972. Even though product-related injuries are 45 percent higher today than they were in 1970, the CPSC has the smallest budget of any federal health and safety agency. As a small agency, it has been vulnerable to the moods of Congress, and its budget and staff have been repeatedly cut since 1973. In 1977, the budget was $39 million and the staff 900. By 1997, the budget of the CPSC had barely increased to $42.5 million and staff had been nearly cut in half to 480 full-time employees. In 1997, the Government Accounting Office (GAO) calculated that the agency's budget had decreased 60 percent since 1974 and staff reduced by 45 percent. In the 1980s, regulatory reforms partial to industry crippled the agency's effectiveness. Presidents Carter and Reagan both tried to abolish the agency. Still, the vast majority of staff members of the CPSC work hard to protect consumers from unsafe products. Their work is sometimes compromised by the politics of political appointments. The commissioners of the CPSC are appointed by the President and as such often have political agendas or personal loyalties that can create conflicts of interest within the agency. 
The mission of the CPSC is to protect the public against the unreasonable risk of injury and death associated with consumer products. Specifically, the agency can collect and maintain a national database of product-related injuries and deaths, create mandatory safety standards, recall and ban dangerous products, and impose civil penalties on companies that fail to comply. In fact, few products have mandatory standards, most have voluntary standards. Twice a year the American Standard and Testing Methods (ASTM) meets to develop and write standards for infant products. The standard-making process of the infant product industry has been widely criticized because it is heavily dominated by industry. Largely this is because of money. Industry can pay to send representatives to attend these meetings. Although the law requires consumer participation, most consumers cannot afford to take the time or pay the expenses to attend. 
The CPSC has also been criticized for acting after the fact. You will probably be as surprised as I was to learn that testing is not required before infant products are sold. The CPSC acts only to recall products after there have been reports of injury and death. It can take months if not years for a product to be recalled. Meanwhile, other injuries and deaths can occur and continue to occur because recalled products stay in circulation in basements, at garage sales, and in daycare centers. The parents of a baby who was killed in a portable crib that had been recalled started the advocacy organization Kids in Danger. Executive Director Nancy Cowles supports HR 3283, federal legislation introduced by Illinois Congresswoman Jan Schakowsky that mandates that infant products have to be tested before sale. She also supports Illinois state legislation that prohibits recalled or dangerous products from being sold in resale shops or used in licensed childcare centers. 
As Cowles says, "You think someone is checking, but no one is." Child products are recalled at the rate of one or two a week. Most of us, about 42 percent, only hear about recalls two or three times a year. The 2001 Annual Survey of Illinois Voters found that African Americans, for example, hear about recalls less frequently than do others. This is somewhat by design. Regulatory reforms from the Reagan era gave industry the opportunity to collaborate on press releases that announce a recall. Predictably, numbers of injuries and deaths are downplayed and the tone is softened. In fact, by the time a recall is issued, it's more of a report than a notice. The low budget and staff challenges make it difficult for the agency to distribute the information on recalls effectively, and industry does not like the bad publicity. 
Publicity is one thing that the CPSC garners when it talks about infant sleep in adult beds. The recent sleep safety announcement at the JPMA show was a publicist's dream. On May 6, 2002, the nation's premier product regulatory agency announced at a juvenile product manufacturing show that it is only safe for infants to sleep in approved cribs or playpens. I doubt if any babies died in adult beds that night, but I'm sure that thousands of parents went out and bought an approved crib. In contrast to their September 1999 announcement, the CPSC was careful in their May 6 statement to make no mention of cosleeping or the family bed. One industry pro who attended the show said that following the announcement all of the media attention was on the cosleepers. While I'm glad to see these products getting more attention, it is potentially tragic if marketing of them takes advantage of the fear of co-sleeping or if we, in any way, begin to think of the mother's body as dangerous. As Dr. James McKenna, the recognized world expert on cosleeping, says, "These studies imply that the mother's body is no more than a wooden rolling pin." His research shows just the opposite, that cosleeping partners are uniquely attuned to one another and share a synchronicity of sleep stages and arousal. 
It discredits the CPSC that they ignore the work of McKenna and it further discredits the agency that it would choose to make an announcement of this nature at the tradeshow of an industry that will prosper from it. When I asked Jennifer Swalek of the JPMA why the CPSC had made their announcement there, she said JPMA only offered them a venue. Ken Giles of the CPSA, however, says that the agency hopes that the JPMA will help with posters, ads, and audiovisuals. He said that the "JPMA reaches an audience that is the target audience" for their message and that the CPSC regularly partners with others including The Danny Foundation and Kids in Danger. However, although these groups were contacted prior to the announcement by the CPSC and asked to help with this campaign and to distribute information, they were not mentioned at the JPMA press conference. 
