The Finnish Baby Box Is Becoming Popular Around the World

But does a cardboard bassinet actually reduce infant mortality?

Baby in Pip & Grow's Smitten box (Pip & Grow)
smithsonian.com

Beginning around my seventh month of pregnancy, I began to obsess about where the baby would sleep. My husband and I wanted to follow the American Academy of Pediatrics’ safe sleep recommendations, which call for parents to share a room with their baby for the first year, ideally, to reduce the risk of Sudden Infant Death Syndrome (SIDS). But the bedroom in our tiny Hong Kong apartment didn’t have room for a crib, and it seemed ridiculous to spend hundreds of dollars on a bassinet we’d only use for such a brief period.

An old friend in the U.S. solved my problem by mailing me a cardboard box containing…another cardboard box. Fitted with a tiny mattress, the box would become my son’s bassinet for the first several months of his life.

This box was a version of the so-called “Finnish baby box.” Since the 1940s, every pregnant woman in Finland has been gifted a baby box by the government. All she has to do in return is attend a prenatal clinic before her fourth month of pregnancy. The boxes contain about 50 items of baby gear, including a snowsuit, socks, diapers, a bath towel, a thermometer, a picture book and (for the parents) a pack of condoms. Once the items are taken out, the box can be used as a bassinet.

The baby box program was begun as an attempt to reduce Finland’s once-high infant mortality rate. In the 1930s, about 65 out of every 1,000 Finnish babies died in their first year. Poor families didn’t have money for proper clothes, and many parents slept in bed with their infants, a risk factor for SIDS. The box was meant to provide all Finnish babies with an equal start, including a safe separate sleeping space. Today, Finland’s infant mortality rate is about 2.5 babies per 1,000, one of the lowest rates in the world.

Lately, the baby box has been catching on in countries far from Finland. Some public health experts see it as a way to reduce the SIDS rate, others are skeptical, while an increasing number of parents simply appreciate its low cost and portability.

Starting this year, Scotland is offering free baby boxes to all new parents. The boxes contain baby care items similar to those that come in the Finnish boxes. From England to Canada to India, a number of hospitals and municipalities have begun offering free baby boxes as well. There are also various public health projects in the works to bring baby boxes to disadvantaged mothers in the developing world, including Barakat Bundle, a baby box full of items specifically useful in a South Asian context, including a clean delivery kit, and South Africa’s Thula Baba Box.

In the U.S., three states—Ohio, New Jersey and Alabama—have recently started offering baby boxes to parents of all newborns, in exchange for completing some online educational materials about safe sleep. The boxes are provided by Baby Box Co, a California-based company that offers its own take on the Finnish baby box. It also sells boxes directly to the public, as do a number of other recently launched companies from the U.S. to France to Australia.

“I think parents appreciate the simplicity of the idea,” says Kate Compton Barr, of the rise of baby box companies. “In a time where everything comes with 45 bells and whistles and connects to Wi-Fi, baby boxes represent a simpler, back-to-basics solution.”

Compton Barr is a co-founder of Pip & Grow, a baby box company that both sells boxes to the public for about $70 each and partners with community organizations to offer free or discounted boxes. Compton Barr is a public health researcher, while her business partner, Amber Kroeker, is a safe sleep expert. As part of her job, Kroeker reviews situations where babies died and looks to see if anything could have prevented that death.  

“[Kroeker] saw babies dying because parents didn’t have a convenient safe sleep space,” Compton Barr says. “That’s unacceptable. As a mom, I cry at the mere thought of another mom losing her baby. Don’t get me started on what happens if I think about losing my own. We have to do better by parents.”

The SIDS rate is highest in the first six months of life, Compton Barr says, which is exactly when parents are the most exhausted and the least equipped to make safe sleep choices. Tired parents will often let their babies sleep in places like bouncers or on cushions or couches, which are known to be less safe than cribs, even when there’s a crib in the house. Giving families a light, portable place to place a baby may make it more likely that parents follow sleep guidelines.

The United States’ high infant mortality rate makes safe sleep a pressing public health issue. In the U.S., infant mortality is about 5.8 babies per 1,000, more than twice Finland’s. It’s a higher rate than any other wealthy developed nation, just above Serbia and below Bosnia and Herzegovina. But whether baby boxes can help reduce the number of babies dying in a significant way remains to be seen. Some of the problems that lead to America’s relatively high infant mortality rate are deeply rooted and don't have simple solutions.

Racism is one of these roots. Black infants in America die at twice the rate of white infants. SIDS rates among black and Native American babies are about twice as high as among white babies. Poverty and its attendant ills account for some of this. But some studies have shown that wealthy, highly educated black women still lose babies at a higher rate than uneducated white women. This has led some to wonder whether racism itself may lead to things like premature birth and low birth weight, both of which are risk factors for death in the baby’s first year. Perhaps the chronic stress of discrimination and segregation can cause biological changes in the mother that make babies more likely to be early, small or sick.

It’s also not clear how much of Finland’s drop in infant mortality was due to the baby box itself, and how much was due to improving prenatal and postnatal care. In Finland, the baby boxes were a symbol of the country’s larger effort to combat social inequality, an effort which eventually included the establishment of a universal public health care system. The United States lacks such an effort. So while baby boxes may remove some risk factors, they don’t make up for the larger inequalities experienced by ethnic minorities and the poor in America.  

Still, no one doubts that an inexpensive, safe, portable sleeping place for babies is a good thing for both parents and babies. As for us, our son is now too big to sleep in the box, so we use it to store toys. And when we no longer need it for that, there will be no need for Craigslist or a landfill. We'll just unfold it and pop it in the recycling bin. 

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