The Indiana Cudtodian of Records ent this to us. It had no header or specific date, but appears to have been presented in November 2015
Distinguished commission members, thank you for the opportunity to present to you today regarding House Enrolled Act 1016 that describes the installation of incubators to facilitate anonymous delivery of newborn infants. My name is Jennifer Walthall and I am currently the Deputy Health Commissioner and Director of Health Outcomes for the Indiana State Department of Health and co-chair of The Infant Mortality and Child Health Task Force with Jane Bisbee, Deputy Director of the Department of Children Services. Our task force convened to review the medical literature and outcomes and experience of this policy worldwide. The circumstances that surround a new mother who finds herself unable to care for an infant speak to one that is in desperate need. Those who work in public health, medicine, and social services are committed to finding comprehensive solutions that address both the elimination of those circumstances, but also provide multiple avenues of support for that moment of overwhelming hopelessness. The importance of protecting our most vulnerable cannot be overstated and was fully understood by the Child Health Task Force.
As a pediatric emergency physician who cares for critically ill infants and as the Deputy Health Commissioner for the state department of health where reducing infant mortality is our primary mission, comprehensively addressing infant safety is a personal imperative. I would like to commend Representative Casey Cox for his leadership and bringing heightened awareness to this issue.
My remarks are structured in the following 5 areas:
1) Recount the current Safe Haven Law in Indiana
2) Describe a brief history of the safe haven and the effect of the “baby box” 3) Summarize the medical literature surrounding baby box outcomes 4) Describe Logistical issues surrounding baby boxes in developed countries 5) Recommendations for future work in this area from the Task Force
All fifty states have a Safe Haven law, which provides a mechanism for legal amnesty for persons who are unable to care for newborn infants. Each states’ law is different, and Indiana has a thoughtful and generous version. We allow for persons to leave an infant to the care of a designated Safe Haven location (hospital emergency department, fire station, law enforcement agency) with 24/7 staffing until the infant is or appears to be 30 days old and has no signs of intentional abuse. This law has been in place in Indiana since 2001 and has proven to be highly effective for the care of over 2000 babies nationally.
Despite the provision of similar statues in many places in the world, there remain tragic cases of infants who are abandoned outside of designated locations. There is a practice that began in medieval times where infants were left in foundling wheels or hatches so that they could be raised in convents or monasteries. The practice was gradually discontinued until a resurgence in the 20th century in several European and Asian countries and Australia as a response to growing infanticide. Additionally, a hospital program called Angel’s Cradles in Canada recently celebrated it’s five year anniversary with two infants dropped off at its’ facility.
The literature and data regarding outcomes from these efforts are limited. Despite the difficulty in collecting comprehensive data around the number of infants abandoned in order to sufficiently study the impact of new policies or programs, several longer-term studies have been done across Europe. These studies have demonstrated that the intended outcomes of decreasing neonatal death were not met despite increased utilization of baby boxes. Stated differently, safe placement of infants in baby boxes/hatches occurred, but without concurrent reduction in unsafe abandonment and resultant death. These findings have been replicated in Germany, Austria, Canada, South Korea, and China.
As of 2012, there are baby boxes in 10 of the 27 EU countries with a movement to decrease their use. In contrast, the anonymous birth policy implemented in Austria demonstrated a significant decrease in neonaticide as compared to baby box deposits of infants, which was minimal. Germany is currently exploring the feasibility of anonymous birth in health care facilities as well based on the findings of their 10-year review.
Finally, the United Nations Committee on the Rights of the Child has called for a ban on baby boxes across Europe due to emerging evidence that the expansion of supportive programs for pregnant mothers and new mothers that addresses social determinants of health is far more effective for proactive placement of infants or continued parenting if desired. In fact, the single study on the features of mothers who surrender infants suggest underlying mental health barriers that preclude problem solving. Addressing those issues must be addressed upstream to the moment of desperation leading to unsafe abandonment.
There are several logistical issues raised by the task force concerning widespread use of baby boxes.
• Impact on existing Safe Haven law
o Indiana currently has a robust Safe Haven law that provides a 30-day window following birth. Many other states only allow a 24 to 48 hour window.
• The existing Safe Haven law allows a parent, family
member, friend, minister or priest, social worker or any
responsible adult to give up custody of a baby to a
hospital emergency room, fire station or police station
in Indiana without repercussion. All of these facilities
are open 24/7.
• Cost and liability
o When a baby box is installed at a facility, there are short-term and long-term costs that must be taken into account. Specifically, the Child Health Task Force noted:
▪ Questions surrounding a potential safety concern during
extreme weather that could lead to power outages.
▪ Questions were raised about the cost of monitoring the device 24/7 and the liability associated with a worker calling off or
the device notification system malfunctioning.
▪ Questions were raised about the effectiveness of such devices in an urban versus a rural setting.
• Education
o Is the general public aware of Indiana’s Safe Haven law?
o Do individuals know where to locate a Safe Haven facility?
o Are the Safe Haven locations discoverable online or at the local level? o Do those staffing a hospital emergency room, fire station or police station know how to properly respond to an infant being abandoned? o Is additional education necessary to ensure consistency at each facility?
• Target audience
o Identifying individuals who would be more inclined to use a baby box as opposed to dropping off an infant to an approved facility is
extremely difficult, if not impossible.
o It also has the potential to create confusion about what services the different facilities offer.
Summary Recommendations
HEA 1016, authored by Representative Casey Cox, provided the Task Force on Infant Mortality and Child Health with the opportunity to debate and explore the medical facts surrounding the best ways to protect and serve our most vulnerable children. It also highlighted the need for increased coordination and communication among stakeholders and those who collect data regarding infants who are surrendered safely and unsafely in Indiana.
Following the Task Force’s review of the history and medical effectiveness of baby box installation in other countries, the data suggests that baby boxes are not effective and that countries who have lead that charge are now moving to phase them out. Additionally, multiple concerns were raised about implementation and whether the cost associated with that installation was the most effective use of those dollars. The world’s literature suggests that policy and programming for pregnant women and those in their support systems is more effective at a lower cost.
Consequently, the Task Force on Infant Mortality and Child Health recommends that the state focus additional resources on improving awareness of the existing Safe Haven law through intergovernmental cooperation and marketing efforts. Additional training and education should also be available to those staffing a
hospital emergency room, fire station or police station in Indiana to ensure consistency if, and when, an infant is abandoned at a facility.
Uniform signage at safe haven facilities is strongly encouraged. However, the public would also be well served with an easily accessible online resource directory that lists all Safe Haven locations in their area.
We have much work to be done to provide comprehensive support services for vulnerable pregnant women before, during, and after childbirth. Early identification of those at risk for poor outcomes including unsafe abandonment should be a priority. With that said, we look forward to continuing to work with the Commission and other stakeholders to further the Governor’s goal to improve the health, safety, and well-being of Hoosier families, especially children.