Sleeping with an infant in an adult bed is different than putting an infant to sleep in an adult bed. The data that the CPSC used to base their current recommendation on was organized, categorized, and analyzed by agency statisticians from the CPSC data collected from death certificates. This same methodology was criticized in 1999, and this time no study has been published, the data is obscure, and the analyses hard to obtain. It is common knowledge that data on death certificates is speculative. If a baby dies in a crib, it is called SIDS. If a baby dies in an adult bed, overlaying or entrapment is assumed. What is significant about the CPSC data is not that infants died in adult beds, but that 92 percent of the babies were alone when they died. It is not their place of death but their isolation that is the culprit. 
Infants die in all settings. What is cruel and misleading about this current CPSC pronouncement is that by being prescriptive rather than descriptive, the agency gives the impression that death can be avoided by using a safe product. While this fits right in with the market economy, it is simply not true. New products get recalled just as often as old ones. The fact that a product is new does not mean that it has been safety tested because safety testing is not required. It may mean that it meets mandatory standards, but if it is a new design, there may be no standards yet for the product. The May 6 announcement reported "more than 180 infant deaths in adult beds in three years." That's 60 per year. According to the CPSC's own data, as reported on the Consumers Union's website, 900 babies die each year in cribs. Since 1988, 200 babies have died in playpens, portable cribs, or play yards. Since the late 1970s, there have been 36 crib recalls, 24 car seat recalls, and 21 stroller recalls. In fact, every major manufacturer of baby equipment, including Evenflo, Hasbro (Playskool), Century Products, Baby Bjorn, Cosco, Safety First, Mattel (Fisher-Price), and Kolcraft, have recalled a product after babies have been seriously injured or killed. In 1999 alone, 65,000 children were rushed to emergency rooms with injuries associated with infant products and hundreds died. 
Why would the CPSC suggest a veritable ban as opposed to offering information on how to make sleep safe in any setting? The CPSC announcement assumes that all parents can buy a crib. Twenty-five percent of parents, more than one million each year, cannot afford furniture, much less a new crib. It is elitist to think that making an announcement at retail outlets will benefit anyone other than the manufacturers and people who were already planning to buy a crib. Parents who can't afford one will not know how to sleep safely in what may be the only bed they have. This statement fails to address the needs of the poor. 
It is unusual for the CPSC to ban a product, even products that have taken many more infant lives than those that have been lost in adult beds. In the case of infant walkers, for example, the CPSC was petitioned in August 1992 to ban wheeled baby walkers by the Consumer Federation of America, the American Academy of Pediatrics (AAP), the Washington Chapter of the AAP, the National Safe Kids Campaign and Consumers Union. Baby walkers are associated with more injuries than any other infant product. In 1994 alone, there were 28,000 emergency room visits associated with infant walkers. Nonetheless, the CPSC deliberated for eight months, while thousands of injuries continued to occur, and finally voted unanimously on April 15, 1993, to deny the petition. The commission wasn't confident that it could make statutory findings "that the benefits of the ban would bear a reasonable relationship to its cost." In other words, the risk of the infant walker is not worth the effort the companies would have to make to comply with the ban. In the case of baby walkers, the CPSC accepted a new design from industry rather than ban the product as the consumers had requested. 
While it's obvious that the May 6 announcement financially benefits the juvenile products industry, I can find no evidence that this is its primary intention. In a pro-industry administration, this may simply be a way to make political friends or reward financial contributions. More likely, this is simply an opportunity for the CPSC to be friendly with the industry that they regulate. This announcement, however, does primarily benefit the researchers who are invested in its theory. What is curious about the theory that infants are unsafe in adult beds is that it contradicts the body of international literature. And more tragically, much of that literature not only suggests that cosleeping is safe but also offers explanations for how bed sharing could reduce the risk of SIDS. I asked Jack Walsh of The Danny Foundation if he thought it was usual for the CPSC to rely only on its own data and to ignore other scientific literature. He said, "No." In fact, he had been convinced of the safety of cosleeping himself at a CPSC conference in 1998. That conference, "Bed Coverings for Infants: What's Safe," was a failed attempt by the CPSC to reach a consensus that it was unsafe for babies to sleep in adult beds. An alliance of SIDS researchers, pediatricians, and CPSC epidemiologists including Bradley Thach, James Kemp, and N. J. Scheer view infant sleep as a medical issue, while other research scientists like Peter Fleming, Elizabeth Wilson, and James McKenna see sleep as a relational issue. As McKenna says, sleep is not a coherent practice. It is affected by social and physical circumstances. It cannot be prescribed. Nonetheless, the CPSC researchers hope to convince the AAP to issue a statement warning against cosleeping. 
