Boarder Babies, Abandoned Infants, and Discarded Infants
Often no distinction is made between the terms "boarder babies," "abandoned infants," and "discarded infants." In the interest of clarity and consistency, this fact sheet will use the U.S. Department of Health and Human Services (DHHS, 2001) definitions:
- Boarder babies are infants under the age of 12 months who remain in the hospital past the date of medical discharge. Boarder babies may eventually be claimed by their parents and/or be placed in alternative care.
- Abandoned infants are newborn children who are not medically cleared for hospital discharge, but who are unlikely to leave the hospital in the custody of their biological parents.
- Discarded infants are newborns who have been abandoned in public places, other than hospitals, without care or supervision.
In 1991, James Bell Associates conducted a nationwide study of boarder babies and abandoned infants commissioned by the Children's Bureau of DHHS. The increased availability of services through child welfare and the Abandoned Infants Assistance (AIA) Act demonstration program, as well as nationwide declines in crack/cocaine use as reported in the 1996 National Household Study of Drug Abuse (as cited in DHHS, 2001), prompted DHHS in 1997 to commission a follow-up study. This study, 1998 National Estimates of the Number of Boarder Babies, Abandoned Infants and Discarded Infants, was designed to evaluate the effect of these changes on the boarder baby and abandoned infant populations. The report also attempted, for the first time, to capture data about discarded infants.
Nationally, the number of boarder babies rose by 38% from 9,700 in 1991 to 13,400 in 1998. This increase represented an expansion of the problem beyond major urban centers. In 1991, three cities (New York City, Chicago, and Los Angeles) accounted for 47% of the boarder baby population. In 1998, those cities accounted for 27% of the boarder baby population, while the number of boarder babies in the rest of the country increased by 90%. The racial/ethnic make-up of the boarder baby population also shifted. The percentage of boarder babies who were African-American declined from 75% in 1991, to 56% in 1998, whereas the Caucasian and Latino boarder baby populations almost doubled in 1998 (DHHS, 2001).
Substantial improvements were made in reducing the mean length of stay past medical discharge. The mean number of days declined from 22 in 1991 to 9 in 1998. The percentage of babies who remained in the hospital longer than 21 days declined from 24% to 12% (DHHS, 2001).
The abandoned infant population increased 46% from 11,900 in 1991 to 17,400 in 1998. In 1998, the abandoned infant population became more widely dispersed throughout the country, accounting for much of the increase in the abandoned infant population. In New York, Los Angeles, and Chicago, the number of abandoned infants increased 11%. However, the number of abandoned infants in the rest of the country increased 64%.
There was no change in the length of stay for abandoned infants. The mean length of stay was 34 days in both 1991 and 1998. However, in 1998, there were small decreases in the percentage of abandoned infants who were drug exposed (from 78% to 72%), and those with low birth weights (from 76% to 71%). The percentage of abandoned infants born prematurely remained constant at 70% (DHHS, 2001).Discarded Infants
Research on the discarded infant population is limited. States are required to submit data to DHHS on the number of children who enter foster care due to abandonment. However, national statistics on the number of infants discarded in public places (e.g., dumpsters, trash bins, alleys, warehouses, bathrooms) are not kept (DHHS, 2001).
Currently data on the number of discarded babies is based solely upon newspaper accounts and other media reports (Dailard, 2000). In an effort to estimate the prevalence, DHHS (2001) used newspaper reports from the Lexis-Nexis database to estimate the number of discarded infants. In 1992, there were 65 reported discarded babies. In 1997, 105 were reported, representing a 62% increase. Of the total number of discarded infants in 1997, 33 were found dead, compared to eight in 1992.
