Researchers at the University of Tampere are conducting research for the first time ever on the extent to which the Finnish maternity package – also known as “the baby box” – has spread around the world.
“We are mapping out how different organisations and groups have been inspired by the Finnish maternity package that has been internationally promoted over the past few years,” says postdoctoral researcher Annariina Koivu, leader of the “Thinking outside the box” research project.
In Finland, the Maternity Grants Act came into force in 1937. Since 1949, the grant has been available to all mothers in Finland. Mothers can currently choose to have the maternity package with its 50 items of baby clothing and hygiene products or a €140 cash benefit. Nearly all first-time mothers choose the package. Each year, the Social Insurance Institution of Finland (Kela) issues around 60,000 maternity grants, of which about 40,000 are provided in the form of the maternity package.
Estimates suggest that the maternity package idea has already reached thirty countries. Koivu says that the number of different maternity package projects in the world is likely to be double that.
In addition to Finland’s success in the OECD’s Programme for International Student Assessment (PISA), the popularity of the maternity package has raised Finnish self-esteem.
“It’s important that we do not think that the Finnish maternity package concept can be exported ‘as such’ and just like that, without considering local needs. However, we can be genuinely proud of this great social innovation. It’s fantastic that different countries want to follow our example,” Koivu says.
Local versions of the Finnish model
The study carried out in the Global Health and Development Programme at the University of Tampere must carefully consider what kind of starter kits should be regarded as maternity packages.
“If someone does a charitable project by collecting children’s clothing in order to donate it, can that be seen as a maternity package?” Koivu asks.
The Finnish maternity package has been designed for Finnish circumstances and needs. The same model would not work everywhere in the world.
The most recent countries to experiment with the maternity package include Scotland and Canada, where “baby boxes” are somewhat different from the Finnish version.
“A maternity package is also planned for Kenyan refugee camps and that is again completely different,” Koivu says.
In Finland, the maternity package is offered to all mothers, but elsewhere in the world, it may be given to targeted groups, such as teenage mothers. In order to be entitled to the maternity grant or package in Finland, the mother must visit an antenatal clinic before the end of the fourth month of pregnancy. Elsewhere in the world, participation in online training, for example, may be the precondition for receiving the package.
The idea of the maternity package was enthusiastically received in Namibia when Koivu attended a large conference with decision-makers and ministers present. Since then, initiatives have been taken that aim to investigate the feasibility of developing a baby box concept that would address the Namibians’ local needs.
The cardboard box replaced by a bag or a bucket
Projects based on the maternity package are underway on all continents except Antarctica. Their shapes and contents vary according to the local context.
In Finland, the package includes, among other things, an overall for outdoor use, a snowsuit and insulated mittens. In tropical areas, it would be more important to have a mosquito net that can be installed around the baby’s crib. Written information about postpartum depression or online peer support programmes might be important somewhere else.
“It is interesting to learn about all the versions of the package that have been inspired by this excellent Finnish social innovation,” Koivu says.
Yen Phan, a Vietnamese researcher in the project says that so far there is no maternity package in her home country. The contents of the package should be amended to meet the tropical climate of Vietnam, where many Finnish clothing items would be unnecessary.
The Finnish idea to use the cardboard box of the package as the baby’s first crib would not work in Vietnam either because having the baby sleep in a box would be culturally unacceptable.
“Sleeping in a cardboard box is a culturally sensitive issue. In some countries, the baby’s place is seen to be by the mother’s side. There are many reasons for this,” Koivu says.
In some countries, the entire box may be unnecessary. Koivu thinks that a better container for the items included in the package might be a plastic or metal bucket, which could be used for washing. Even a bag might work better in some contexts.
The name of the research project, “Thinking outside the box”, refers to the fact that the researchers must be able to think outside the box; not even the packaging should be identical across contexts.
The maternity package is not just a matter of distributing goods. Ella Näsi, an expert in communications in the research project, wants to see how much counselling is involved in the delivery of the package. In Finland, women come to antenatal clinics to receive guidance about pregnancy and parenting. The maternity package offers materials needed in the first year of the baby’s life. The setting may be different somewhere else.
Executives or philanthropists?
In Finland, the maternity package is a part of the services provided by the welfare state, but there are obviously countries without such a welfare state system.
In these countries, the distribution of the maternity package may be an academic project or part of a social experiment. Non-governmental organisations or commercial actors, such as not-for-profit social enterprises, may run the programme. Koivu says that it is difficult to distinguish what is commercial and what is not.
“When public authorities cooperate with commercial actors, it is hard to draw the line between what is public, public-private or something else,” Koivu points out.
Could the distribution of the maternity package be good business?
“It is already a business around the world. When I gave my presentation in Namibia, somebody approached me already during the first break giving me his business card proposing that his business would like to be our partner in developing the Finnish-style Namibian baby box. I replied that discussions were already underway with academic and NGO partners,” Koivu says.
Businesses in the United States and Finland are selling their own versions of the maternity package. There is a wide range of different concepts around the world. Some of these are provided by entrepreneurs who are not entirely clear on whether their work is for profit or not.
Is commercial involvement a good thing?
“I prefer models where people think about why they are doing this and who they want to help or reach. It is something other than just a purely commercial activity.”
Impact not studied yet
According to Koivu, there is surprisingly little research on the maternity package.
“That is a surprising gap. The history of the package has been studied and Kela has conducted studies in Finland, but to our knowledge nobody else is looking at the global picture,” Koivu explains.
The real effects of the maternity package have not been studied, even though there is a consensus about its benefits in Finland. According to Koivu, it is hard to distinguish the effects of the package from general developments in health care and the effects of establishing antenatal clinics, which happened at the same time.
“In places where antenatal clinics were established, infant mortality rates fell from fifteen to three percent in three years,” Koivu says.
In Finland, the first antenatal clinic started in the firewood cellar of a children’s hospital in Helsinki in 1922. Maternity packages spread round the country in 1938 after the enactment of the Maternity Grants Act.
Decreasing poverty, better availability of antibiotics and vaccinations as well as developments in the prevention and management of infectious diseases are all part of the overall development. On the other hand, the Second World War had a negative impact on public health. This makes it difficult to evaluate the effectiveness of each individual factor.
“Pinpointing the health effects of the maternity package is very difficult, but the general consensus is that it has contributed to reducing infant mortality rates in Finland,” Koivu says.
Namibia as a testing ground
The Mannerheim League for Child Welfare, an NGO whose idea it was to introduce the maternity package in Finland in the first place, funds the global baby box mapping study. Already in the 1920s, the League started a system of circulating baskets filled with baby items, which were the preliminary form of the maternity package.
The review will be completed in March 2018, after which further studies are planned, including evaluating the feasibility of implementation.
Namibia is a likely place for a further study evaluating the introduction of the maternity package. In the long run, the aim is to investigate the before and after effects of the package in a systematic and sustainable way.
“There are already too many arbitrary short-term projects in the world. We are more interested in projects that are in a position to produce sustained well-being and to continue for a longer time through the long term activities of the state and other collaborators,” Koivu says.
Text: Heikki Laurinolli