Baby Boxes Cut Infant Mortality in Finland—U.S. Cities and States Give Them a Try

Five reasons baby boxes are more than cutesy cardboard containers, from offering a safe place to sleep to giving an equal start in life.
Baby in box by Kela / Annika Söderblom

Photo by Kela / Annika Söderblom

In 1938, the Finnish government presented a gift to impoverished expectant mothers: a box. This gift would transform parenting in the Scandinavian nation. Measuring roughly 27.5 inches long, 17 inches wide, and 10.5 inches tall, each box contained a sturdy mattress and essentials for the first few months of infancy: blankets, clothing, pacifiers, and bibs. Today, the boxes are showing up all over the world, representing much more than a collection of baby items.

1. Boxes provide a safe sleep space

Baby boxes are more than cutesy cardboard containers: They contribute to safe sleep. The Finnish government extended the baby box program to all mothers in 1949. Prior to the box program, 65 out of 1,000 babies died within the first year of birth. Today, Finland’s infant mortality rate is 2.52 deaths per 1,000 births.

Of course, improved medical care accounted for much of that change. But studies suggest that the box has also played a critical role as it provides a safe sleep space for infants, a fact not lost on American doctors. 

U.S. pediatricians and advocacy groups are pushing hospitals to give away the cardboard cribs to help reduce America’s infant death rate: 5.87 deaths per 1,000 births—the highest of any wealthy nation.

According to the National Institute of Child Health and Human Development, the safest sleep environment for babies is sleeping alone on a firm surface without blankets, pillows, or loose bedding. The baby box provides that, and officials in Texas recently decided to pursue using baby boxes to help curb an increase in cases of sudden infant death syndrome. According to data from the Texas Department of Family and Protective Services, in 2015, 159 infants died in circumstances involving sharing a bed with a parent or sibling. University Hospital in San Antonio introduced the boxes in 2015 to address that problem.

Initially, the hospital provided boxes to 100 new mothers. The boxes proved popular, and the hospital ordered 500 more to fulfill the demand of parents-to-be.

Meanwhile, in Seattle, the King County Public Health Department has begun distributing baby boxes to needy families who don’t have a safe place for an infant to sleep. And several South Asian nonprofits have introduced a version of the box called the “Barakat Bundle.” This version contains additional items—including antiseptics, sterile razor blades, and other equipment to ensure a hygienic delivery—to address the fact that many women have limited access to maternity care. More than a third of the 5 million infant deaths worldwide occur in the region.

2. Boxes are eco-friendly

Once an infant outgrows the box (usually at 8 or 9 months), the box and its nontoxic foam mattress can be recycled or reused, instead of ending up in a landfill.

“The philosophy behind the boxes is saving lives, but it’s also about what kind of world we are leaving them,” says Jennifer Clary, co-founder of The Baby Box Co., believed to be the only baby box manufacturer in the United States.

Clary says that environmentalism factors heavily into her company’s decisions, down to the ink and glue used in producing the boxes. She says both are certified nontoxic and environmentally safe.

Babies are born “prepolluted” —exposed to some 200 chemicals in the womb.

Concerns about pollution are not just for the environment, but for the babies themselves. A report by the President’s Cancer Panel stated that babies are born “prepolluted”—exposed to some 200 chemicals in the womb.

Doctors suggest this increases the risk of developing diseases such as cancer later in life.

3. Boxes demonstrate support

Baby boxes send a powerful message to mothers, says Danielle Selassie, executive director of Babies Need Boxes, a Minnesota nonprofit.

“It says that all babies start at the same spot and that the community cares about you,” she says.

Selassie, who had her first child at 19, said she suffered firsthand the stigma that comes with being an unwed pregnant teen. The experience inspired her to establish her organization in 2015 after reading a BBC article about Finland’s program.

For Selassie, now 37, the boxes are as much about intangible benefits as about the items inside.

Teen moms often see the boxes as a desperately needed symbol of support. Whatever the circumstances of a woman’s pregnancy, Selassie said, she gets her box without judgment or contempt, a welcome contrast from what many experience while pregnant.

Her organization gave away 54 boxes in 2015. Some recipients had no one to help them during their transition to motherhood, says Selassie.

Baby boxes send a powerful message to mothers

“The mothers are so grateful to have such a show of community support for their children,” she says.

The nonprofit recently distributed boxes at a Minneapolis homeless shelter to pregnant teens, many of whom cried when they lifted the lid to discover the supplies.

Babies Need Boxes also connects teen mothers with service providers such as housing and employment agencies.

The organization plans to hand out 500 more boxes this year.

Baby box clothing by Kela / Annika Söderblom

Photo by Kela / Annika Söderblom

4. Boxes provide supplies to those in need

Baby boxes have long provided a head start in child-rearing for Finnish mothers: Supporting needy families was one of the original reasons behind Finland’s maternity box program.

It was a way to ensure Finnish babies an “equal start in life,” regardless of background, a goal established by the Finnish government in light of the high infant death rate among poor families.

At first, those receiving boxes were required to verify their need. In 1949, legislation stemming from public-health concerns made them available to all pregnant mothers.

The boxes have become so ingrained in Finnish culture that 95 percent of parents accept the box even though they can decline it for a cash payment of 140 euros.

“The boxes really take a lot of stress off of mothers,” says Joy Johnson of Simpson Housing Services, a Minneapolis nonprofit that distributes baby boxes to homeless women.

Johnson says the supplies alleviate the financial pressure many new mothers face when trying to provide items for a newborn.

Baby boxes have long provided a head start in child-rearing

The poorest are the ones who benefit the most, according to Johnson.

“Poor mothers have a hard time finding a safe place for their babies to sleep at times,” says Johnson.

Without baby boxes, Johnson says, many of Simpson Housing’s clientele would make makeshift cribs out of air mattresses or a pile of blankets on the floor.

“Rich or poor, they make the process of having a baby enjoyable,” she adds.

5. Boxes are democratic

True to the egalitarian principles associated with their Scandinavian heritage, baby boxes distributed in Finland cut across socio-economic lines.

Affluent and impoverished families alike receive the same box. To many Finns, this government gift accentuates the collective value placed on family and equality. The country has no private schools, was the first in the world to give women the right to vote, and has the lowest economic inequality of any European Union member.

Clary, of The Baby Box Co., estimates that 75 percent of her company’s business comes from hospitals, local governments, or nonprofits that give away the boxes, regardless of income.

“A baby box is for any parent, rich or poor,” she says.

They also send a symbolic message: In the eyes of a community, all babies matter.