Safe Haven Laws and Baby Boxes

     Safe Haven Baby Boxes are implemented with the goal of preventing illegal abandonment of newborn children. Not only is the Baby Box offered as a last resort option for women, maintained with complete anonymity, but the organization itself raises awareness and offers a 24 hour hotline for mothers in crisis. 

Safe Haven Baby Box

    The primary goal of Safe Haven Baby Boxes is to raise awareness of the Safe Haven Law. These laws vary across states, in areas such as maximum age at which an infant can be relinquished, whom can relinquish the infant, and where the relinquishment can occur, but overall provide safe places for parents to relinquish their newborn infants. It provides anonymity and protection against prosecution for the infant's caretakers as well as immunity of liability for providers who accept the infants. All fifty states and Puerto Rico have some variation of the Safe Haven Law. The first state to enact this type of law was Texas, who in 1999 created their "Baby Moses Law." This laws was created in a reaction to thirteen incidents of child abandonment that year, with three of the infants being discovered dead. Kentucky's version of this law is the Safe Infants Act, which allows parents to leave babies younger than 30 days old at a designated safe place, where no one will call the police or ask for your name. The baby will get medical care and be placed with a family for adoption. If the parents of the infant do not contact the Cabinet for Health and Family Services within 30 days after leaving the infant at a safe place, the Cabinet will begin the process of terminating parental rights. The World Population Review provides a breakdown for the law by each state. 

Viral TikTok Shows How Safe Haven Baby Boxes Work

   

    According to the National Library of Medicine, more than 100 infants are abandoned each year, with approximately one-third of these infants being found dead. However, since the implementation of the Safe Haven Baby Box, the hotline has received 9,000 calls, the organization has referred over 500 women to crisis pregnancy centers and assisted in 9 adoption referrals, and over 150 infants were safely surrendered. Since the implementation of the first Safe Haven Law in 1999 in Texas, more than 3,500 newborns have been successfully surrendered. 

Newborn baby safely surrendered to the Safe Haven Box at the Beech Grove, Indiana Fire Department

    Despite their benefit towards preventing infant abandonment, scholars have offered critiques of safe haven laws, stating they do not address the root problem of infant abandonment and mortality. They argue that these laws make citizens feel like the crime is being prevented while ignoring racial, cultural, and socioeconomic issues impacting infant relinquishment. These scholars argue for more research to be done on infant abandonment so that evidence based interventions can be implemented to decrease the issue in the first place. 

The Opioid Crisis and Maternal and Child Health

     The Opioid Crisis is a rising epidemic across America. According to the CDC, the number of people who died from drug overdose in 2021 was over 6 times the amount in 1999. This number increased by 16% from 2020 to 2021 alone, with 75% of drug overdose related deaths in 2021 involving opioids. 

Center for Disease Control and Prevention: Three Waves of Opioid Overdose Deaths

    The chart above describes the rise of the opioid epidemic over time. The CDC describes this in three waves.

1. The first wave began in the 1990s, with physicians increasing the amount of opioids prescribed. The majority of these deaths involved prescription opioid overdoses (natural and semi-synthetic opioids and methadones).
2. The second wave began in approximately 2010, with overdose deaths rapidly increasing with the involvement of heroin.
3. The third wave began not long after, in 2013, with significant increases in overdose deaths involving synthetic and illegally manufactured opioids, particularly fentanyl 

    This epidemic has had major affects on maternal and child health, with opioid use disorder causing negative health outcomes for both mothers and infants. The CDC also addressed this issue, describing the following health outcomes associated with opioid use during pregnancy: 

• Pre-term birth
• Low birthweight
• Breathing problems 
• Feeding problems
• Maternal mortality

   Babies exposed in vitro to drugs can often be born with neonatal abstinence syndrome, in which the are dependent on the substance at birth and face withdrawal symptoms as the drug is cleared from their system. 

    In addition to physiological morbidities, this crisis is causing more and more families to be separated, whether by social services or by the loss of a parent. 

    The National Network of Perinatal Quality Collaboratives, which is funded by the CDC, has the focus of improving the health outcomes of those affected by the opioid crisis. They have the goal of improving three potential encounters at three early stages of motherhood, via public health interventions.

1. Prenatal opportunities: Screening and intervention

This intervention focuses on screening for opioid use disorder as early as the mother's first prenatal visit. The provider can measure the mother's addiction severity and can then offer information on the risks of continued drug abuse, advise on the next steps throughout the pregnancy, connect the mother with available support system (Medication Assisted Treatment providers, psychiatric care, social workers, etc.).

    2.  Opportunities post-delivery: Empowering caregivers

 After birth, opioid exposed newborns are typically taken in for critical and intense care to try to alleviate their negative health outcomes. This can often leave mothers feeling alienated from both their baby and their baby's care. An attending neonatologist explained that, "Rather than inspire change, this approach risks telling a mother that she's not capable of caring for her child." Thus, care teams must empower mothers and teach them how to console their babies. This is shown to improve long-term outcomes for families and to help babies recover at a faster rate. Mothers must be informed of what to expect and be prepared to talk to social services. 

    3. Postpartum opportunities: Supporting the dyad

When mothers first return home, they are often still battling addiction, now with the additional stress of a newborn. During the first year of life for a newborn, relapse rates spike for mothers, causing accidental overdose to be one of the leading causes of death in first year mothers. Thus, it is recommended for a two-generational approach at pediatric visits. These can allow for discussing addiction treatment and directing mothers to additional community support systems. 

