‘Let's start from a point of celebration: “You've had a baby, congratulations!” I think if we just start at that point, it's such a positive strategy…’ Gill Perks, lead midwife at Queen Charlotte's and Chelsea Hospital, London, was one of many people at the launch of the UK's first Baby Box programme to speak so enthusiastically of the initiative.
The Baby Box idea originated in Finland where, since the 1930s, the state has provided pregnant women with a ‘starter kit’—a box containing various items that they will need when their baby is born. The box itself contains a hard mattress, and serves as the baby's first bed; this aspect of the programme has been credited with reducing Finland's infant mortality rate from 65 per 1000 births in 1938 to 2.26 per 1000 births in 2015 (World Health Organization, 2016).
The UK currently has among the highest rates of infant mortality in Europe, ranking 22/50 European countries with 4.19 deaths per 1000 births (World Health Organization, 2016). Dr Karen Joash, consultant obstetrician at Imperial College Healthcare NHS Trust, who is leading the Baby Box trial, said that the reduction in infant mortality seen in Finland ‘is something that we can bring to the UK’.
The idea is simple. At her first midwife appointment, a woman is given a Baby Box University membership card, which allows her to access the Baby Box University website. Her unique membership number will log her onto her local Trust's hub, so there will be information available on the site about local resources and support groups, as well as more general antenatal education. The site hosts an educational programme for women to complete during pregnancy, at the end of which they receive a certificate. They can then take the certificate to the hospital and receive their Baby Box, containing items such as a sleep suit, wipes, nappies and various other products that new parents will need. Crucially, the box is fitted with a waterproof mattress and cotton sheet, so parents can place the baby to sleep inside it (Figure 1). The other items in the box are tagged with educational information and parenting interaction tips, suggesting how their use can help to improve bonding between the parents and baby (Figure 2).
This educational aspect of the Baby Box is one of the key elements of the programme, according to Baby Box Company chief executive officer Jennifer Clary. ‘We believe education is transformative,’ she explained at the launch event. ‘Obviously, you can't just give parents a box and expect to change health care outcomes. But what you can do is tie it to an education platform. With this programme, as you get the education programme through the “Baby Box University”, you're getting a product that you already know how to use. Because, of course, it doesn't help if I give somebody a safe sleep base and then they place the baby to sleep on its stomach. It's important that parents understand how to use the items they're given. So the whole idea is making a logical programme out of this, and actually building it with health professionals.’
She went on to explain the potential for the programme—which operates in countries across the world—to be tailored to specific communities, depending on their populations. ‘In the US, for example, swaddling isn't allowed now; but in India, it's the done thing. So we aim to be really culturally sensitive and give people what they actually need. In developing countries, the boxes have things like a clean birth kit and a mosquito net.’
With plans to extend the initiative throughout the UK, Ms Clary said the diversity of the country's population would be taken into account. ‘It won't be a standardised Baby Box that's the same across the UK. When I visit a community like Blackpool, and then come down to London, it's very different. You have to look at the metrics—are we going to focus on tracking the reduction in maternal smoking, for example? What are the particular issues that you're having in your community that we could be assisting with? This is a diverse country.’
Ms Clary founded the Baby Box Company with her friend, Michelle Vick, in the USA, her home country. She says their experience there has been beneficial, as the USA has such a broad range of different communities with varying needs. The company is currently working with hospitals, government agencies and non-profit organisations to provide Baby Boxes and ongoing education to families in 52 countries.
From a midwifery perspective, Gill Perks was full of praise for the potential of the Baby Box scheme. ‘It's so simple,’ she said. ‘Everything in the box has an educational value, so it's not an opportunity for corporations just to jump on the bandwagon. It also gives us an opportunity to provide more localised education, perhaps advice about breastfeeding groups or other support groups, and we're planning something in there on mental health.’
During the pilot phase there is opportunity for ongoing feedback from both service users and health professionals, so that the Baby Box Company—which Ms Clary describes as ‘a tech company, first and foremost’—can tailor the educational content accordingly. Ms Perks added: ‘We're surveying mums before they receive the box, and then we're evaluating their thoughts again afterwards, so that can give us an idea of whether we're pitching this right. It will evolve as time goes by.’
Scott Johnston, Imperial College Healthcare NHS Trust head of midwifery, said he thought the programme would help new parents to engage with the maternity service. ‘It's something physical, but also something virtual in terms of the website and the network it brings. Plus there are some useful things within the box, so I think it's hitting the spot in a few different ways. It gets important health promotion messages across in a non-threatening way.
‘I think, in some ways, people are overloaded by different types of media—especially when they're pregnant or have a newborn baby—but this is a kind of solid way that we can give people information, and give them something physical that we know makes a difference.’
When asked whether the cost of the scheme may be prohibitive for some Trusts, Mr Johnston said this was not a concern; the programme may actually bring benefits by engaging more parents with services early, thus saving costs later on. He added: ‘I think it's more about the logistics. Within our service we have about 750 births per month, so actually storing [the boxes] and distributing them can be a bit of a challenge. But I can say, as head of service, it's definitely worth it. It's something we'll get over.’ Ms Perks suggested that, at Queen Charlotte's, they may engage local volunteers to help make up the boxes so that they are ready for midwives or trained maternity support workers to give out.
A crucial aspect of the programme is its inclusivity. Baby Boxes will be available to all new mothers, with no eligibility criteria. The website contains audio and video elements so that low levels of literacy are not a barrier to accessing the educational content, and by August this information will be available in 14 languages.
Ms Perks added: ‘Tired mums—who may have had a long labour and a couple of nights on the postnatal ward—may not feel, at that point in time, at their most receptive. So because the box is so lovely, and it feels like a gift, hopefully that will encourage the mother to explore—you know, we've valued her so much to give her this, so what have we put in there for her that we think will be helpful to her? So it's a really good medium to get that education out there.’
If the Finnish experience is anything to go by, this initiative could lead to tangible improvements in maternal and infant outcomes, and could become a valuable element of maternity care in the UK.