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The “Miracle” of Finnish Baby Boxes May Not Be in the Box at All

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It’s hard to believe that in 2015, 4.5 million babies never even reached their first birthday. But according to the World Health Organization (WHO), the numbers are sadly true. The global infant mortality rate is a growing concern — one that has health officials thinking outside the box on how to solve it. Or make that inside the box.

The much-talked about Finnish “baby box” — a simple cardboard box that’s designed to be a baby’s first bed  has been credited with dramatically lowering Finland’s infant mortality rate since the 1930s. In fact, in the years since the boxes were first introduced, Finland has laid claim to the lowest infant mortality rates in the world. So they’re clearly doing something right.

But a recent BBC News report posed an important question that’s sparked a new conversation: Is putting babies to sleep in a simple cardboard box really what’s saving lives? Or is there more to the story?

To better understand infant mortality rates, you must first understand the primary infant mortality factors, which the CDC lists as: birth defects, preterm birth, maternal pregnancy complications, Sudden Infant Death Syndrome (SIDS), and injuries.

But therein lies the next question: If SIDS accounts for only a fraction of the infant mortality rate, Finland must be doing something other than placing their infants to sleep in boxes, right?

Yep; turns out they are. In fact, the country has made impressive strides over the last quarter century to dramatically improve maternal and child health.

Dr. Mika Gissler, a statistician at the National Institute for Health and Welfare in Finland, told BBC News that low-income Finnish women were among the first to be provided with baby boxes full of essential must-haves some 75 years ago, when prenatal care first became available.

And that’s not all.

“Women had to attend clinics early on in their pregnancy to qualify for the maternity package,” explained Gissler. “Their health could then be monitored throughout and after the pregnancy.”

The box alone doesn’t seem likely to matter.
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In other words, boxes were provided along with prenatal and postnatal care, which in turn had big impacts on new mothers and their children — but only for some. It wasn’t until 1944, when municipalities were required to provide prenatal and child healthcare to all residents, that things really began to improve throughout the nation. Within one year, prenatal care in Finland increased a whopping 55 percent! And within five years, baby boxes became available for all expectant women.

But it didn’t end there: According to Gissler, further reduction of Finland’s infant mortality rate continued into the late 1960s, when the national health insurance system paved the way for more hospital births. So while moms and babies indeed continued using the baby boxes, they were also receiving more comprehensive medical care at the same time.

That hasn’t stopped hopeful parents and health officials in the U.S. from jumping on the baby box bandwagon, though. In fact, Ohio, Alabama, and New Jersey now plan to distribute baby boxes to all state residents with newborns as part of a growing initiative to promote sleep safety. (With approximately 1,600 SIDS-related infant deaths occurring in 2015 alone, SIDS remains the leading cause of death for infants under 12 months old in the U.S. according to the CDC.)

But prenatal and child healthcare access in the U.S. remains an ongoing challenge — one that a baby box alone cannot solve. As Dr. Emily Oster, an economist at Brown University, told BBC News, we simply cannot underestimate the power of quality medical care, and all that comes with it:

“What often comes along with the boxes is some additional contact with somebody. It may be the healthcare assistant, a nurse, a social worker. The box alone doesn’t seem likely to matter.”

h/t: BBC News

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