Climate Change and Maternal and Child Health

    The CDC analogs the negative health outcomes associated with climate change, such as increased respiratory and cardiovascular disease, injuries and premature deaths related to extreme weather, changes in the prevalance and geographic locations of food and other resources, increased spread of food and water-borne diseases, increased spread of other infectious diseases, negative effects on mental health, etc. As such, climate change is often referred to as "the biggest public health crisis of the twenty-first century."

The World Health Organization: An overview of climate-sensitive health risks, their exposure pathways and vulnerability factors.

  As most things that result in increased morbitiy and morality, climate change poses an especially increased risk for maternal and child health. According to the World Health Organization, climate hazards are associated with raised risks of developing complications that lead to adverse maternal and perinatal outcomes. 

     These may include multiple causes of maternal and neonatal morbidity and mortality, including, but not limited to:

• gestational diabetes 
• hyper tensive disorders of pregnancy 
• preterm birth 
• low birth weight 
• stillbirth
• anemia

    The exposure to climate hazards can also lead to health issues later in life for both the parent and child, such as decreased mental health and a rise in intergenerational trauma. 

    According to the American Psychological Association, climate change even poses an irreversible threat to prenatal development in physiological systems, cognitive abilities, and emotional skills/

    Why are mothers and their children to susceptible to the negative outcomes of climate change?

1. Pregnant women and children need reliable transportation and medical care.
2. Biological and behavioral changes during pregnancy and postpartum can cause women to be more prone to insect-, food-, and water-borne diseases, which are more easily spread in times of climate crisis.
3. Pregnant and postpartum women can be at an increased risk of post-traumatic stress disorder and depression as a result of natural disasters and extreme weather.

Several organizations have proposed interventions that address the issue and seek to improve maternal and child health:

• systems-level solutions to tackle climate change at its root
• community solutions to increase resilience, meet children’s basic needs and increase access to mental health care
• school-based support and hands-on opportunities to act
• screenings by health care professionals to identify climate-related distress and treatment interventions
• parental support, to teach their children about climate change, manage their fears, find hope, take age-appropriate action and nurture their capacity for resilience
• targeting resources to pregnant and postpartum women in climate affected areas
• developing a national heat vulnerability index to protect pregnant and postpartum women form extreme heat
• improving the quality and resiliency of housing and local infrastructure

Studies have shown interventions addressing the climate crisis to improve maternal and child health. For example, a study examining the association between air pollution and poor maternal health outcomes found that in the 10 years after a California coal power plant closed, there was a 27 percent reduction in the rate of preterm births in the surrounding region. 

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Call for Action

The Burden of Malaria on Child Health

Malaria is a life threatening disease spread to humans via mosquito bite. It mostly spreads to people through the bites of some infected female Anopheles mosquitoes, but can also be spread via blood transfusions and contaminated needles. According to the World Health Organization. the African region carries a disproportionate rate of the world's Malaria cases, with 94% of all Malaria cases and 95% of all Malaria deaths occuring here. Infants, young children, pregnant women, and those who are immunocompromised are at the highest risk of Malaria morbidity and mortality. In the African region, children under the age of five accounted for 78% of all Malaria deaths, with a child dying of Malaria every two minutes.

NPR: James Gathany

Cambridge Independent: Malaria kills a child every two minutes - and now mosquitoes are becoming resistant to insecticide

Malaria in pregnancy contributes to significant prerinatal morbidity and mortality. Infection is known to cause higher rates of miscarriage, intrauterine demise, premature delivery, low-birth-weight neonates, and neonatal death. Pregnant women are at increased risk of contracting the disease, being 3 times more likely to suffer from severe disease as a result of malarial infection compared with their nonpregnant counterparts, with the mortality rate from severe disease approaching 50%. In areas where Malaria is endemic, as many as 25% of pregnant women become infeted with the disease. The first Malaria vaccine was reccomended by the WHO in 2021, with the goal of preventing Malaria in children. The vaccine has reached nearly 2 million children in Ghana, Kenya and Malawi through the Malaria Vaccine Implementation Programme, MVIP, since 2019. Despite this, the number of Malaria related deaths grew from 2022 to 2023, increasing from 244 million to 249 million. Thus, as of October 2023, WHO recommends the programmatic use of malaria vaccines for the prevention of P. falciparum malaria in children living in malaria endemic areas, prioritizing areas of moderate and high transmission, with the addition of a new vaccine. Aside from vaccines, another form of prevention against Malaria is the sleeping under insecticide-treated mosquito nets (ITNs) on a regular basis. UNICEF describes that this is one of the most effective ways to prevent Malaria morbidity and mortality, and that almost 2.5 billion ITNs have been distributed globally since 2004, with 2.2 billion (87 per cent) distributed in sub-Saharan Africa. In 2022, manufacturers delivered about 282 million ITNs to malaria endemic countries, an increase of 22 per cent compared with 2021. However, despite this, fewer than 30% of sub-Saharan African children use ITNs. Household ownership of these ITNs needs to be increased to meet universal access.

A baby in Kenya sleeps under an insecticide-treated bed net.SVEN TORFINN/WHO/PANOS PICTURES/REDUX

There are other areas of improvement neccessary to decreasing the buden of Malaria in children. Some of the disparaties below contribute to the effect of Malaria: - In sub-Saharan Africa, about 6 in 10 children who have a fever are taken to a health care facility - Despite the importance of malaria testing, less than 1 in 3 children are tested in sub-Saharan Africa - Too few children in sub-Saharan Africa receive the recommended treatment for malaria, independent of wealth or residence - In sub-Saharan Africa, too few women receive intermittent preventive treatment (IPTp) Overall, improved access to health care treatments and testing will curb the negative outcomes of Malaria.