Providing a Safe Haven: Staff Response to a Simulated Infant Relinquishment in the Emergency Department

Every state in the United States has established laws that allow an unharmed newborn to be relinquished to personnel in a safe haven, such as hospital emergency departments, without legal penalty to the parents. These Safe Haven, Baby Moses, or Safe Surrender laws are in place so that mothers in crisis can safely and legally relinquish their babies at a designated location where they can be protected and given medical care until a permanent home can be found. It is important for health care professionals to know about and understand their state's law and how to respond should an infant be surrendered at their facility. No articles were found in the peer-reviewed literature that describe a method to evaluate nurse competency during infant relinquishment at a Safe Haven location. This article will describe commonalities and differences among these Safe Haven Laws, responsibilities of the hospital and staff receiving a relinquished infant, and 1 hospital's experience when running an infant relinquishment drill in their emergency department.

Infanticide and illegal infant abandonment in Malaysia

Infant abandonment and infanticide are poorly understood in Malaysia. The information available in the public arena comes predominantly from anecdotal sources. The aim of this study was to describe the prevalence and characteristics of infanticide and illegal infant abandonment in Malaysia and to estimate annual rates for the most recent decade. Summaries of data about infanticide and illegal infant abandonment were gathered from police records; the annual number of live births was ascertained from the national registry. The estimated inferred infanticide rates for Malaysia were compared with the infanticide rates among countries of very high, high, medium, and low rankings on the Human Development, Gender Inequality, and Gini indices. From 1999 to 2011, 1,069 cases of illegal infant abandonment were recorded and 1,147 people were arrested as suspected perpetrators. The estimated inferred infanticide rate fluctuated between 4.82 and 9.11 per 100,000 live births, a moderate rate relative to the infanticide rates of other countries. There are substantial missing data, with details undocumented for about 78-87% of cases and suspected perpetrators. Of the documented cases, it appeared that more boys than girls were victims and that suspected perpetrators were predominantly Malays who were women, usually mothers of the victim; the possibility of arrest bias must be acknowledged. Economic and social inequality, particularly gender inequality, might contribute to the phenomena of infanticide and abandonment. Strategies to reduce rates of infanticide and illegal infant abandonment in Malaysia will require strengthening of the surveillance system and attention to the gender-based inequalities that underpin human development.

Releasing mother's burdens: child abandonment and retrieval in Madrid, 1890-1935

In nineteenth-century Europe, the foundling hospital grew beyond its traditional purpose of mitigating the shame of unwed mothers by also permitting widows, widowers, and poor married couples to abandon their children there temporarily. In the Foundling Hospital of Madrid (FHM), this new short-term abandonment could be completely anonymous due to the implementation of a wheel—a device on the outside wall of the institution that could be turned to place a child inside—which remained open until 1929. The use of survival-analysis techniques to disentangle the determinants of retrieval in a discrete framework reveals important differences in the situations of the women who abandoned their children at the FHM, partly depending on whether they accessed it through the Maternity Hospital after giving birth or they accessed it directly. The evidence suggests that those who abandoned their children through the Maternity Hospital retrieved them only when they had attained a certain degree of economic stability, whereas those who abandoned otherwise did so just as soon as the immediate condition prompting the abandonment had improved.

[Babyboxes in the Czech Republic--what next?]

Though from the perspective of history babyboxes are not new phenomenon, their present existence, however, brings many problems, either in terms of Pediatry and neonatology, or because of their social, ethical and also legislative issues. The authors provide an overview of the arguments proponents of babyboxes with their critical analysis, then provide arguments against placing babyboxes and then summarize the experience with their operation in the Czech Republic. In conclusion, authors present a list of recommendations to improve the current bad situation.

Children abandoned and taken back: children, women, and families in dire straits in Lyon in the nineteenth century

Abandoning a child was no rare deed in European towns in the nineteenth century, mostly among single women in underprivileged environments. On the other hand, taking this same child back was more unusual. By analyzing the registers of the Lyon hospitals, it is possible to determine the percentage of children taken back by their mothers, how this was actually achieved, and to examine the family status of the mothers at the time of both events. Both of these acts -- abandoning a child and then taking it back -- can be put back in their context in these women's lives, for instance, by looking into the length of time separating the two procedures. To finish with, it appears that the 'Hospices civils de Lyon' encouraged mothers to take the children back and generally had a conciliatory attitude toward them, supposedly in the children's interest.

