ile movies like Three Men and a Baby have glamor- W ized the notion of finding an abandoned baby on the doorstep, the reality of newborn abandonment has far-reaching

sociopolitical, psychological and economic implications and

consequences. The incidence of newborn abandonment, once again, is on

the rise. Women, overwhelmed with the belief they have no other option, are leaving their newly born infants in dump- sters, along deserted stretches of roadway and in public rest- rooms.

It’s almost impossible to determine the exact number of newborns abandoned each year. Over the years, no local, state or federal agency has kept these kinds of statistics. When a newborn is abandoned, they typically record such an act as an incident of child abandonment, neglect or endangerment, and, unfortunately, homicide with no easy way of sorting cases involving newborns from those of older children. Also, it’s believed that many more newborns are abandoned than actu- ally discovered either alive or dead. Therefore, only sketchy statistics exist on how many babies are abandoned in public places each year.

Trying to Count Relying on media accounts, the Department of Health and Human Services determined that 65 babies, 8 of whom-died, were born without the assistance of a health care professional and left in public places in 1991 to die or to be discovered by a stranger. By 1998, that number had increased to 105 such abandonments, including the 33 newborns that were found dead (Whitaker, 2000).

It’s important to note that these figures don’t represent the number of newborn infants left in hospitals by their families.

This statistic is more accurately recorded and is also rising. Officials estimate that approximately 22,000 babies were abandoned in the hospitals where they were born in 1991, many by drug-addicted or HIV-infected mothers. This number rose to 31,000 in 1998 (Whitaker, 2000).

Anonymous, public abandonment of newborns is also dif- ficult to track even after the baby has been found and placed in the care of a foster family, usually through child protective services.

Beginning life in a world without any identifying informa- tion or a social or medical history places these infants at an

immediate disadvantage. In most cases, the mother is never located and the baby is assigned a first name often associated with the circumstances surrounding the abandonment. For example, “Baby Patrick” was found in a sealed trash bag at the bottom of a dumpster suffering from hypothermia two days before St. Patrick’s Day. “Baby Trinity” was wrapped in a tow- el and left on the ground by an apartment by Trinity Boule- vard. And “Baby Noel” was left near a church during the Christmas holidays.

Lack of Research An extensive search of health-related literature fails to yield any nursing studies or accounts of the phenomenon of new- born abandonment. The majority of information and research studies related to this topic can be found in the disciplines of sociology and psychology. Interestingly, most of these formal studies have been conducted in countries such as China, France, Russia and Argentina. Research studies conducted in American cities have been largely retrospective, historical accounts of a specific era.

Newborn abandonment and neonaticide are generally believed to be horrific crimes in our society, seemingly unthinkable and contradictory to human goodness and caring. However, the practice of abandoning newborns shortly after birth has always existed.

Occurring in primitive and contemporary societies, the moti- vations for this practice are varied (Rascovsky & Rogers, 1995). Economic factors are often cited and include (Bloch, 1988),

poverty population control class structure greed profit exploitation of labor

Political climate and ideologies or philosophies of racial and eth- nic superiority also play a role in a woman’s decision-making

Sandra K . Cesario, RNC, PhD, is an assistant professor in the College of Niirsing d t Texas LVomaii’s University and chair of t h e AWHONN Practice Committee. She is a member of the Harris County Baby Abandonment Task Force and recently received a Parry Grant to study the phmomenm of newborn abandonment.

process when faced with an unwanted pregnancy and having limited options available to her in managing the situation (Green, 1999; Rosner & Markowitz, 1997).

Psychological disorders and mental instability also account for a portion of the incidents in which newborns are left in public places, disposed of in dumpsters and toilets or occa- sionally mutilated or murdered (Bonnet, 1993; Long, 1993).

Religious beliefs, both in ancient times and in modern day society, provide a moral basis for human action and shape the paradigm of what is acceptable behavior in a given society at a given point in time (Rascovsky & Rogers, 1995). Some reli- gions have practiced human sacrifice of infants while others have forbid abortion and murder.

Infants at Risk Overpeck, Brenner, Trumble, Trifiletti, and Berendes (1998) summarized the primary risk factors for contemporary newborn abandonment and homicide as maternal in origin relating to

age education postpartum psychosis ambivalence toward the pregnancy emotional health

This view is contradicted by psychologists who have found the phenomenon to cut across all social, racial and economic lev- els (Hurst, 2000). West (1999) suggests that demographic con- clusions are accompanied by blame and don’t address the familial and societal issues involving both men and women that may contribute to contemporary practices of newborn abandonment and neonaticide in the U.S.

