The Baby Box and Infant Mortality
The aim of family policy in Finland is to create a safe environment for children to grow up and to provide parents with the material and psychological means to have and raise children. These services include financial support which comes in the form of the following:
- Maternity grant: maternity package or cash lump sum.
- Maternity, paternity and parental allowances and child benefits and housing supports.
The maternity package granted in 1938 has been reformed by the Finnish government and a number of legislatively changes have been made between 1938-2014.
These include the following:
- In 1949, the package was given as standard to all expectant mothers who visited a doctor before the fourth month of pregnancy as per the Finnish Maternity Grants Act. A baby bottle was added to the package, but was removed in later packages to encourage breastfeeding. The requirement to visit a doctor as a prerequisite to receiving the package was done in order ensure that the woman received adequate prenatal care.
- The Health Care Act (2010)
- Government Decree (2011) on maternity and child health clinic services, school and student health services and preventive oral health services for children and youth.
- Child Welfare Act (2007)
- Social Welfare Act (2014)
The package contains children’s clothes and other necessary items, such as nappies, bedding, cloth, gauze towels and child-care products. The box containing the package transforms into a crib in which many newborns have their first sleep. A mother may choose to take the maternity package, or a grant of €140, however 95% of Finnish mothers choose the box.
The maternity package is not a commercial product and the contents are updated every year.
Ireland 2016: University Maternity Hospital Limerick (UMHL)
During the programme mothers are asked to complete e-learning modules and on completion are provided with a free baby box for their infant to sleep in. The online training element is available in 17 languages.
The baby box is made from a durable cardboard and can be used as a newborn’s bed for up to the first eight months of their life.
The box also includes baby clothes, a firm foam mattress, waterproof mattress cover, cotton sheet and advice on recorded tutorials made by UMHL staff on reducing SIDS risk, improving parental bonding, and making the transition to parenthood. At its launch in September 2016 Dr Mendinaro Imcha, Consultant Gynaecologist/Obstetrician, UMHL, said the programme, “is a proactive approach to improving the health and safety of the newborn child and parents”.
We are combining tradition with current technology and supporting the newborn child’s family with online educational material covering a broad range of essential topics on ante and postnatal care, ” she continued.
Literature review regarding the impact that the baby box has had on infant mortality
No studies were found to support the claims, being made by the popular media, regarding the impact that the baby box has had on infant mortality. While many of the media articles refer to the baby box as being credited with the reduction of infant mortality rates in Finland, none of them quote a source for this statement. In addition to this, no studies pertaining to the frequency of use of the baby box as a sleep space were found.
The BMJ published an article reviewing the baby box initiative in April 2017. Aside from one Finnish paper in the 1950s, there has been a “dearth of research” since then. In relation to the recent decision by the Scottish government to pilot the baby box scheme, the author of this BMJ piece questioned: “What academic research has the Scottish government commissioned to show that the box will help child health and deprivation? None.”
The National Paediatric Mortality Register at CUH, Temple Street, noted that from 1980 – 2004 the sudden infant death syndrome (SIDS) rate in Ireland dropped by 76%, a fact which they attributed primarily to the Back to Sleep campaign.
The benefits of the baby box initiative
The baby box initiative has certainly captivated the imagination of the media and in doing so, has brought a lot of media attention to the issue of safe sleep. It has highlighted that babies need to sleep in their own space, within their parents bedroom. The introduction of the baby box in Ireland and internationally has raised awareness of infant mortality rates and the need for all healthcare professionals, policy makers, parents and indeed, society, to implement necessary changes to keep these rates as low as possible.
The cost of the baby box
The Scottish government have committed to implementing the baby box initiative at a rate of 60,000 boxes per year, and a £7 million estimated cost per annum. As the birth rate in Ireland in 2015 was over 65,000, the cost would be higher if a similar scheme were to be piloted here.
The implication that the baby box is responsible for the low infant mortality rate in Finland is not supported by evidence. In the 1930s, Finland had a very poor economic climate, with many infants dying from poverty, poor nutrition and infection. Finland has emerged from this to become one of the most affluent and developed countries in the world. It has an excellent social welfare system and boasts superlative antenatal and postnatal care. Surely these factors have had more of an impact on infant mortality than the mere introduction of a box? Interestingly, an even greater reduction has been seen in infant mortality rates in Ireland over the same period of time, with no baby box intervention.
It is well-recognised that the safest place for a baby to sleep is in a cot, in the parental room, for at least the first six months of life. Babies should be put on their backs to sleep, with their face and head uncovered, and the cot and the mattress should be in good condition.
A literature review found no studies to assess the safety of the baby box, or to support the claims made by the popular media regarding its impact on infant mortality. There is no evidence to support that the positive health outcomes attributed to the baby box are solely due to this intervention.
The potential for corporate ties and the use of the baby box to sell baby products to postnatal parents, who may be a vulnerable group, is also a cause for concern and this issue would need to be addressed should the baby box initiative be introduced across Ireland.
McCartney M. (2017): Cool and cute—but cost effective? BMJ 2017; 357 :1766