A Box Reduces Infant Mortality?

Photo Credit: BBC News, Milla Kontkanen
Ladies and gentleman, the answer to all your early parenting fears and needs: a box. The media has been a buzz about boxes supplied to expectant mothers by the Finnish government and filled with such nursery necessities as baby clothing, nappies, nail clippers and a picture book. The boxes each include a small mattress and thus double as tiny beds too. It is claimed the boxes have reduced infant mortality since the late 1930s. Indeed Finland boasts one of the lowest infant mortality rates on the planet. The boxes are said to increase pre-natal care and more recently, breastfeeding rates. In other words, behold the miracle box!

 A simple cardboard box helped Finland reduce infant mortality UPI

How can a mere box keep infants from dying? Good question. Some suggest the very act of sleeping in the box prevents death:
Health officials have long warned parents not to place their infants in adult beds because it can put babies at risk of suffocation or falling in between the headboard and the mattress. UPI
The suffocation explanation is simply not reasonable given the rarity of suffocation and also the other well-known and documented factors surrounding infant mortality, namely pre-natal care and premature births.

No surprise, other experts point towards the fact mothers must visit a prenatal clinic or doctor early in pregnancy to get the box:
Mika Gissler, a professor at the National Institute for Health and Welfare in Helsinki, gives several reasons for this (reduced infant mortality) - the maternity box and pre-natal care for all women in the 1940s, followed in the 60s by a national health insurance system and the central hospital network. BBC News
It's reasonable to assume the boxes increased pre-natal care but what about breastfeeding rates? It won't surprise anyone familiar with the Baby Friendly Hospital shtick here in the US that baby bottles have been removed from boxes. Did the lack of free bottles discourage formula or was it the heavy pressure put on women to breastfeed? 

Huffington Post couldn't help mention the Finnish boxes but in true New Media fashion contained their comments (news article? teaser?) to a mere 47 words: For 75 years, Finland's expectant mothers have been given a box by the state. It's like a starter kit of clothes, sheets and toys that can even be used as a bed. And some say it helped Finland achieve one of the world's lowest infant mortality rates. HuffPo

So upon reading the illuminating 47 words we learn the free goodie boxes might help save infants but have no idea how. 

The most entertaining reader comment on HuffPo: 
We would have to create a department of cardboard boxes. They would hire 10,000 employees to write 20,000 regulations pertaining to the boxes. The boxes would require years of testing and clinical trails. By the time a box is approved it would be valued at about 200,000 per box because of all the government expense required to bring us the official approved box. If a box failed, we would spend months in congressional hearings and new box legislation would be introduced and we would start over again with another box. Some people would choose not to use the box and we would have to find a way to enforce box use. Parenting box use training would have to be required to ensure proper box usage. Eventually the Chinese would make the box and we would have toxic chemicals in the cardboard. Start the hearings and legislation again. Look at how our government works now and you know my sarcasm is actually not far from the truth. Most stores will give you a box if you ask. Why get government involved.
This anonymous libertarian missed a few things like how the media and health officials would report the boxes prevent childhood obesity, SIDS, ADHD, diabetes, learning disabilities and gaps in educational readiness skills. Then some mompreneur would offer customized, eco-friendly boxes with baby's name, organic cotton mattresses (up to California code) and chemical-free lavendar-infused baby body butter, etc. She'd name it something cloying like Baby Booty and end up at Mom 2.0, Evo, TED and land a book deal as the latest parenting expert.

As for the libertine commenter, he or she also missed the pre-natal care part. The local supermarket can supply a cardboard box but as of yet not a pre-natal exam. Manicure, vision test, flu shot, yes but no stirrups or ultra-sounds.

Does anyone else find this statement particularly chilling given the anti-formula climate right now?

Some people would choose not to use the box and we would have to find a way to enforce box use.

Are we enforcing breastfeeding? No but locking up formula along the narcotics in hospitals is not exactly encouraging to mothers. It's certainly not any way to treat a woman who due to any number of valid real-life reasons does not attach a baby to her nipples up to several hours a day for a year during which she remains the sole provider of nourishment for said child for the first six months. It might not be the best way to treat a new mom.

Yet it's just so convenient to pretend breast milk or  a bunch of cardboard and a few onesies keep babies alive and healthy. If you live in an impoverished region of the world then sure, a few devices and techniques, some inexpensive medicines could have a huge impact. Each year almost two million babies die on the day they are born, almost 99% of those babies are born in the developing world. Many die simply because they can't start breathing on their own although a simple inexpensive hand pump could save them. So when we talk about a powerful maternal gift bag, yes such a wonder exists and could save lives but it doesn't look like something your thoughtful auntie would wrap up for a baby shower.


Becky said...

Actually, cosleeping with a newborn increases the SIDS risk by several times, so I do think the box itself could make a difference. Probably not as much as the incentive to get prenatal care.

Polly Palumbo, Ph.D. said...

Hi Becky! True, there are some studies suggesting co-sleeping raises the risk of SIDS but then some do not or suggest the opposite. It is one of those intriguing areas of unknowns. Did you see that recent British(?) study that reviewed a handful of studies and reported co-sleeping raises the risk, if I remember correctly, especially among parents (esp moms) who smoke or are heavy drinkers? It's still unclear what causes SIDS and why co-sleeping might trigger it. I hope we'll have some answers soon.