Around a century ago, Finland was an agricultural society where most of the population lived in poverty.
Many families lacked basic necessities such as clothes. Poor hygiene and nutrition and infectious diseases led to 10% of babies dying before the age of one year.
In 1922, the newly established Mannerheim League for Child Welfare began lending baskets to low-income families, which contained clothes and sheets for the baby sewn by volunteers.
“As the babies grew, the clothes in the baskets were washed, mended and given to the next family,” says Researcher Ella Näsi from Kela, the Social Insurance Institution of Finland.
In 1938, the first governmental versions of the maternity package were introduced and given only to underprivileged mothers. Four years later, the items began to be packed in a cardboard box designed to act as a crib for the newborn.
In 1949, the government decided to issue a maternity grant either as the maternity package or as a cash sum to all expectant mothers on the condition that they visit an antenatal health clinic. The Finnish baby box was born.
In 2013, the maternity package received special international media attention.
First, the BBC published a story titled “Why Finnish babies sleep in cardboard boxes”. Kela soon donated a maternity package to Prince William and Duchess Catherine of the British royal family, who were expecting their first baby.
After this, many NGOs and other actors began to set up their own baby box programmes around the world.
“Finnish embassies have showcased the maternity package as an example of a Finnish social innovation. This is another way by which many partners have received information and become interested in the issue,” says Postdoctoral Research Fellow Annariina Koivu from Tampere University.
Koivu led a research group at Tampere University that investigated how the Finnish maternity package or baby box has spread across the world. The research group found a total of 91 baby box programmes in 63 countries.
Among them, the group chose 29 projects, and the contents of the boxes and the projects’ goals were investigated with in-depth surveys and interviews. Half of the interviewees reported that they had got the idea for their project from the Finnish baby box.
However, the Finnish baby box has not been copied by these projects wholesale, because the programmes have been tailored to local needs.
The items are not necessarily packed in a cardboard box. Alternatives include, for example, a bag, a bucket and a woven basket. Local conditions and needs have also been considered in the planning of the contents. For instance, a mosquito net is included in many areas where mosquitoes spread malaria and other diseases.
“Baby box programmes often have more general goals concerning the well-being of mothers, babies and the entire community. In addition to material assistance, mothers are offered counselling and training on breastfeeding or family planning among other things,” Koivu says.
The programmes often target the most vulnerable families. In Colombia, the baby box is offered to most low-income teens and single mothers and immigrants from Venezuela. The goals include reducing inequities and promoting non-violent parenting.
“The condition for receiving a baby box can be for instance that the mother attends antenatal care or that she gives birth at a clinic instead of at home. The baby box can therefore save lives in settings where the use of these health services would otherwise be low,” Koivu adds.
Several baby box programmes have targeted women and children who have had to flee their homes due to natural disasters or conflicts.
In the Za’atar refugee camp in Jordan, for example, women can earn a living by making the baby boxes that are distributed to mothers who give birth at the camp.
“The programme benefits women at both ends of the production line by encouraging refugee women to attend antenatal care and by providing them with a livelihood which strengthens their agency, restores social engagement, and reduces isolation,” says Jad Abuhamed, a doctoral researcher at Tampere University.
In the future, the number of displaced people will only increase as climate change and political unrest force people to leave their homes, which will create humanitarian challenges that require innovation and cooperation.
“The baby box has a lot of potential because it can be used in demanding environments and tailored to the population groups that are in the direst need of help,” Abuhamed points out.
According to Koivu, the effects of baby box projects have rarely been scientifically evaluated, which is why it is difficult to ascertain what kind of benefits the programmes really provide.
“I hope that in the future there will be more evidence on how the baby box can be used in different circumstances and for different groups of people in order to achieve health and social benefits,” Koivu says.
In Finland, the effects of the baby box have not been systematically studied either. Since the creation of the maternity package in Finland, child mortality has fallen considerably. However, the significance of the baby box is indistinguishable from other developments, such as antenatal and child health care, antibiotics and vaccinations.
According to Näsi, it would be interesting to study what the current meaning of the baby box is in Finland. Is it just a financial benefit or do people consider it important for other reasons?
“The baby box may have an intergenerational symbolic meaning. It is possible that its very existence communicates that Finnish society appreciates babies and wants to support the well-being of children and families,” Näsi says.
Annariina Koivu, Yen T H Phan, Ella Näsi, Jad Abuhamed, Brittany L Perry, Salla Atkins, Mikko Perkiö, Meri Koivusalo (2020): The baby box. Enhancing the wellbeing of babies and mothers around the world. Kela Research. Finland.
In Finland, mothers can choose between a maternity package and a tax-free cash benefit of €170.
A prerequisite for receiving the maternity grant is that mothers have a health check-up before the end of the fourth month of pregnancy.
The 2020 version of the maternity package contains 56 items in addition to the box, which may be used as a cot. In addition to clothes, the package contains, among other things, a sleeping bag, bedding, toiletries and a cuddly toy.
Multiple-birth families receive multiple maternity grants.