French psychologist Catherine Bonnet (1 993) interviewed 22 female subjects between 1987 and 1989 using a psychoan- alytic methodology in an attempt to understand why women chose to take advantage of French law permitting anonymous, free delivery and immediate placement of the infant for adop- tion as an alternative to newborn abandonment. The inter- views revealed that the motives behind this choice stemmed from denial of the pregnancy and fantasies of violence toward the fetus resulting from psychological and sexual traumas experienced by the subjects during childhood.

In China, the increase in infant abandonment and infanti- cide during the 1980s coincides directly with regulation and

a4 AWHONN Lifelines Volume 5, Issue 5

enforcement of birth planning by the Chinese government. Johnson, Banghan, and Liyao (1998) surveyed 629 families and found that the biological father-typically in his late 20s to late 30s and of average education and income-most often made the decision to abandon the newborn o r young infant. Birth mothers frequently expressed emotional pain and remorse for the act but had no recourse or other options in the

~-

zine published an article towel in a gym bag discussing the study of

desperate mothers toward emergency rooms instead received a five-year sen-

school where she was born. In California, a 22-year-old woman hid her pregnancy, birthed the infant secretly in a motel room, placed the healthy live male infant on the floor of her car, and drove around for two days. When the infant felt cold, she believed he was dead and disposed of him in the trash. She received a seven-month jail sentence for willful cru- elty to a child causing injury or death. O n the other hand, an

parenting and abandon- of trashcans seems to be a straightforward and tence for child abandon- ment in primates and oth- er animals that offers

ment. In most states, if logical approach to this issue. However, the issue the father of the infant

clues to human behaviors. opens to examination some of our most sacred was also involved in the

beliefs about motherhood and has generated This type of study aids scientists in examining

act of abandonment, he too would be charged.

mothering strategies that work and identify situa- tions in which they break

opposition from several sectors of the population. To date, more than 30 states have adopted or are

down. A similar pattern of abandonment of young occurs in mice, birds, spiders, primates and humans when each species is faced with a wide variety of stressors (Kluger, 2000).

Legislative Actions Across the U.S., “safe haven” bills are being introduced in state legislatures to save lives by reducing the number of new- borns abandoned, as well as to change society’s view of the desperate woman who abandons her newborn from that of a criminal to one of a victim. Within this legislation is the notion that these women are a t the mercy of their life circumstances and require assistance in managing a difficult situation.

Until recently, newborn abandonment was considered a crime in most states and, if the woman was found, criminal charges were tiled against her. Depending o n the condition ot the baby when found, the woman’s state of residence and the specific charges filed against her, she may have received a sen- tence ranging from probation to life in prison.

For example, a 15-year-old adolescent in Texas was charged with capital murder, which carries a life prison sen- tence, for allegedly delivering seven blunt blows to the head of her living newborn and placing her in the trash at the high

considering legislation regarding newborn abandonment. A variety of bills have been authored and are supported by Republicans and Democrats alike. Prompted by 13 newborn abandonments in a 10-month period of time in the Houston area, Texas was the first state to sign such a bill into law on September 1, 1999. U.S. Represen- tative Sheila Jackson Lee worked closely with Texas State Rep- resentative Geanie Morrison to sponsor the legislation that now allows parents of babies up to 30 days of age to leave them with a health care provider, such as an emergency med- ical technician or a nurse. The Texas law doesn’t guarantee that a parent will not be prosecuted for child abandonment, but it does provide an affirmative defense. In Texas, the deci- sion to file charges against the parent is still up to the prose- cuting attorney. Other states, however, have passed bills that provide complete immunity to the parents if they surrender the child to another person unharmed and within a specified peri- od of time. These criteria vary greatly from state to state.

In New Jersey, Republican assembly members introduced a bill that would allow a woman to leave her baby at a hospital or police station to escape prosecution for abandonment. Oklahoma lawmakers have rewritten a bill setting new guide- lines for mothers who abandon their babies. The first draft of that senate bill received a veto from the governor.

Oc?ober/tVavember 200 1 AWHONN Lifelines 45

In April 2000, federal lawmakers passed a nonbinding res- olution that supports further study of the problem, urges agen- cies to accurately track cases of newborn abandonment and spurs policy makers to develop approaches to address this issue. While the resolution lacks the force of law, it’s an impor- tant “first step” in finding a solution (Lash, 2000).

Passing legislation to steer a very small minority of desper- ate mothers toward emergency rooms instead of trash cans seems to be a straightforward and logical approach to this issue. However, the issue opens to examination some of our most sacred beliefs about motherhood and has generated opposition from several sectors of the population (Williams, 2000). Some people believe that the bills are well intentioned but raise many questions about how effective they will be, how they will be implemented and whether they will send a message to some women that abandoning a baby is an easy way out. Other critics maintain that “legalizing abandonment” con- tributes to irresponsibility, fearing that it will be used as anoth- er form of birth control and may alleviate the need for safe sex.