Safe haven laws as crime control theater

OBJECTIVES

This article examines safe haven laws, which allow parents to legally abandon their infants. The main objective is to determine whether safe haven laws fit the criteria of crime control theater, a term used to describe public policies that produce the appearance, but not the effect, of crime control, and as such are essentially socially constructed "solutions" to socially constructed crime "problems."

METHODS

The analysis will apply the principles of crime control theater to safe haven laws. Specifically, the term crime control theater applies to laws that are reactionary responses to perceived criminal threats and are often widely supported as a way to address the crime in question. Such laws are attractive because they appeal to mythic narratives (i.e., saving an innocent child from a predator); however they are likely ineffective due to the complexity of the crime. These laws can have deleterious effects when policymakers make false claims of success and stunt public discourse (e.g., drawing attention away from more frequent and preventable crimes). This analysis applies these criteria to safe haven laws to determine whether such laws can be classified as crime control theater.

RESULTS

Many qualities inherent to crime control theater are present in safe haven laws. For example, the laws are highly publicized, their intentions lack moral ambiguity, rare cases of success legitimize law enforcement and other agencies, and they appeal to the public sense of responsibility in preventing crime. Yet the goal of saving infant lives may be unattainable. These qualities make the effectiveness of the laws questionable and suggest they may be counterproductive. This analysis determined that safe haven laws are socially constructed solutions to the socially constructed problem of child abandonment.

CONCLUSIONS

Safe haven laws are appropriately classified as crime control theater. It is imperative that further research be conducted to examine the effectiveness and collateral effects of safe haven laws.

PRACTICAL IMPLICATIONS

Longitudinal studies and a nationwide database to better determine the effectiveness of safe haven laws are suggested. It is also crucial that agencies implementing SHLs closely monitor the reasons parents abandon their children, and adopt policies that re-focus the attention safe haven laws receive to address more frequent causes of harm to infants.

Abandoned in Brussels, delivered in Paris: long-distance transports of unwanted children in the eighteenth century

The study uses examinations and other documents produced in the course of a large-scale investigation undertaken by the central authorities of the Austrian Netherlands in the 1760s on the transportation of about thirty children from Brussels to the Parisian foundling house by a Brussels shoemaker and his wife. It combines the rich archival evidence with sparse indications in the literature to demonstrate that long-distance transports of abandoned children were a common but historiographically neglected by-product of the ambiguities of foundling policies in eighteenth-century Europe and provides insight into the functioning of the associated networks and the motives of parents, doctors, midwives, transporters, and local officials involved.

Nebraska Safe Haven Laws: a feminist historical analysis

The Nebraska Safe Haven Laws have been a fervent topic of discussion during 2008. Rather than identifying that newborn infants (born to those women not wishing to parent) could be dropped off at a safe haven in the first day of life, there was inadvertently no specified end date in Nebraska law. To the surprise of many, children in teen years and from throughout the country were brought to Nebraska's doors. This article examines what that means for women and children through the lens of a feminist historian.

Neonaticide: Phenomenology and considerations for prevention

This article explores the phenomenon of neonaticide, the murder of an infant during the first day of life. Characteristics of maternal neonaticide offenders in industrialized countries were identified based on a systematic literature review. Neonaticides were most often committed by poor, relatively young, single women who lacked prenatal care. Efforts to better prevent these tragedies should include improved sex education and contraceptive access. Two legal responses to the problem of neonaticide, Safe Haven laws utilized in the United States, and anonymous birth options in Europe are discussed.

[Syphilis, brothels, unwanted children and wet nurses. Italy and syphilis infection in the 19th century]

In 1861 in Italy a repressive law was passed against prostitution to reduce syphilis transmission. After the constitution of the Kingdom of Italy there began a debate on this law which was harsh on prostitutes and failed to resolve the health problem in question. In 1880, in Italy, studies were promoted under the aegis of a royal commission to understand the social situation of prostitution and the epidemic spread of syphilis. In 1888 Crispi issued new regulations concerning prostitution, prevention and therapy of infectious diseases: three years later a new regulation was established which partly restored the 1861 law. In this paper we present not only the question of prostitution in Italy in relation to syphilis, but also the serious problem of infection transmission to unweaned babies and to wet nurses in orphanages.

