First, the bad news: Worldwide, almost 5 million infants die each year. These mortality rates are highest in South Asia and Africa, but babies die in wealthy countries, too. In the United States, for instance, about six babies out of 1,000 die before their first birthdays.
The prize for lowest infant mortality rate in the world goes to Finland, who over the past 70 years has shown the world the good news: babies don't have to die, and preventing infant deaths doesn't have to cost a lot.
Before World War II, Finland had a big infant mortality problem. About 65 out of every 1,000 Finnish babies died in their first year. In response to these abysmal rates, the Finnish government began distributing a "baby box" — a cardboard box full of high-quality baby supplies. These were handed out first to every low-income expectant mother in the country, and later to every family expecting a baby.
And it worked! The Finnish baby box has been a legendary success, significantly reducing Finland's infant mortality to half of what it currently is in the United States.
"Finland was very poor after World War I," says Dr. Panu Pulma, a social historian at the University of Helsinki. "The baby box was absolutely worth receiving, but families could only get it if they visited the doctor regularly before the baby was born."
According to Pulma, in addition to helping Finland rapidly institutionalize a strong public health care system, it has become a tool for helping to spread public health information. The government incentivized good behavior — regularly visiting a doctor while pregnant — with free stuff that costs less than what a higher death rate costs a country and its citizens (both financially and emotionally).
Most of the contents of the box comprise stuff you might give any new mother: onesies, blankets, hygiene products, diapers, etc. But something the Finnish baby box has always contained is a little mattress that fits down in the bottom of the cardboard box for the baby to take her first naps in. This has significantly cut down on infant deaths from suffocation or falling out of adult beds. In the beginning, bottles were included in the box, but later cut out to encourage breastfeeding.
These days, expecting mothers in Finland have the option of taking the box or a 140 euro grant, and 95 per cent of them choose the box, partly because the contents are worth more than the grant, but also because that's just what you do in Finland.
In recent years, the global public health community has taken notice of the success of the Finnish baby box, and has begun adapting it for communities all over the world.
For instance, the Barakat Bundle, produced by a team based out of the Harvard Innovation Lab Venture Incubation Program for populations in South Asia, includes supplies needed to both deliver a baby and keep her clean after birth. Receipt of the Barakat Bundle requires mothers to visit local clinics for prenatal visits, and includes a mosquito net to protect newborns from mosquito borne illnesses, as well as a thermometer that beeps extra loud when the baby has a high fever--an important feature in a part of the world with low literacy levels, where many infants die of respiratory infections.
Karima Ladhani, CEO of Barakat Bundle, estimates the Barakat Bundle can save approximately 58,000 infant lives and 3,000 maternal lives in the next five years.
Similar programs in Africa, Australia, Canada, and the United States are underway. Some incorporate plastic bins instead of cardboard boxes, to provide a place for parents to bathe their newborns during their first months. Some target specific communities, like four hospitals in Fort Worth, Texas, where the infant mortality rate is significantly higher than in the rest of the United States. And U.S.-based maternity box company Baby Box Co., for instance, has launched an educational service called Baby Box University. In fact, the company partnered with the state of New Jersey to launch a statewide program in January 2017 where all new parents receive one of the boxes after completing an online educational parenting course.
"Regardless of geography, culture, religion, economic status, every mother has hopes and dreams for her baby," says Ladhani. "Finland does a great job of tapping into this feeling. It's important to capture that intangible feeling and specifically tailor the box to the culture, context, and needs of family, no matter where they are."
Editor's Note: This article was updated on Feb. 3, 2017, to include the New Jersey baby box program.