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Infant Mortality: Do Baby Boxes Really Save Lives?

It's been claimed that Finland's baby boxes, given to every newborn in the country, help reduce cot deaths. But what evidence is there that they lower infant mortality rates, asks Elizabeth Cassin.

In June 2013, the BBC News website published an article entitled Why Finnish babies sleep in cardboard boxes. It's been viewed over 13 million times and sparked global interest in the idea.

The article explained Finland's 75-year-old policy of giving every pregnant mother a cardboard box filled with baby products, such as clothes, sleeping bag, nappies, bedding and a mattress, and how the box itself could be used as a bed.
Baby Box

One reason it attracted such attention is that Finland has one of the lowest infant mortality rates in the world - two deaths per 1,000 live births, compared with a global rate of 32 in 1,000, according to the UN. Over the past three years, companies selling the boxes have popped up in the US, Finland and the UK.

And they're incredibly popular not just with individuals but - more significantly - with governments. The promise of lower infant mortality rates is something to aim for. But if you stop and think about it for a minute, this is a bold claim. How does getting a baby to sleep in a box and a few baby items bring down infant mortality rates?

There are lots of reasons why babies die, from health problems to accidents. But there's one in particular that these boxes have been thought to help reduce - sudden infant death syndrome (Sids), also referred to as "cot death", is the unexpected and unexplained death of an apparently healthy baby.

Although it's difficult to always understand what causes these deaths, there are environmental factors that increase the risk - including being around tobacco smoke, getting tangled in bedding, or sleeping alongside parents - especially if parents have been drinking.

In the early 90s, many Western countries introduced Back to Sleep campaigns, when it was discovered that babies who sleep on their tummies are more vulnerable to Sids. This led to the last significant reduction in countries like the US and UK.

"Since we had the dramatic decline of Sids in the 90s, we're now in a situation where the remaining Sids is much harder to try to alleviate," says Prof Helen Ball, director of the Parent-Infant Sleep Lab in the UK. "And so people are looking for new interventions, new changes to social care practices that might specifically help some of the more vulnerable families."

Putting a baby in a box, and keeping the box near a parent, could prevent some of the hazardous scenarios. But it's important to understand that nearly all countries have seen a dramatic reduction in infant mortality over the last century. In 1900, about 15% of babies in Europe would have died in their first year. Now it's less than 0.4%.

And Finnish academics and health professionals have been keen to point out that there is some misunderstanding about the box scheme. - Online Sources

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