Boarder Babies and Abandoned Infants
In order to understand the phenomenon of boarder babies and infant abandonment, one must understand the magnitude of the issues confronting the mothers of these children. The mothers of abandoned and boarder babies have very few resources and are often struggling with poverty; insecure or inadequate housing; physically, sexually, and emotionally abusive relationships; HIV infection; mental illness; and/or drug addiction (Curran, Bankhead, & Goldberg, 2000). Most of these mothers (63%) are willing to care for their infants, but Child Protective Services (CPS) determined that it was unsafe to allow the infants to be discharged to the parents (DHHS, 2001).
Substance abuse continues to be the most common factor in cases of abandoned infants and babies boarding in hospitals. Nationally, an estimated 5.5% of women used licit or illicit substances at some point during their pregnancy (Jansson & Velez, 1999). In comparison, the DHHS report found that of the children tested in 1998, 65% of boarder babies and 72% of abandoned infants tested positive for drug exposure. In 1998, of the boarder babies and abandoned infants that tested positive for substance-exposure, more than one substance could be identified in the system of each infant. Cocaine was the most frequently identified substance (DHHS, 2001).
At the beginning of the HIV epidemic in the United States, 7% of persons with AIDS were women. In 2000, there were 70,000 women living with AIDS in the United States, a majority of whom were also mothers (Forsyth, 2000; Centers for Disease Control [CDC], 2001). Perinatal transmission of HIV accounts for over 90% of pediatric AIDS cases in the U.S. and almost all (98%) of new HIV infections in children (Institute of Medicine, 1999). Despite the increase in the number of mothers with HIV infection nationally, the percent of abandoned infants and boarder babies testing antibody positive for HIV decreased between 1991 and 1998. In 1998, 4% of both boarder babies and abandoned infants tested HIV antibody positive, compared to 14% and 7% respectively in 1991 (DHHS, 2001).
The decrease in the percentage of boarder babies and abandoned infants that tested antibody positive for HIV coincides with the reported decrease in HIV infections among children nationally. Before 1995, 1,000 - 2,000 infants were born infected with HIV each year. However, improvements in information about transmission and methods of harm reduction, in conjunction with the introduction of prophylactic treatment, has reduced the number of infants born infected with HIV to 280 - 370 per year (CDC, 2001, November).
Due to the relatively small proportion of mothers who are identified or apprehended after having discarded their infant, research on the discarded infant population and their families is limited. Available literature indicates that individuals who commit acts of neonaticide and public abandonment are predominantly young, unmarried, physically healthy women who are pregnant for the first time and not addicted to substances (Kaye, Borenstein, & Donnelly, 1990; Oberman, 1996). There is no indication that this problem is limited to certain races, ethnicities, or incomes. The vast majority live with their parents, guardians
, or other relatives (Oberman, 1996). An even more fundamental similarity among these cases is the seemingly self-imposed silence and isolation during pregnancy (Oberman, 1996). Women who kill and/or discard their newborns generally made no plans for the birth or care of their children and did not receive prenatal care (Pitt & Bale, 1995). In the case of public abandonment, the women are often not mature enough to weigh thoughtfully their options or the consequences of their actions. Reasons for killing and/or discarding infants include extramarital paternity, rape, illegitimacy, and perceiving the child as an obstacle to personal achievements (Oberman, 1996).
Financial and Social Implications
Boarder Babies and Abandoned Infants
The plight of boarder babies and abandoned infants has not been a short-term problem as they continue to place demands on medical and child welfare systems. These infants not only affect the bottom lines of many hospitals, but also can diminish patient care, as the needs of boarder and abandoned infants potentially displace other infants in need of attention.
The average cost of care per day associated with boarder babies increased 17% between 1991 and 1998, from $478 to $570. However, the cost of care per boarder baby has decreased slightly in 1998 to between $2,280 and $5,130. This is in contrast to the cost per boarder baby reported in 1991 of $2,380-$10,472. The decrease in cost per boarder baby reported in 1998 may be attributed to the overall decrease in length of stay. In 1998, the estimated annual cost of care for boarder babies ranged from $30.6 million to $68.7 million; compared to $23.1 million to $101.6 million in 1991 (DHHS, 2001).
