Introduction: Healthy, safe sleep is important for child development and family well-being. Despite international safe sleep recommendations, sleep-related infant injury and death remain major concerns. However, adherence to guidelines may be influenced by contextual factors, yet data from low- and middle-income countries like South Africa is scarce, limiting development of tailored interventions.
Purpose: This study examined adherence to international safe sleep recommendations and underlying parental motivations among South African parents of infants (M age = 5 months), with the aim to inform contextually relevant interventions strategies.
Method: An online cross-sectional survey was completed by 203 caregivers (predominantly mothers, M age = 30 years). Measures included the Brief Infant Sleep Questionnaire and additional items on motivations for sleep practices. Descriptive statistics were used to assess adherence to recommended practices.
Results: Analysis revealed complex adherence patterns. While recommended practices such as room-sharing (86%) and providing breastmilk (84%) was typical, pacifier use was low (28%), and risky practices such as non-supine sleep positioning (67%) and bed-sharing for most of the night (61%) were prevalent. Bed-sharing was primarily motivated by managing infant sleep difficulties (96%) and ensuring child safety (91%). Feeding (67%) and bonding (61%) were also important drivers, while convenience (41%) and cultural and parental beliefs (40%) were secondary. Financial factors had a limited impact (11%).
Conclusion: Substantial disparities exist between global recommendations and South African practices, yet motivations for non-adherence were multifaceted and often driven by functional, emotional and contextual needs. This highlights a need for interventions that address parental motivation for bed-sharing and knowledge gaps on safety, educate on safer shared sleep practices, and offer feasible, culturally sensitive alternatives that support infant safety and family well-being.