For the nearly 80 years, a large number of newborn babies in Finland have been sleeping inside a cardboard box. Since 1938, the Finnish government has offered expectant, low-income mothers a free baby box that doubles as a bassinet, along with bedding, a coat, diapers, a thermometer, and a few other new-baby essentials. The initiative began as an attempt to curb Finland’s high infant mortality rate, and as a way to incentivize women to receive prenatal care (they were given the boxes during a doctor’s appointment). Today, Finland has one of the lowest infant mortality rates in the world, and many countries, including Canada, the U.K., and the United States, are now trying to copy the baby box phenomenon at home.
Earlier this year, Alabama, Ohio, and New Jersey all began distributing cardboard baby boxes to a number of families: New Jersey is expecting to hand out 105,000 boxes, Ohio 140,000, and Alabama almost 60,000. Texas just announced they would be jumping on the baby box bandwagon with a statewide initiative of more than 400,000. Along with a sturdy cardboard box, this prenatal package also includes a firm mattress, a snug bed sheet, a swaddle sack, and details on safe sleeping practices. The hope is that the boxes will drastically lower the amount of children lost to sudden unexpected infant death (SUID) in the U.S., where SUID currently claims more than 3,500 newborn lives a year. (Sudden infant death syndrome (SIDS) accounts for about half of these deaths.) While New Jersey has an infant death rate below the national average (4.5 of every 1,000 babies born), Alabama and Ohio have some of the highest in the country.
It’s easy to get excited about the potential impact of the baby box program. Not only does it provide families that perhaps couldn’t otherwise afford to buy a crib or a bassinet with a free space for their child to sleep, it’s also a simple way to educate new moms about safe sleeping practices. But Dr. Harvey Karp, the pediatrician behind the hugely popular book and video The Happiest Baby on the Block, warns about placing too many expectations on a simple cardboard box.
“Supposedly, since Finland started [giving out] these boxes, there has been a dramatic reduction in SIDS,” Karp says. “But it’s one of those things where correlation does not mean causality. They also started using microwaves during that period, but no one is crediting microwaves with stopping SIDS.” Some doctors have [posited](http://www.wcpo.com/news/local-news/hamilton-county/cincinnati/baby-box-craze-promoting-safer-infant-sleep-comes-to-cincinnati-but-doctors-arent-on-board) Finland’s low infant mortality rate has more to do with the country’s low preterm birth rate. Either way, as of now, it’s impossible to prove whether or not the baby box is behind the downward trend.
“There’s a fine line between simple and simplistic,” Karp adds, “and this idea that if babies only had had a box then they wouldn’t die is simplistic.” While Karp acknowledges that the baby box is a safe sleeping space for newborns, he points out that the real problem is that mothers—even those who have bassinets or Pack ’n Plays at their disposal—still end up putting their babies in unsafe sleeping environments.
The American Academy of Pediatrics (AAP) recommends that infants sleep on their backs, in a crib or bassinet without any blankets or stuffed animals or bumpers, in order to avoid suffocation. And yet, many parents in those first frazzled months often bring their babies to sleep in their bed with them, or fail to adhere to other AAP recommendations. A report that came out in 2015 in Wisconsin found that 75 percent of babies lost to SUID in the state had a crib or bassinet at home, while 90 percent of them were exposed to soft toys or pillows. So why are parents blatantly ignoring doctor’s orders?
According to Karp, the answer is often the obvious one: exhaustion. “The reason isn’t because moms aren’t listening to their doctors, it’s because the doctors aren’t listening to the mothers,” he says. “The majority of people who are falling to sleep with their babies is because they’re tired, and the only way to get their babies to sleep is to bring them into bed.” Karp shares that he often asks his patients whether they would ever go to sleep with a baby in their bed if they were drunk. “Their faces would go blank and they would adamantly say no,” he remembers. “But then I ask them if they would ever bring their baby in bed with them when they were so tired that it was the equivalent of being drunk, and they would say yes. The fact is that we’re drunk parenting.”
Instead of putting all of our hopes of ending SUID on a cardboard box, Karp suggests we should instead focus on improving support for those new mothers who are about to endure extreme levels of sleep deprivation. “Exhaustion is the number one cause of postpartum depression,” he says. As of now, 10 percent of new mothers will suffer from postpartum depression after having a baby. “When it comes to breastfeeding, there’s excellent support from hospitals. But what about information on sleep? For something that affects 10 percent of the population, we need more preventative help.”
But what does preventative help look like? A large push to educate parents on sleep and calming techniques for their babies is a good start. “There’s one huge misconception in our culture, which is new moms and dads think they’re supposed to know how to do everything,” says Karp. “But most parents today have little to no experience and little to no family support.” The United States is still shamefully the only industrialized country in the world that does not offer new mothers any paid parental leave or childcare benefits. The lack of financial support after birth often leads new moms to race back to work at a time in which they are still intensely sleep deprived. Rather than just buying a cardboard box and crossing our fingers, we need to start providing better systems for new families, both at home and in Congress. By making sure new mothers are supported in the long run, we can ultimately help stop many preventable deaths of infants in the short run.
This story originally appeared on Vogue.
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