The number of illegally abandoned and legally surrendered newborns in the state of Texas, estimated from news stories, 1996-2006

In 1999, Texas was the first of 47 states to pass a Safe Haven law allowing for the anonymous surrender of unwanted newborns at designated locations. However, state agencies do not systematically collect data on the number of illegally abandoned infants and infants legally surrendered under the law. Using the LexisNexis database of Texas newspapers, this study estimated the number of illegally abandoned and legally surrendered newborns younger than age 60 days in Texas, 1996 to 2006 and describes their demographic characteristics. Of 93 infants (53% male) identified during the study period, 82 were illegally abandoned (70% found alive) and 11 were legally surrendered. On average, 7.5 (range: 4-16) infants were illegally abandoned each year, with the greatest number found in 1999. Infants continued to be illegally abandoned following passage of the Safe Haven law. A statewide surveillance system should be implemented to evaluate this important public health problem.

Comment: Evan B. Donaldson adoption institute response

It has been 8 years since Texas became the first state in the country to address the discarding of newborns in public places by legalizing anonymous infant abandonment. The central question in the debate over the efficacy of Safe Haven laws remains whether they are succeeding in their stated objective, that is, to reduce the number of unsafe, illegal newborn abandonments. The lack of official recordkeeping makes it difficult to assess the effectiveness of the law in Texas, or elsewhere in the United States. Furthermore, because the law protects the anonymity of the abandoning adult and does not require any collection of information from or counseling of that adult, there is no way to determine whether people abandoning infants at Safe Havens are those who would have abandoned unsafely in the absence of the law. In addition to the law's dubious effectiveness, it evidently causes multiple troublesome, unintended consequences.

Comment: National Council For Adoption's response to the Texas Safe Haven Study

The author responds to a study on the effectiveness of Texas's Safe Haven law. More than 1,000 newborns nationwide have been placed safely under Safe Haven laws, and this number includes only the documented cases in 36 of the 48 states that have enacted such laws. The author agrees that further study of Safe Haven laws is needed because many states with Safe Haven policies have not accurately monitored or documented the number of infants safely relinquished, and data to measure usage and effectiveness of Safe Haven programs are lacking. In addition, states would benefit from studies of at-risk parents, which might lead to more effective messages that would reach these parents before abandonment takes place. All states with Safe Haven policies must recognize the need for increased funding of public awareness campaigns to educate residents about Safe Haven laws.

Safe-haven laws focus on abandoned newborns and their mothers

In the United States, 47 states have safe-haven laws that allow a mother to relinquish her newborn infant at a hospital emergency department or a manned fire station and maintain her anonymity. In addition to anonymity, immunity from prosecution is given to the mother, provided the relinquished newborn is unharmed and meets the age specified by the state's law. This article describes safe-haven laws and how they developed, barriers to successful use, nursing implications, and the nurse's role in increasing public awareness and influencing legislative policy.

Prevalence of mental disorders and associated service variables among Ontario children who are permanent wards

OBJECTIVE

To identify the prevalence rate of mental disorders among Ontario children who are permanent wards and also the key practice and descriptive variables associated with their diagnostic status.

METHOD

I reviewed case files from a stratified random sample of 429 Ontario children who were permanent wards with no access to biological parents on December 31, 2003. Data abstracted from files included information on descriptive variables (such as age, sex, and type of permanent ward), all disorders (that is, mental and other current medical diagnoses and disabilities), family history, maltreatment experiences, service history (such as age at admission to care and current residential placement type), and permanency plans.

RESULTS

The prevalence of mental disorders was 31.7%. A significantly higher proportion of children with mental disorders experienced maltreatment. Children with mental disorders were almost 3 times more likely than those without mental disorders to be placed by Children's Aid Societies in privately operated resources, such as group homes, and almost 10 times less likely to be living in a probationary adoption home. Although children with mental disorders were less likely to have a permanency plan of adoption than were children without mental disorders, regression analysis found that only 2 variables--age on becoming a permanent ward and age at the time of the study--were predictive of children's adoption plans.

