Zoe McLaren from the University of Michigan sent me a link last night to this fascinating article that describes the custom of giving new mothers in Finland boxes that contains an incredible set of goodies that most newborns need in early life. Once the clothes, diapers, and other items are removed, the box can then be used as a bassinet. Doctors encourage the use of bassinets as safe sleeping spots for infants, rather in their parents’ beds.

Contents of the Finnish Maternity Box as shown on the the BBC Website.

The custom is over 75 years old and was started as a way to encourage Finnish women to deliver in health facilities and to get seek early antenatal care services (an uncommon practice back then, as it was in most of the world), in particular among low income women. The article claims that the box may help explain why Finland has one of the lowest infant mortality rates in the world.

“Maybe there is are some lessons for Africa?”, she asked. Well actually, it turns out I have been thinking a lot about this, and how this might actually fit into reducing maternal and newborn mortality in low income settings.

I am back in Uganda this week wrapping up some interviews for the external evaluation of Saving Mothers, Giving Life that I have been working on over the past year with a great team of researchers up at Columbia SPH. In both Zambia and Uganda one of the interventions that was implemented, as part of the scale-up of SMGL, was the use of “Mama Kits”, small packages that included important medical supplies and other materials needed for a safe delivery.

The use of Mama Kits themselves is not a particularly new innovation in Uganda, as they have been around for a while and have been deemed successful here. What was more innovative, some kits also included other items, including well-made receiving blanket. Apparently, the blankets were a huge hit among Ugandan women.

So much so that when I was here in November, I heard stories (I can’t say if they are true or not) of women going to one facility to deliver, finding out that the kits that were being provided at that facility did not contain the popular blanket, leaving, and moving onto to the next facility. Although, it is difficult to attribute any increases in the SMGL focus districts to any one intervention, I kept asking, how much did these kits contribute to the gains in institutional deliveries?

Earlier today I was talking to one of the researchers on our team who told me about some related research she had done in the past where in focus groups of women with non-institutional deliveries would report fear of delivering facilities because they did not have any clean clothes for the baby to go home with and were ashamed.

A quick search of Google scholar turned out no obvious literature on this topic, but I am by no means and expert on this. It seems almost silly to think that this might be a deciding factor in the decision to either (1) deliver your baby in a place that has potentially life saving health services or (2) at home where if something goes wrong you can die very quickly. But the story from Finland and my own observations here in Uganda seems to suggest that they might. Perhaps we can all learn an important lesson from those crazy Finns. Anyone want to fund a crazy impact evaluation study?

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