Kenya cribs Fin­land’s so­lu­tion to

The Finns’ card­board box prompts an African grad­u­ate to de­velop a life-sav­ing de­vice for ba­bies

Mail & Guardian - - Health - Adri Kotze

When Lucy Kaigutha read about a Fin­nish tra­di­tion that dates back to the 1930s, she was struck by a thought: Could the Scan­di­na­vians have a tool that would save the lives of new­born ba­bies in Africa, in her na­tive Kenya? Could a sim­ple card­board box dou­bling as a bed keep a baby safe in the first months?

“I re­mem­bered a stu­dent field trip to Marachi vil­lage in north­ern Kenya. There was a mum with a two-week-old baby who didn’t have much to take care of this child,” says Kaigutha, a grad­u­ate in pub­lic health and in­ter­na­tional de­vel­op­ment. “[It] re­ally moved me. And I thought maybe I could also come up with a box, but one that will help moth­ers and ba­bies in our poor ar­eas.”

For that is what Fin­land’s wel­fare state has been do­ing for decades: giv­ing ev­ery ex­pec­tant mother a brightly coloured, sturdy card­board box that is 74cm long, 43cm wide and 27cm high. It comes with a small mat­tress to turn it into a bed, and also sheets and clothes.

The box serves as an in­cen­tive to preg­nant women to visit ma­ter­nity clin­ics: only women who have a preg­nancy cer­tifi­cate con­firm­ing that they had a health ex­am­i­na­tion be­fore the fifth month of their preg­nancy re­ceive a box.

Stud­ies have shown that the ear­lier a preg­nant woman vis­its a ma­ter­nity clinic, the bet­ter the chances are that doc­tors will be able to save her baby, should some­thing go wrong dur­ing her preg­nancy.

As many women have more than one child, and there­fore al­ready have a box, they can also choose rather to re­ceive a ma­ter­nity al­lowance of about R2200. But, ac­cord­ing to Fin­land’s health depart­ment, only about a third of moth­ers choose the money.

Gov­ern­ment sta­tis­tics for 2014 show that 99.6% of Fin­land’s preg­nant women vis­ited ma­ter­nity clin­ics be­fore the fifth month of their preg­nancy.

The coun­try also has one of the low­est in­fant mor­tal­ity rates in the world — two deaths in 1000 live births of ba­bies be­fore their first birth­day, data from the World Bank shows. This is a re­mark­able drop from the end of the 1930s, when nearly ev­ery 10th child born in Fin­land died un­der the age of one, ac­cord­ing to Sta­tis­tics Fin­land.

In com­par­i­son, South Africa’s in­fant mor­tal­ity rate is 35 in 1000 live births, ac­cord­ing to the 2015/2016 Health Barom­e­ter. World Bank sta­tis­tics show Kenya’s is 36 in 1 000.

In July last year, af­ter con­sult­ing mid­wives, nurses and moth­ers, Kaigutha used crowd­fund­ing for the Toto Care Box.

“It is a crib for the first three months, but the box also comes with 18 es­sen­tial items that pro­tect the baby in its first 28 days,” Kaigutha ex­plans.

This in­cludes a water­proof mat­tress, baby clothes, a blan­ket and a mos­quito net. The con­tainer looks like any brown stor­age box, al­though it boasts the bright Toto Care logo.

But these boxes are sturdy and spe­cially com­mis­sioned from young men from poor ar­eas, Kaigutha ex­plains.

The idea of baby boxes has spread across the world. Health pro­fes­sion­als and lo­cal au­thor­i­ties have run pi­lot projects or adopted the boxes in ef­forts to cut in­fant deaths and to help poor par­ents. Busi­nesses have caught on to the idea and are sell­ing bumper de­signer ver­sions to the well-heeled and trendy — the Baby Box Co of­fers a deluxe, if still card­board, style stacked with prod­ucts for $449.

In South Africa, a plas­tic baby box is be­ing stud­ied and tri­alled by the depart­ment of eco­nom­ics at Stel­len­bosch Univer­sity and the health depart­ment is in­ves­ti­gat­ing a ma­ter­nity pack­age linked to baby boxes.

Ja­pan, New Zealand, Mex­ico, In­dia and Canada all have lo­cal vari­a­tions of the ma­ter­nity pack­age and in the United Kingdom, where gov­ern­ment sta­tis­tics show there are four in­fant deaths in 1000 live births, health chiefs in sev­eral hos­pi­tals have started giv­ing the boxes to new fam­i­lies.

The Scot­tish gov­ern­ment has con­firmed all ba­bies born on Au­gust 15 or af­ter will get a box with es­sen­tials as a “welcome gift” and to help tackle de­pri­va­tion. The box acts as a Moses bas­ket, ac­cord­ing to in­for­ma­tion on the Scot­tish gov­ern­ment web­site, and is a safe and com­fort­able place for ba­bies to sleep.

But the Lul­laby Trust, a Bri­tish char­ity that pro­vides sleep­ing ad­vice and works to cut sud­den in­fant death syn­drome (Sids), has warned there is no ev­i­dence to sug­gest the use of the boxes will cut the risk of in­fant mor­tal­ity caused by Sids.

“We sup­port all ef­forts to pro­mote safer sleep for ba­bies,” ex­plains Francine Bates, chief ex­ec­u­tive of the char­ity, in a state­ment. “How­ever, we do have con­cerns about the baby boxes be­ing mar­keted as prod­ucts which will re­duce in­fant mor­tal­ity and Sids.”

The Lul­laby Trust has also ex­pressed con­cern about whether the boxes com­ply fully with safety stan­dards, be­cause there is no “spe­cific stan­dard for the use of a card­board box as a sleep­ing place for an

Good­ies: The Fin­nish box comes with the items for an in­fant and is a bid to en­cour­age ex­pect­ing moth­ers to go to a clinic.

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