Nearly
three years ago, the Magazine reported on the Finnish baby box - a starter kit
of clothes, sheets and toys the state gives to expectant mothers. The story
went viral and was read by 10 million people in 18 months. Now the box idea
itself is spreading around the world.
It's a tradition
that dates back to the 1930s. Every new mother, regardless of background or
income, gets a baby box from the government. The box contains a stash of
supplies - bibs, bodysuits, nappies, a sleeping bag, outdoor gear, bathing
products - as well as a small mattress. Putting the mattress in the bottom of
the box creates the baby's first bed.
It has been
credited with helping Finland achieve one of the world's lowest infant
mortality rates.
More publicity for the idea quickly followed when the
Finnish government gave a baby box to the Duke and Duchess
of Cambridge, who were then expecting their first
child. Soon afterwards, three fathers in Finland set up a business to supply
boxes to customers all over the world. Two women in the US did the same thing.
There is now a similar business in the UK, and there may be others elsewhere.
It was such a simple idea, and apparently so effective, that health
professionals and social entrepreneurs also wanted to put the box to the test,
in some cases teaming up with one of these private suppliers.
Often the
contents of the box or the way it is distributed are designed to address local
problems, from preventing infection to getting the baby out of the parents'
bed, where there may be a risk of suffocation. And in some cases one of the key
goals is - as it was in Finland in the early days - to encourage expectant
mothers to attend antenatal clinics.
Two South
African entrepreneurs, Ernst Hertzog of Action Hero Ventures and marketing
executive Frans de Villiers, concluded that a plastic box, that can be used as
a bath rather than a bed, was more useful for South African mothers.
But the main objective was to get mothers to antenatal classes, and a
trial carried out by a team from Stellenbosch University last year concluded
that the Thula Baba Box, as it is known, encourages mothers to attend clinics
at an earlier stage of pregnancy, and to attend more frequently. Among other
things, this reduces the risk of an HIV-positive mother dying in childbirth,
and reduces the risk of HIV being passed from the mother to the baby.
De Villiers and
Hertzog are keen for the project to be rolled out across the Western Cape
region, and hope that it may one day become a national programme.
"We thought
the Finnish box was an amazing example of design that changed a nation,'' says
Hertzog. ''We hope that, given some tweaks, our product will have just as much
of an impact.''
A doctoral student at Harvard University, Karima Ladhani, had a similar
idea about adapting the Finnish box for use in South Asia. She developed the
Barakat Bundle project (Barakat means "blessing" in some regional
languages) which has now swung into operation at a rural hospital in Jagadiya,
India.
The box includes
a clean-birth kit to prevent infection during or soon after delivery and a
mosquito net to protect babies against malaria.
"We wanted
to provide low-cost life saving solutions to new mothers - specifically
targeted to causes of preventable infant and maternal mortality," says
Ladhani,
But it's not
just in developing countries where infant mortality is a concern.
A pilot baby box
project is being launched this month at Queen Charlotte's and Chelsea Hospital
in London, in collaboration with the US company, Baby Box Co, which says the
education component of its programmes is "crucial" to their success.
"We take it
for granted people have money for a separate sleeping cot or Moses basket but
that might not be the case," says Karen Joash, the consultant obstetrician
and gynaecologist behind the plan.
She also thinks
the box will enable mothers to keep the baby in the same room with them,
because it is so easy to carry, "which is good for bonding," she
says.
About 600 boxes will be given to all women who give birth at the
hospital over the next few months.
There are dozens
of projects under way in US states, but the biggest will launch later this year
in Fort Worth, Texas, when all four of the city's hospitals start handing out
baby boxes in an attempt to bring down the high infant mortality rate of 7.1
per 1,000 births in 2013. This compared to 5.9 per 1,000 births in the US as a
whole.
About 36,000
boxes are expected to be handed out over the next two years. Here a key
objective is to encourage parents not to sleep alongside their babies, in the
same bed.
"We
realised the community wasn't aware infant mortality was a big problem
here," says Dyann Daley, of Cook Children's Hospital System.
"Our goal
is to provide a box for every live birth in the city and give babies a safe
sleeping environment because that is critical to preventing suffocation
deaths."
A baby box project is also about to get under way in Australia, in the
state of Victoria, and the province of Alberta in Canada has been running a
pilot project since October 2015.
Karen Benzies, a
professor of nursing at the University of Calgary, says the original intention
was to target vulnerable families, but they soon realised "the idea of
vulnerability that most people have around low income doesn't necessarily hold
true in Alberta". It's a province that has done well out of the oil and
gas industry, but when men stay away working on oil rigs for weeks at a time,
that creates a different kind of problem - as new mothers are left alone with a
new baby.
"Our goal
is to support first-time families transitioning from pregnancy to
parenting," says Benzies.
A key element of
this is mentoring. Every mother and father has to identify a mentor who agrees
to be in contact - via phone or in person - about 20 times from when the mother
is 32 weeks pregnant to six months after the birth.
"We find in
Canada that family and friends see a problem, but don't want to, or are told
not to, interfere," says Benzies. "And we wanted to change
that."
So far about 50
boxes have been distributed, with 1,500 more ready to go.
Another innovation in the Canadian boxes is a "crib-side
assistance" booklet for fathers, to encourage them to bond with the child.
Modelled on a car-repair manual it provides a do-it-yourself guide to burping
("You know how good it feels to burp sometimes?") underlines the
importance of "fuel" (mother's milk) and explains how to "look
under the hood" for those inevitable nappy problems, because "keeping
your new model clean and comfortable is important".
The Finnish
government says it is aware of the global interest in their baby boxes and
often provides consultation to other countries. It now gives presentations at
embassies around the world.
But not everyone
is convinced the box is the best way forward.
Colin Pritchard,
a professor at Bournemouth University who has studied child and infant
mortality, says the box system makes some "theoretical sense", as it
provides the baby with somewhere to sleep other than the parents' bed and could
therefore reduce the number of deaths linked to suffocation.
But he believes
the effect will be marginal. Alleviating poverty, stopping parents smoking, and
improving education and antenatal care - all these things are more fundamental,
he argues, in tackling the problem of infant mortality.
If confirmed, this is a world first that offers hope
to infertile men to have more children one day thanks to reproductive health.
For the first time, complete human sperm would have been obtained by culturing
in vitro cells taken in the testes of men unable to produce naturally.