James McKenna was not invited to the 1998 conference and his research has been subsequently ignored by the CPSC. McKenna is the world expert on infant sleep. He invented the field, has published more than 100 papers on the subject, and is the director of the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame. He has conducted 210 detailed ethnographic studies on individual mother-child pairs. McKenna is particularly frustrated because his research has been funded by the taxpayer through the National Institutes of Health and has been purposely omitted from the CPSC research. He believes that contradictory views are being censored at the CPSC. 
McKenna calls this scientifically fraudulent. He cites numerous studies, including one from New Zealand that shows that cosleeping protects from SIDS, and another in Bristol that shows that an active caregiver sleeping in close proximity also protects against SIDS. The single most dangerous thing we can do to infants, according to McKenna, is to leave them alone during sleep. It is the proximity of an adult, even more than the cosleeping that is protective. 
We must certainly conclude from all of this that the CPSC has no authority or expertise to make a statement such as they did on May 6. They are clearly in bed with industry (no pun intended). What can we do? We must remember that it was citizen activism that created the CPSC and citizen activism that can fix it. We need a strong CPSC. Let's get involved. The CPSC is an organization that could use our help. It was created to protect consumers, and yet it has insufficient citizen participation. We cannot afford to be naïve, to believe that someone out there in government is watching over us. But we can contact our representatives and ask them to vote for Jan Schakowky's HR 3283. We can ask also that they act to strengthen the budget, staffing, and regulations for the CPSC to ensure that the agency has the resources required to protect against dangerous products both before and after distribution. You may want to contact the CPSC and ask for data on babies sleeping in adult beds or to make an inquiry under the Freedom of Information Act. 
We can also petition our healthcare providers and pediatricians to provide us with information on safe sleep in any setting. I'd like you to join me in requesting that the AAP only make a statement on infant sleep if it is supported by research. Ask them to convene a consensus conference on infant sleep that includes all of the world experts as well as the input of families. And do not be willing to accept the recommendations of government agencies or medical associations only on the basis of their authority, but on the weight of the evidence. We can get involved in product safety advocacy organizations. Mothering will feature links to product safety sites on our website so that you can keep updated on product recalls. Make sure and read E. Marla Felcher's book It's No Accident: How Corporations Sell Dangerous Baby Products (Common Courage Press, 2001), an eye-opening exposé of the CPSC and the juvenile product industry. And consult the following websites for up-to-date product safety information or to offer your help to ensure that safety: 
www.safetyforum.org <http://www.safetyforum.org> 
www.kidsindanger.org <http://www.kidsindanger.org> 
www.dannyfoundation.org <http://www.dannyfoundation.org> 
www.consumerfed.org <http://www.consumerfed.org> 
I'd like to enlist the help of the African American Journalists Association and the Native American Journalists Association to pick up this story. As the incidence of infant death is much higher in poor populations of color, it is imperative that we understand the risks to these populations and that they have access to information on safe sleep even if they cannot afford an approved crib. 
Organize campaigns in your communities to educate parents about safe sleep. Be proud of cosleeping and educate others about its advantages. We've invited the world experts on infant sleep to contribute to our September-October issue, and we expect to be able to present you with the latest in scientific research as well as with practical suggestions on safe infant sleep in any setting. The safety of babies has more to do with the instincts of mothers than with infant products. These instincts are activated by the hormonal chemistry of normal birth. They tell a new mother not to leave her baby alone, to put her baby to nap in a cradle in the same room with her, to keep the covers off the baby's face, to sleep with her baby. Instincts can't prevent all tragedy, but they are still our best protection. We would like to rely also on the authority of informed knowledge and are disappointed not to dependably find it in our institutions. It is up to us to revitalize these institutions or to replace them with ones that truly protect rather than patronize the consumer. And it is up to us to reject advice, even from the highest authorities, when it is compromised by politics and power.