Finding suitable placements for boarder babies and abandoned infants continues to be a struggle. Children are entering the foster care system faster than they are exiting. Child welfare agencies, in their search for solutions to the overwhelming number of boarder and abandoned infants, contend with high caseloads, shortages in foster care placements, and a lack of substance abuse treatment programs for pregnant women (Maza, 1999). DHHS (2001) reports that 84% of abandoned infants, or more than 14,000 children, were expected to have an out-of-home placement. Of the reported 13,400 boarder babies, 66% were expected to have out-of-home placements.
Developmentally, boarder babies and abandoned infants are "at-risk." Developmental problems for boarder babies and abandoned infants have a complex etiology. Perinatal substance exposure, other factors associated with parental substance abuse (e.g., no prenatal care, poor diet, inadequate housing, chaotic lifestyle), premature birth, low birth weight, medical conditions, and extended hospital stays place boarder babies and abandoned infants at-risk for a range of physical, social, and cognitive developmental problems (Frank et al., 2001; Curran, Bankhead, & Goldberg, 2000; NIDA, 1999).
To address this multiplicity of issues, expedited placement in home-like settings and early intervention services are needed to assist in helping boarder babies and abandoned infants to develop normally. DHHS (1999) maintains that the postnatal environment is probably more important than the prenatal environment in determining outcomes in child development. In fact, some researchers have found that appropriate early intervention services and stable home environments can help mitigate some of the effects of prenatal drug and alcohol exposure (Streissguth, Barr, Kogan, & Bookstein, 1996). Currently, it is estimated that special education and extra tutoring costing up to $352 million per year is provided to children born exposed to illicit drugs (DHHS, 1999).
Little information exists about discarded infants, making concrete conclusions about financial and social costs difficult to draw. A better understanding of the characteristics and circumstances of parents who discard their infants, and tracking the experiences of infants who are discarded would provide a more complete picture of the societal and fiscal implications of this problem. However, it is clear that the discarding and possible death of a newborn is of societal concern. Other issues and costs may include the emotional and physical health of the parents and the child, foster care, and adoption.
Boarder Babies and Abandoned Infants
In 1988, Congress passed the Abandoned Infants Assistance (AIA) Act (P.L. 100-505), which authorized the Children's Bureau to provide funding to support comprehensive social service programs to serve infants and young children affected by drugs and/or HIV and their families. The original objectives of the program included: (1) preventing the abandonment of infants and young children; (2) identifying and addressing the needs of abandoned infants and young children, particularly those with acquired immune deficiency syndrome (AIDS); (3) assisting infants, particularly those with AIDS, to reside with their natural families or in foster families, as appropriate; (4) recruiting, training, and retaining foster families; (5) carrying out residential care programs; (6) carrying out respite programs for families and foster families of infants and children with AIDS; and (7) recruiting and training health and social service personnel to work with such families and residential programs.
In 1991, Congress reauthorized the AIA Act, (P.L. 102-236) mandating that programs funded through the Act give priority to infants and young children who were prenatally exposed to dangerous drugs, as well as those infected with or exposed to HIV. It also promoted the concept of comprehensive service sites; or programs offering health, education, and social services
at a single geographic location in close proximity to where abandoned infants reside. In addition, it expanded the focus of the program to include prevention, encouraging the provision of services to all family members for any condition that increased the probability of abandonment. In 1996, the AIA Act was reauthorized for an additional four years (P.L. 104-235) under the Child Abuse Prevention and Treatment Act emphasizing expedited permanency
Since the passage of the AIA act in 1988, DHHS has funded over 65 demonstration projects and a National Resource Center. As of April 2002, there were 36 AIA projects: 22 comprehensive service demonstration projects, nine family support projects for relative caregivers, and four therapeutic recreation projects for children affected by HIV/AIDS, and the Resource Center.
