Mail & Guardian

South Africa weighs up the value of Moses baskets


South Africa is exploring the possibilit­y of giving boxes to mothers of newborn babies in an effort to reduce infant deaths.

The concept is based on a worldfamou­s Finnish policy of giving every mother, regardless of her financial status, a cardboard box stacked with baby products if she attends health checks during her pregnancy. The box, which comes with a mattress and a blanket, can also be used as a crib for the baby.

Almost 40% of pregnant women in South Africa’s public health sector go for their first check-up only after their 20th week of pregnancy, figures from the Health Systems Trust’s 2015/2016 District Health Barometer show.

Studies have found that the babies of pregnant women who visit a nurse or doctor early on in their pregnancie­s have better chances of survival because problems can be picked up in time.

Thirty-five out of every 1 000 babies in South Africa die before their first birthday, according to the Barometer. Compare that with Finland’s mortality rate of two in 1 000, as reported by 2015 World Bank data.

Yogan Pillay, deputy director of health, says he has investigat­ed various options based on the Finnish model. But, he stresses, there isn’t yet convincing evidence that the boxes will save lives. He cautions: “We are still researchin­g all the aspects [of the boxes]. There are many questions we’ll have to answer first.”

One South African option is a plastic version of the Finnish cardboard baby box.

The Thula Baba Box is the brainchild of two Western Cape fathers, Frans de Villiers and Ernst Herzog. They teamed up with Stellenbos­ch University’s research on socioecono­mic policy (Resep) project to develop a box that could be used as a reward for pregnant women to attend antenatal clinics early on in their pregnancie­s and also regularly throughout their pregnancie­s, rather than a box that could serve as a crib or a bed.

In 2015, Resep conducted a small feasibilit­y study to explore the larger-scale implementa­tion of the Thula Baba Box among 72 lowincome pregnant women in two Cape Town townships.

About half of them were promised a plastic box containing essential items if they reported to an antenatal clinic within 30 days of having been recruited into the study and thereafter made four visits to a specified antenatal clinic during their pregnancie­s.

The box contains items such as clothes, a blanket, maternity pads, a kangaroo mother or father care wrap, condoms, soap, nappies and a recipe for controllin­g diarrhoea. The other half of the group wasn’t promised anything.

The interventi­on group also received monthly visits from community health workers, who gave them psychosoci­al support and health informatio­n during their pregnancy.

The study found that women in this group were “significan­tly” more likely to attend an antenatal clinic at least four times before giving birth, and “significan­tly more likely” to attend the clinics early in pregnancy.

The study design, however, didn’t allow researcher­s to determine to what extent the box, as opposed to the community health worker visits, was responsibl­e for the increase in antenatal visits.

Pillay argues any potential benefit wouldn’t derive from the actual box — whether it be cardboard or plastic — but rather from “everything that comes with it”.

“The key question will be how to make the baby boxes available and who should get them,” he explains. “Should [getting the box] depend on a certain number of antenatal visits? Or should it for instance rather be linked to social grants?”

Pillay says there are also questions about whether the use of the boxes will decrease contact between newborns and their mothers or affect breast-feeding. “Should they only be used during the day? This is something that needs a lot of work.”

Although the plastic Thula Baba boxes are expensive — R440 with all the products included — Pillay points out that they will be more durable than a cheaper cardboard version.

But Miemie du Preez, a neonatolog­ist at Tygerberg Children’s Hospital, explains many lowincome mother’s shacks simply don’t have space for big plastic boxes.

A fold-away version would be preferable, she says.

“In South Africa, babies sleep with their parents. If the boxes are meant to be beds, I don’t think the concept will work. But if it is indeed an incentive for pregnant women to attend health clinics earlier and more regularly, it could save thousands of lives.

“It is crucial to diagnose women with HIV early [on in their pregnancy]. So, any incentive would be good, but it would have to be something that really makes it worth their while to buy into.”

Studies have found that HIVinfecte­d women who start antiretrov­iral therapy early on in their pregnancie­s drasticall­y reduce their babies’ chances of contractin­g the virus from them in the womb, during pregnancy or during breast-feeding.

Whether the baby boxes are the best incentive to encourage pregnant women to attend antenatal clinics during the early stages of their pregnancie­s, and also to visit clinics regularly throughout their pregnancie­s, has however not yet been confirmed through research.

But Du Preez points out: “There are many women who don’t even have a babygrow, who have nothing. Maybe that will encourage them, just to have something nice for their babies.”

 ??  ?? Baby boost: The Thula Baba Box is not just a cot – it may encourage more women go to antenatal clinics early on in their pregnancy
Baby boost: The Thula Baba Box is not just a cot – it may encourage more women go to antenatal clinics early on in their pregnancy

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