TO: FROM: DATE: RE: Indiana General Assembly Indiana State Department of Health December 30, 2015 Newborn Safety Incubator Report (IC 16-35-9-6) In accordance with IC 16-35-9-6, the Indiana State Department of Health (ISDH) has prepared this report, concerning “standards and protocols for the installation and operation of newborn safety incubators.” The ISDH has considered sub-sections one through eleven. House Enrolled Act 1016 (HEA 1016), authored by Representative Casey Cox, provided the ISDH the opportunity to explore the best ways to protect and serve Indiana’s most vulnerable. It also highlighted the need for increased coordination and communication among stakeholders on the existing Safe Haven law. In addition to the report required of the ISDH, HEA 1016 assigned to the Commission on Improving the Status of Children the task of reviewing this policy proposal. The Task Force on Infant Mortality and Child Health completed a review of the scientific and historic literature, discussed issues surrounding the impact of the current Safe Haven law, cost and liability, education, and audience targeting. The Task Force recommended the following to the Commission on November 18, 2015: The state should instead 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. With regard to uniform signage at facilities, it should be strongly encouraged. However, the public would be better served by having a resource directory that lists all Safe Haven locations for their area. This information could be made available online or through local social service providers. The Commission voted unanimously in favor of three motions: 1. Not to endorse newborn safety incubators in HEA 1016 in the next legislative session 2. Support promotion of existing Safe Haven law 3. To assign to the Task Force on Infant Mortality and Child Health the study of liability and immunity issues for institutions who accept newborns as part of the Safe Haven law After considering potential procedures, protocols, and design standards, the ISDH concurs with the recommendations of the Commission. The ISDH will continue to work to promote the Safe Haven law with the Commission. The literature and data regarding outcomes from these newborn safety incubator 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 longerterm 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 boxes1. 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 neonaticide2 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 Europe3 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 barriers4 that preclude problem solving. Addressing those issues must be addressed upstream to the moment of desperation leading to unsafe abandonment.   1 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 or hot/cold temperatures.  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? Lehman V. Abandoned by parents. Children from the foundling wheel. Gynakologe 40(12):1009-1016, 2007 Klier C, Chryssa G, Gynmed CF, Brockington I. Anonymous birth in Austria-babies saved, where to go next? Archives of Women’s Mental Health 18(2):317, 2015 3 Meyer J. UN condemns ‘baby boxes’ across Europe. Christian Science Monitor:N.PAG, 2012 4 Erler T, Rohde A, Swientek C. The anonymous abandonment of a child – Realistic solution or a dangerous option? Padiatrische Praxis 77(1):1-8, 2011 2  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.