Located in eighteen states (CA, CT, FL, GA, IL, LA, MD, MA, MI, MO, NJ, NM, NY, OK, PA, RI, TN and WV) and the District of Columbia, these diverse programs operate out of hospitals, community-based child and family service agencies, universities, public child welfare agencies, and drug and alcohol treatment centers.
Since 1990, the AIA demonstration projects have had far-reaching effects on the lives of children and families. Generally, parents are better able to care for their children because of AIA programs. For example, mothers were more likely to have their children residing at home after completing AIA project services than mothers who did not. Evaluations have shown that the AIA programs have increased the permanence and stability of caregiving; been instrumental in expediting hospital discharges; monitored child safety and taught parents new child safety skills; facilitated participation in drug treatment programs; worked to eliminate child abuse and neglect within program families; helped to improve parent-child interactions; improved the well-being of the child and family; improved health outcomes; improved child development outcomes; improved maternal mental health; and improved living conditions for families (National Abandoned Infants Assistance Resource Center, 2002).
In response to highly publicized instances where infants have been discarded in public places and often left to die, a number of states, beginning in 1999, passed laws that offer a safe, anonymous, and lawful means to relinquish a newborn. These laws allow a parent to surrender a newborn anonymously under certain circumstances without the threat of prosecution. Variations by state include limits on the infant's age at time of relinquishment (72 hours - 1 year) and the people and places authorized to accept the infants (e.g., Emergency Medical Services, hospitals, fire stations, and police stations). Most state policies adopt a "no questions asked" approach, but some state policies require that a person accepting the infant ask for a medical history. These "safe haven" or "safe surrender" laws exist in 35 states, as of February 2002 (AK, AL, AZ, CA, CO, CT, DE, FL, IA, ID, IL, IN, KS, LA, MI, MN, MS, MT, NC, ND, NJ, NM, NV, NY, OH, OK, OR, RI, SC, SD, TN, TX, UT, WI, WV) (The Alan Guttmacher Institute, 2002).
The intent of these new laws is to encourage mothers, who might otherwise discard their children, to go to an emergency room or other safe place to drop off their infants. Proponents of safe haven legislation have argued that if even one child is saved these laws should be considered successful (Decriminalization of the Abandonment of Newborns, 2000). Others have raised issues regarding the implementation of these laws. For example, allowing a mother to leave an infant anonymously may not protect a father's parental rights. In addition, many of the safe haven laws do not require the person relinquishing the infant to provide a medical history, which could affect the adoption of these children and their long-term health (Dailard, 2000; American Adoption Congress, 2001).
The success of these laws is uncertain (Bernstein, 2001). For example, in Mobile, AL, nine children have been dropped off under their safe haven program (Pierce, 2002). In Texas, 12 infants were found discarded between the passage of a safe haven law in September 1999 and April 2000 (Martinez, 2000). Similarly, since the passage of Florida's legislation, one child has been legally dropped off, compared with 12 infants who were discarded (Lim, 2002). Lack of public knowledge about these laws may be a barrier to their utilization (Lim, 2002; Martinez, 2000).
The boarder and abandoned baby problem has not gone away, nor has chemical dependency and HIV. The problem may have intensified, with an increase in the number of boarder and abandoned infants and a wider distribution of the problem. Newly affected communities will need to develop innovative ways of addressing their emerging boarder baby and abandoned infant problem. However, the overall decrease in the median length of hospitalization indicates success, across systems, in expediting permanence for children. Further, in communities where AIA programs exist, there has been considerable success in preventing abandonment, and improving the lives of these children and their families.
It is difficult to identify women who are at greatest risk for discarding their infants. Our understanding of these mothers, their motivations, and their circumstances is extremely limited, making intervention a challenge. At present, public education about resources available to pregnant women and alternatives to discarding an infant remains the primary method for addressing this issue. In view of the lack of information, efforts to collect data about the circumstances and characteristics of parents who discard their infants, and tracking the experiences of discarded infants and those dropped off in safe havens are critical to addressing this problem.
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