Some health care providers also express a concern for women who may be suffering from postpartum depression and may elect to take advantage of the opportunity to abandon their infants at a time when they may not be able to think rationally about such a life-changing event. Also, allowing a new mother to walk away with “no questions asked” prevents prospective adoptive parents from tracing the infants’ medical histories and may cause fathers to unwittingly lose their parental rights. Allowing the woman to remain anonymous interferes with the opportunity to offer care to a woman who is obviously distressed and in need of assistance.

Community Efforts A number of community projects and initiatives have surfaced in an attempt to address various aspects of the problems regarding newborn abandonment. Each of these programs have unique missions that meet local needs and range from providing safe drop-off locations (not government designated) or enhancing community awareness and resources to provid- ing burial arrangements for newborns who were left alone to die.

Project Cuddle, founded by Debbe Magnusen in Costa Mesa, CA, began as a project to equip police vehicles with soft toys to mitigate the emotional trauma to children who may be

taken into protective custody by local h w enforcement +r- sonnel. Since its inception, Project Cuddle has developed sev- eral other programs and events to aid chil-ne such pro- gram being The Baby Rescue Program. This branch of Project Cuddle offers a 24-hour hotline for women contemplating abandoning their infants. A seemingly successful endeavor, the agency claims to have prevented 155 abandonmmts since 1996.

In Calimesa, CA, Debi Faris initiated a program dealing with the worst outcomes of newborn abandonment. In May of 1996, Faris began tending her “Garden of Angels,” a quiet cemetery where she has now buried 38 abandoned babies. The babies are given a first name, and a funeral ceremony is per- formed. It has become her mission to provide the brief lives with a finale other than anonymous cremations or mass bur- ial-the fate that the majority of abandoned newborns face. Timothy Jaccard, president of Hope Foundation Infant Burial, Inc., offers a similar service in the New York City area where he has provided graves for more than 20 infants in the last year and a half.

In suburban Pittsburgh, Gigi Kelly, a nurse and a mother, established a community program called “Baskets for Babies.” When a newborn baby boy was left in a trash bag behind her church, Kelly found an old laundry basket, lined it with a warm blanket and put it on her front porch. Then she called reporters with a plea for young mothers to bring their babies to her. Although nobody has taken her up on her offer, her actions have sparked a public awareness campaign regarding the desperation suffered by women who are at risk for aban- doning their newborns. Now, some 608 Pittsburgh families, following Kelly’s lead, leave their porch lights on and have a basket ready to receive and unwanted newborn (Roche, 2000).

“Safe Places for Newborns,” a program under the leader- ship of the Rev. Andrew Cozzens of Minnesota, began when parishioners of the Cathedral of St. Paul persuaded local hos- pitals to allow women to anonymously drop off their new- borns, no questions asked. They also convinced local district attorneys to not prosecute women for abandoning their babies. This program was the basis for the recently passed Minnesota law governing this issue. Safe Places for Newborns spread to other states such as Alabama and spurred legislation in those states as well.

In Texas, the Harris County Baby Abandonment Task Force was formed in 1999, under the direction of Representa- tive Sheila Jackson Lee. This consortium of individuals and

46 AWHONN Lifelines Vblume 5, lssue 5

agencies has come together to promote community awareness, study the problem and support legislation addressing the issue. The task force is now in phase two of “The Baby Moses Project,” which is a community-awareness campaign consisting of billboards in English and Spanish, media cover- age and the availability of a 24-hour hotline regarding new- born abandonment.

Internationally, community and governmental programs are springing up in response to needs very similar to what is being seen in the U.S. In Germany, Social Services offices have installed “baby drops.” The project, dubbed “Operation Foundling,” allows a mother to place her newborn through a door onto a warmed bed. An alarm is sounded summoning a nurse to care for the infant. There is no attempt made to iden- tify the person dropping off the infant. If the infant is not reclaimed in two months, the baby is placed for adoption. A similar program entitled “The Door of Hope” operates through the Baptist Church in South Africa. And since the 1940s, women who give birth in Italian hospitals have had the opportunity to walk away from their newborns with no ques- tions asked (ABC News, 2000).

Implications for Nurses Nurses can play a multifaceted role in preventing and manag- ing newborn abandonment. Impacting practice, creating edu- cation needs for patients and communities, opening new doors for advocacy for women and children, and creating opportu- nities for research-newborn abandonment has added a new dimension for nursing. As the laws are currently being written in most states, any nurse in any type of health care setting could be the recipient of a newborn infant that the mother is voluntarily relinquishing with no questions asked. Would you know what to do?

