Her gift — a cardboard box where the baby can sleep for his first six months — came loaded with swaddles, a first-aid kit, a rubber duck thermometer to test water temperature, diapers, and tea and sanitary pads for her.
Baby boxes, which were started in Finland 80 years ago and helped to substantially reduce the country's infant mortality rate, according to the government, are now coming to the United States through nonprofits, community health organizations and private entities.
“I’m a first-time mother, and I work full time, but I’m actually low-income,” says the 24-year-old Formel. She received her box through the nonprofit Berkshire Baby Box organization, which connects new moms and dads to local resources.
In Finland, all families are given baby boxes — or cash grants if they prefer — as long as the mother is receiving prenatal care. The country's infant mortality rate decreased from 65 deaths for each 1,000 children born in 1938 to an estimated 2.5 deaths per 1,000 births in 2016, less than half the U.S. rate of 5.8.
The program, enacted in 1937, was initially meant for low-income mothers. The Finnish government was looking for a way to better support babies and families when the child mortality rate was high and the birthrate had dropped, said Kiti Laitinen, coordinator of family benefits at Finland's social services institution, known as Kela. The baby boxes not only provided material support but also helped connect families with health care and social services.
Formel received her box after taking part in several online tutorials offered by Baby Box University, an educational offshoot of the for-profit Baby Box Co., which uses nonprofits to distribute the boxes. People can buy a box for $70 to $225 from the company, which also sells clothes, linens and other items.
The tutorials include information on safe sleep, nutrition and prenatal health. Once Formel completed the training sessions online, she received a voucher and was able to pick up her baby box, distributed in her region by community organizations and hospitals.
“For someone who is super financial insecure, what are you going to do if you can’t afford a crib or a bassinet or something?” she says.
Rachel Moon, a professor of pediatrics and a SIDS researcher at the University of Virginia School of Medicine, notes that the baby box in Finland is tied to the national health-care system, which includes free health care for the mother and child as well as home visits by health-care professionals during the first weeks of life. But a similar arrangement is not available in the United States, she said, and because the boxes have never been studied, it’s unclear what factors are most important in improving child health.
“This is a vastly different program than what the Baby Box Co. is doing,” she said of the Finnish program. “It may be the prenatal care or the national health care or the home visits, or all of these or none of these. However, we will not know because nobody wants to study this. This is very frustrating.”
Although there have been no studies tying the boxes to reducing sudden infant death syndrome or other hazards, Fares Diarbakerli, an OB/GYN in New Jersey, said the boxes are a way to help ease new moms into motherhood. Diarbakerli said he doesn’t believe there are any risks associated with the box as long as the parents are educated on proper ways for the infant to sleep in the box.
The Baby Box company says that the opportunity for parent education offered along with the boxes is a useful way to improve child and maternal health.
Jennifer Clary, the chief executive of Baby Box, started the company with her best friend in 2013. Today the company, headquartered in Los Angeles, partners with hospitals, government agencies and nonprofit organizations. Alabama, Ohio, New Jersey and Texas offer free boxes, and local programs, including ones in Virginia and the District, also give them out.
“The thing about the Finnish program is that one of the reasons it works is because it’s universal,” Clary said. “If you actually look back at other health-care interventions targeting infant and maternal health issues, historically no matter if it’s a baby box or anything else, if you do a targeted health-care initiative, the most vulnerable families you are trying to reach feel stigmatized, and so you don’t actually engage them on the same level as affluent people, who wouldn’t need it as much anyway.”
Baby boxes, Clary says, are the “great equalizer.” It’s not the boxes themselves that have reduced infant deaths, she notes, but the increased prenatal engagement and knowledge that soon-to-be moms and new moms obtain from the health-care providers.
Clary said the cost to produce the baby boxes varies widely by territory and its contents. She declined to give financial details, calling that proprietary information. The company has three revenue streams: individual consumers, partner organizations that buy the boxes (typically hospitals and corporate health programs) and community programs financed by nonprofits, government agencies and private contributions.
Amanda Frigon, who had her daughter, Avalea, in August, says the tutorial information she received from the Baby Box University could “make or break” a new mother.
“I think it’s pretty awesome that Finland gives them to every single mother before they have their child,” says the 29-year-old from Massachusetts. “We don’t do anything like that for expecting mothers in this country. We don’t really do much in the way of trying to help new mothers, so if that started happening here, I think it would definitely be a bonus to any expecting moms.”