CONCLUSIONS

The findings support the need for improved monitoring of the aggregate mental health needs of children who are permanent wards. Numerous implications for service delivery and future research are discussed.

Rechtsprobleme von Babyklappen und anonymen Geburten

It is illegal to propagate or offer anonymous births or to "cradle" abandoned babies in anonymous coop slots ("Babyklappen" in German). Such offers must be rescinded. Offers concerning anonymity of births are ill-suited, since they do not save life. They are unnecessary, because women and children can be assisted even if they are in dire straits, by utilising available help as offered by statutory German child and adolescent aid institutions. Those illegal offers do not solve any problems but create new difficulties and result in lifelong misery for children and parents. Offers for anonymousness create a previously non-existent demand and discredit legal help facilities. Persons assisting anonymous deliveries or recovering "baby cradle" ("Babyklappen") children are obliged to report this to the local registrar's office (in hospitals by the hospital director). Anonymous babies must be immediately reported by hospitals or institutions to local police authorities, and they should be reported to the municipal Youth Office.

Nobody's child

Babies who have been abandoned at birth face a lifetime of uncertainty about who they are and which diseases they might be prone to. Mothers who abandon them have to live with guilt, which can result in anxiety and depression. Abandonment is sometimes linked to domestic violence and poverty. In countries such as France and Germany, women can leave a child anonymously in a safe place.

Perspectives on newborn abandonment

OBJECTIVES

The goals of this study were to identify the socioeconomic influences that may lead to newborn abandonment and the attributes common to individuals who abandon their infants, to develop an understanding of the legislative issues affecting the abandonment of newborns by state, and to describe an emergency care program designed to preserve newborn life.

METHODS

A retrospective review of case files, publications, and headline news was undertaken to identify commonalties among individuals who abandon their infants. Accurate statistical data about this issue are nonexistent; however, extrapolations can be made from documented cases. Predictors of abandonment assist healthcare workers in identifying and preventing the needless deaths of newborn infants through early education and prevention programs. If these children survive, they often become the challenges of emergency care staff.

RESULTS

There are now at least 46 states that have proposed or enacted legislation related to infant abandonment. The laws are designed to promote the safe surrender of newborns to designated child protective agencies, including emergency departments. These legislative controls now regulate safe havens to accept newborns that would otherwise be abandoned.

CONCLUSIONS

There is still much to learn about infant abandonment. A national database to compile statistics about the incidence of abandonment is currently not available. Research is necessary to validate the findings collected in retrospective reviews. The choices parents make between the options of abandoning versus surrendering the infant to a safe haven require further study. Preventative programs and education of the public and particularly of the high-risk groups require a greater emphasis on improving child protection procedures. Programs in emergency departments must be developed to expedite care and to support and protect life.

Debi Faris. Bringing dignity to children in life + in death

Debi Faris founded Garden of Angels so that innocent babies left to die on roadways and in trash bins are treated with value and dignity. She gives them a proper burial service, celebrating their brief lives, and provides a final resting place to honor their memories. Debi Faris is active in the legislative and educational process and is instrumental in passing new laws that save the lives of newborns.

Abandoned infants can be brought to ED

To reduce the number of abandoned newborns, a state law was passed in Texas that allows mothers to abandon infants anonymously in the ED and avoid criminal prosecution. Similar legislation has been introduced in Delaware, Alabama, California, Minnesota, and Georgia. Although the law aims to ensure children aren't abandoned in unsafe places, ED experts question whether it will be effective. Once it is determined a child is abandoned, the burden is on the ED staff to perform a medical evaluation with no background information. ED staff should educate pregnant women and young mothers about community resources in times of domestic crisis.

Autonomy and connectedness: a re-evaluation of Georgetown and its progeny

Focusing on the notable 1964 case of Application of the President and Directors of Georgetown College and subsequent cases, the author explores the connections between parents' and children's interests in ways which tend to support a parent's autonomy and hence a parent's refusal of life-sustaining treatment.