First, because the status of the laws in each state is different and frequently changing, it’s extremely important for nurses to keep abreast of the status of current law and its implications for ntirscs. Institutionnl policies reflecting c~i r rc i i t I J I V should then be developed.

While m,iternity units, Lvith their espertise in caring for new mothers and newborns, might be responsible for drafting a policy to address this issue, all areas of the health care agency should be informed and know what to do when a newborn is being abandoned. Although laws in most states don’t require

States Where Laws Have Been Passed or Are Pending

Laws Passed: Texas Minnesota Alabama Georgia

Legislation Pending: California Colorado Delaware New Jersey New York Florida Pennsylvania Maryland Michigan Missouri Connecticut Illinois Kentucky Mississippi West Virginia New Mexico Ohio Oregon Wisconsin Oklahoma Washington, DC

it, most social service agencies are requesting that nurses or other health care providers receiving a newborn attempt to get as much information as possible. Information about the social and medical history of the infant, birth information and possi- bly identification or description of the person handing the baby over to officials will be helpful in meeting the needs of the baby and aid in placing the infant with an adoptive family.

Such institutional policies should also contain information about where the baby is to be taken, how to notify law enforcement, how to deal with the media, what information should be documented and where, and how to report the inci- dent to state authorities so accurate statistics on these events can be recorded.

Second, nurses can contribute to the development of pre- vention programs and other community action plans. It’s important that nurses become familiar with the needs of the community in which they live. Community education is essen- tial if newly enacted laws are to be effective. Reaching women who are distraught about a pregnancy and who may likely abandon their newborn is difficult as such women typically don’t seek or receive prenatal care. Nurses need to be creative in reaching women in other ways, such speaking in high schools and at church functions, sponsoring media campaigns, or empowering hairstylists and manicurists to share informa- tion regarding the new laws with women.

Also, nurses can serve as an advocate for women and new- borns. Better screening for emotional distress and social prob-

AWHONN Lifelines 47

I GettingAll the Facts

Finally, more research is needed to identify which women might be at risk to abandon a newborn and why. Nurses, car- ing for women every day, are in a unique Position to answer these questions and implement research programs to find addi- tional answers. Even if the nurse is not a researcher, she or he

U. S. News Online, Policies to Stop Moms from Abandoning Babies: www.usnews.com/usnews/issudOO0228/abandon.htm

Project Cuddle. California: www.projectcuddle.org

“Safe Haven” Program in South Africa: http://fifamerica.faithweb.com/ARTICLES/1999DECEMBER/Artl6.htm 0ASIS:A Haven for Women and Children, New York City: www.oxygen.com/pureoxygen/tvcontent/pure~~~~content2S.html

Arizona Republic: Help for Desperate Mothers: www.azcentral.com/opinions/kidsedit3.shtml

Safe Place for Newborns,Alabama: www.helpline-ir.or&11341 .htm

Safe Place for Babies Act, Georgia legislation: www2.state.ga.us/Legis/l999~00/leg/fulltext/hb1292.htm

Long, R. (1993). Abortion, abandonment, and positive rights: The limits of compulsory altruism. Social Philosophy and Policy, 10, 166-191.

Overpeck, M., Brenner, R., Trumble, A., Trifiletti, L., & Beren- des, H. (1998). Risk factors for infant homicide in the United States. New England Journal of Medicine, 339,

their families and society. + References

ABC News. (2000, March 12). Saving our children, ABC News Special Report, 5:OO p.m. News.

Bloch, H. (1988). Abandonment, infanticide, and filicide. An overview of inhumanity to children. American Journal of Disabled Children, 142,1058-1060.

Bonnet, C. (1993). Adoption at birth: Prevention against aban- donment or neonaticide. Child Abuse and Neglect, 17, 501-513.

Green, E. (1999). Infanticide and infant abandonment in the New South: Richmond, Virginia, 1865-1915. Journal of Family History, 24, 187-211.

48 A W H O N N

of children by parents. Northvale, NJ: Jason Aronson. Roche, T. (2000, February 21). Law: A refuge for throw-

aways-The spate of “Dumpster Babies” stirs a move- ment to provide a safe space for unwanted newborns. Time, p. 50.

Rosner, D., &L Markowitz, G. (1997). Race, foster care, and the politics of abandonment in New York City. Ameri- can Journul of Public Health, 87, 1844-1849.

West, S. (1999). Risk factors for infant homicide. New Eng- land Journal of Medicine, 340, 895.

Whitaker, B. (2000, March 6). A woman’s quest: Bury fewer angels. The Austin American-Statesman, p. A-2.

Williams, M. (2000, February 4). Babies in the trash. The Washington Post, p. A-31.

Volume 5, Issue 5