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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6 Responses to “Come for the box, stay for the life saving services”

  1. becca says:

    I bet you could use RocketHub or Kickstarter or the like to crowdfund this- I think it’s got a lot of popular appeal, and I would promote the heck out of it!

  2. Beth says:

    Just for a counter-view: http://www.bmj.com/content/346/bmj.f3448. Don’t you think that the extent to which we can love boxes like this is largely dependent on what is in it, and what sort of corporate sponsorship is involved?

    The boxes in Finland look pretty benign and unbranded. But, by contrast, many of the boxes in the UK are sponsored by Bounty and, therefore, are a promotional package for Bounty products. Nestle has put together similar packages for other national health services.

    Shouldn’t the question not only be “is this a useful product?” but also “to what extent should the state sponsor the commercialization of maternity?” and “to what extent should the state give multinational corporations access to new mothers?” The mama kit is a great idea, but one too that could go badly awry.

    • Karen Grepin says:

      This is definitely a valid concern, but I would argue second order to understanding the first one: to what extent do such incentives schemes increase the demand for life saving medical services in low-income settings. If it is product that women want – and truly value – than I am less worried about who makes it.

    • Eresso says:

      One of the major obstacles for all these fancy ideas of donations is sustainability. How about organizing a livelihood project for women where they produce the required components of those basic kits locally? This will help women earn income, empowers many and we do not need to worry about corporate branding etc. My two cents.

    • The kits or boxes sound like a good idea and certainly deserve a proper impact evaluation. But I agree with Beth on the need for safeguards to ensure that they would not be taken over as an opportunity for corporate promotion — including of products that may be harmful to the mother or infant. This comes from my personal experience: when my daughter was born at NY Hospital hospital 22 years ago, we were sent home with a promo kit that included infant formula samples (I’m not making this up!). My wife had difficulty nursing at first and if we had not been well-read and had access to nursing support it would have been awfully tempting to use those samples–and then go buy more. Which of course is exactly what the manufacture was hoping would happen. If this can happen at NY Hospital, I imagine is could happen in lots of places.

      The boxes and kits are a good idea, but those promoting it should beware of this risk.

  3. Moka Lantum says:

    The 2020 MicroClinic Initaitive has been piloting an initiative that donates a pack of five newborn onesies (baby suites) to mothers who elect to deliver in the facility or who observe ANC visits schedules and return for PNC. The in facility delivery rates in the facilities donating the onesies are significantly higher than neighboring clinics that do not. The same reason: shame of not being able to purchase baby clothes- has been mentioned by several women. Nurses indicate they are more trusted and perceived as caring. That favors enhanced acceptance of the counseling from nurses. Project sites are in Kisumu County.

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