Making infant sleep environments as safe as possible

Every year in Canada and around the world, families are devastated by the loss of an infant sleeping peacefully yet never waking. These heartbreaking tragedies, known as sleep-related infant deaths, encompass SIDS (sudden infant death syndrome), accidental suffocation, and other unexplained causes.

In 2024, the Manitoba Advocate for Children and Youth (MACY) released Shifting the Lens, reporting that between 2019 and 2021, Manitoba experienced 48 such deaths — each one a life cut short, a dream shattered, and a family and community forever changed. Although overall rates initially declined over previous decades, progress has stalled, and inequities persist. As we approach Safe Sleep Week 2026, let’s reimagine our collective approach — from policy to public messaging — to make infant sleep environments as safe as possible for all.

Families facing poverty, housing instability, histories of colonization and systemic inequities are disproportionately affected by sleep-related infant deaths. Addressing these deaths requires shifting the focus from blame and fear to structural solutions and opportunity.

Sleep-related infant deaths are often framed as matters of parental choice or individual behaviours, yet social determinants of health play a decisive role in shaping the conditions in which families care for infants. Factors such as income, housing stability, education, access to culturally safe health care, and systemic inequities influence whether families can consistently follow safe sleep recommendations. For example, overcrowded or unstable housing may limit access to a separate, safe sleep surface. Financial strain can make it difficult to obtain cribs or bassinets. Colonialism, racism and geographic isolation further compound risk. Experiences of racism create barriers to accessing prenatal and postnatal care as well as reduce opportunities for culturally relevant guidance about safe sleep. Systemic racism also takes the form of unfairly judging parents as being unable to properly care for their children, resulting in families being involved with the child welfare system and children being apprehended.

Policies such as guaranteed basic income, enhanced child benefits, and targeted prenatal benefits can reduce financial stress. Increased and stable income provides choice and improves families’ ability to purchase safe sleep equipment like cribs or bassinets, secure stable housing, and reduce overcrowding — conditions directly linked to safer sleep environments.

Investments in affordable housing, rent control, rental supplements, and housing-first models reduce overcrowding and housing instability. Clear housing standards such as addressing mould, temperature control, and safe space for infant sleep surfaces also support safer home environments.

Public health programs that provide free or low-cost cribs, bassinets, or portable sleep spaces — paired with culturally responsive education — have demonstrated positive impact in increasing safer sleep practices. Community-developed and tested prototypes, like the Winnipeg Boldness Project’s Baby Basket, focus on building trusting and supportive relationships with expectant parents to help reduce stress, share information, and provide necessary supplies as they celebrate the arrival of their child.

Investing in Indigenous-led, and community-based maternal and infant health services improves trust, access, and uptake of safe sleep guidance. Policies addressing systemic racism and geographic barriers strengthen prevention efforts.

Together, policies like these can move prevention beyond individual behaviour change and toward structural conditions that allow infants not only to survive, but to thrive.

We also need to shift the focus of our language from fear to opportunity. We owe families more than a checklist for avoiding tragedy: no pillows, no blankets, no bed-sharing. We owe them a vision of infants not merely surviving their first year but flourishing within it.

A thriving-centred approach supports the autonomy of families and emphasizes what they can do: create a calm, uncluttered sleep space; build consistent sleep routines; and, keep babies close, but on their own safe surface.

For many families, closeness during sleep is deeply cultural and relational. Thriving-centred policies do not dismiss these values; they work with them. Side-car bassinets, room-sharing without bed-sharing, and community-led education respect the importance of proximity while supporting safety. Harm reduction approaches meet families where they are at and empower and support them to understand and mitigate sleep-related risks.

Programs led by Indigenous elders, community health workers, and peer parents have shown that when sleep guidance is embedded in cultural knowledge and relational trust, families are more likely to adopt and sustain healthy practices.

When public health messaging does not reflect families’ lived realities, it can inadvertently create mistrust and increase stigma rather than improve safety.

Policies that support decolonization, reduce poverty, improve access to quality housing enhance access to culturally safe and community-based supports, and ensure equitable health and social services help create the conditions in which infants can flourish.

For all infants to thrive, it’s time to shift our focus, from pamphlets to policy.

Uyiosa Chukwuka is president of the Manitoba Public Health Association, Diane Roussin is project director for The Winnipeg Boldness Project, and Sherry Gott is the Manitoba Advocate for Children and Youth.