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CON 321 Health Related Research Questions: Vulnerability And Marginalized Populations  Read Chapter – Vulnerability and Marginalized Populations Read Case 1: Reducing Sudden Infant Death Syndrome in a Culturally Diverse Society: The New Zealand Cot Death Study and National Cot Death Prevention Programme Discuss the following: 1. Evidence suggests that several factors affect the magnitude of risk and that bedsharing in the absence of these factors does not significantly increase the risk of SIDS. But the interplay of risks can be complex and difficult to communicate effectively in a national campaign. Can a definitive “no bed-sharing” message be defended, on ethical grounds, if it causes less confusion but overstates the risk to some groups? What are the most important ethical considerations here? 2.What weight should be attributed to the cultural significance of bed-sharing when generating guideline s, and why? Should risks that relate to culturally significant parental practices, such as bed-sharing, be treated differently from risks relating to practices that are not held to be culturally significant? 3. Parents can control some risk factors for SIDS, but others involve broader societal issues, such as socioeconomic status. Does social justice require that prevention campaigns targeting parental practices be coupled with efforts to tackle social and economic disparities and inequities? Who should be responsible for ensuring that this is the case? What should researchers do when they identify a parental practice as risky if resourcing for broader action is not forthcoming? Answers: 1. Sudden Infant Death Syndrome (SIDS) is a complex health and ethical problem that offers several challenges in determining the best prevention approach to reduce the number of incidences (Wrigley & Dawson, 2016). Some factors have been identified to increase the risk of SIDs and have been classified as modifiable and non-modifiable. The modifiable factors include bed sharing, maternal smoking, breast feeding, prone sleeping position, and attendance level to prenatal classes. The factors that have been classified as non-modifiable include social economic status, baby’s sex, and the mother’s age. There have been concerns regarding the best campaigns that would help promote awareness of the risks factors that parents can modify to reduce the degree of vulnerability. For instance, bed sharing was identified as one of the major risk factors that can be modified. However, it is not considered as a significant risk factor if other underlying factors such as maternal smoking, duration of bed-sharing, and the baby’s age. Therefore, it is difficult to scientifically define the risk factor in a clear manner that parents can understand. Also, the campaign against bed-sharing was faced with varying degrees of criticism and reactions among the M?ori and Polynesian families because the childrearing practice is deeply rooted to their traditions (Wrigley & Dawson, 2016). This is a risky strategy because it may result in alienating this group of people. A definitive “no-bed-sharing” message cannot be defended if the cultural sensitivity of different groups of parents is not taken into account (Hawkes, 2013; Wrigley & Dawson, 2016). If a recommendation that just exclusively states “no bed-sharing,” it might be misleading because parents may not be able to make informed decision, especially, if the child has a relatively low risk of SIDS. Also, such a recommendation would not consider any discussions regarding the reasons why parents practice bed-sharing (Wrigley & Dawson, 2016). As a result, health practitioners might not raise the topic and may result to parents lying about their behavior. The most important ethical consideration is that the baby should receive the best care with minimum harm caused, autonomy, and beneficence. It can be argued that “no-bed sharing” message aims to prevent harm to the babies but considerable harm may occur if it results in alienating the target group because of the cultural beliefs thus fail to reduce the rates of SIDS (Wrigley & Dawson, 2016). In regards to autonomy, parents have the right to make informed decisions. Therefore, they should be sufficiently informed that bed sharing as a risk for SIDS is relatively dependent on the presence of other factors. If the other factors, such as lack of exposure to maternal smoking, healthy terms births, or exclusive breastfeeding, are considered, the child’s risk for bed-sharing related SIDS will be significantly lower. 2. The cultural significance is highly sensitive and should be regarded as a critical factor when generating guidelines because the level of acceptability of the recommendations given will be dependent on how controversial the message is in relation to the cultural behavior (Wrigley & Dawson, 2016). In certain cultures, such as the M?ori and Polynesian populations, bed-sharing is a common practice that has been linked with a relatively low risk level of SIDS. However, other modifiable and non-modifiable factors such as lack of attendance to prenatal classes, maternal smoking, low social economic status, age of first time mothers, and fewer years of education are more prevalent among the Maori parents in comparison to non-Maori parents. Consequently, among the Maori children, bed-sharing, in conjunction with other the mentioned factors, poses a greater risk for SIDS than to non-Maori children (Wrigley & Dawson, 2016). It is therefore very important to consider the cultural significance of bed-sharing among different communities in relation to other social economic and behavioral factors that influence the risk for SIDS when generating guidelines. The culturally significant parental practices related risks such as bed-sharing should be treated differently from other factors because of the complexities associated with the different reactions among people with different traditions (Wrigley & Dawson, 2016). For instance, the message of no bed-sharing had serious implication because it was not culturally sensitive, therefore, some people from M?ori and Polynesian ended up rejecting to comply or turning away from SIDS prevention campaigns. Conversely, the factors that involve 3. The ethical consideration of social justice requires that that such campaigns to promote social change efforts in support of or with venerable and oppressed groups of people focused primarily on issue of poverty, equality of opportunities, and discrimination among other types of injustices (Wrigley & Dawson, 2016). Thus the prevention campaign should consider efforts to help tackle social and economic disparities to promote equal opportunity access to resources needed to promote the changes in parental practices in order to reduce risks for SIDS. If researchers identifies a parental practice as risky but the broader actions to rectify it fail after implementation, they should conduct analysis to understand the reason and develop recommendations based on the findings. References Hawkes, N. (2013). Sharing a bed with your baby increases the risk of sudden infant death syndrome, UK study shows. BMJ: British Medical Journal, 346. Jensen, K., & Gaie, J. B. (2010). African communalism and public health policies: the relevance ofindigenous concepts of personal identity to HIV/AIDS policies in Botswana. African Journal of AIDS Research, 9(3), 297-305. doi:10.2989/16085906.2010.530187

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