This month, two groups announced they will soon be delivering so-called "baby boxes" to new parents in Ontario, initiatives inspired by a decades-old Finnish government program that has been a major public health success story.
The two groups, a non-profit organization and a U.S.-based company, are the latest to send their version of the famous Finnish giveaway to parents around the world – and, in some cases, make a profit along the way.
Finland launched its program in the 1930s, a time when the country was much poorer, infant mortality higher and fewer women sought prenatal care. According to Reija Klemetti, a researcher with Finland's National Institute for Health and Welfare, one of the reasons behind the program's creation was the high rate of syphilis among pregnant women. The government wanted to devise a way to get women tested early in their pregnancy so they could receive treatment and prevent serious harm to the baby and mother. By offering a free box of infant necessities on the condition that mothers received prenatal care, the program helped reduce infant mortality for babies. Decades later, baby boxes continue to be distributed and are seen as a "symbol for investing in children," Klemetti wrote in an e-mail.
Parents can choose to receive the baby box or a one-time cash payment of about $200. About 95 per cent of first-time mothers choose the baby box, while 60 per cent of mothers take the box when pregnant with subsequent children, Klemetti said.
The program does not accept corporate sponsorships. Companies can submit their items to government officials who will test and evaluate them.
On the other hand, Baby Box Canada is going in another direction.
The self-described non-profit organization, started by Toronto couple Romi and Edward Walker, will start sending boxes to Ontario parents who register this month and has plans to expand.
The boxes, which are not suitable for babies to sleep in, are filled with products provided by corporate sponsors, such as teethers, wipes, breast pads and a receiving blanket. In an interview, Edward Walker said companies provide products "as a goodwill gesture for the public and also as an opportunity to showcase their best products." The sponsors also provide funds to help operate Baby Box Canada.
Mr. Walker said they will continue to adjust the items in the baby boxes, with particular attention to sensitive issues around breast and bottle feeding. While groups such as the World Health Organization recommend against giveaways of formula or bottles to new mothers, as it is linked to reduced rates of breastfeeding, Walker said it's a "delicate balance." Baby Box Canada would like to include such items to parents on request.
Meanwhile, The Baby Box Co., a Los Angeles-based company, has plans to distribute its first baby boxes in Ontario in August.
Jennifer Clary, co-founder of The Baby Box Co., says in addition to providing infant-focused freebies, the boxes (which children can sleep in, too), also include educational components, and the company is developing partnerships within the health-care system to help ensure more women receive prenatal care and education. For instance, parents will have access to online educational materials and their doctors can check to see whether the families have viewed them, Clary said.
"We are trying to model this on the Finnish model as closely as possible," Clary said in an interview.
The Baby Box Co. also has corporate partners that provide freebies. According to the company website, boxes may also come with coupons or promotions for baby-related items.
Both of these initiatives are a far cry from Finland's universal program, which uses the box as an incentive to bring pregnant women into the health-care system. The ultimate goal is to improve infant and maternal health using evidence-based practices and materials.
A corporate-sponsored giveaway of items will not accomplish the same goal and represents a fundamental misunderstanding of the philosophy behind the famous Finnish program. And if such giveaway baskets include formula samples or other items pediatric experts recommend against, it could accomplish the opposite. And while The Baby Box Co. has created an educational component to its product, there are no guarantees that parents will get the message or get the prenatal care they need – especially those who are most vulnerable to poor health outcomes, such as indigenous women or those living in low-income or remote areas.
"There's nothing inherently wrong with giving out products," Dr. Shaun Morris, clinician scientist at Toronto's Hospital for Sick Children, said. "I just think it's important the public not get confused about what this is. This is not likely to make any impact on important health outcomes like living or dying or [reducing] hospitalizations or severe infections."
Dr. Karen Benzies, associate professor in nursing at the University of Calgary, is currently working on a research program to measure how well baby boxes can improve health outcomes. The researchers are using boxes and some products provided by The Baby Box Co., but adding their own educational and mentorship components to help at-risk women.
"We're really focused on the evidence base and valuing this new role as a parent, and not focusing on promoting and putting in coupons," Benzies said.