Families pick up baby boxes and learn about safe sleep for infants in Dallas, Texas. (Photograph courtesy of Baby Box Co.)  

Finland has one of the lowest infant mortality rates in the world—a statistic often credited to its famous “baby boxes.” The government mails these cardboard cribs filled with baby supplies to any expectant mother who signs up and comes in for a prenatal checkup. As a result, parents save time and money, and proponents say the boxes may also protect infants who sleep in them from being smothered by a sleeping parent or heavy blanket.

This year, similar boxes are debuting on a large scale in the United States—with a twist. Requiring prenatal checkups is not feasible under the US health care system, so the states of Alabama, New Jersey, Ohio, Texas, and Colorado are using the program instead as an opportunity to educate parents about safe sleep for newborns. Parents of any income level may apply for a free box, but only if they take a series of online educational courses—available in 10 languages—that include videos, reading material, and an “ask an expert” feature.

Once parents pass a quiz, they receive a box containing diapers, wipes, a onesie, nipple cream, breast pads, baby brain development activity cards, a waterproof tote bag, a mattress, a waterproof mattress cover, and a fitted sheet. Each participating state plans to distribute several thousand boxes this year in partnership with the California-based Baby Box Co.

“The baby box program is tailored according to needs and restrictions within the United States and isn’t a one-stop-shop solution for infant mortality,” says Jennifer Clary, cofounder and CEO of Baby Box Co., which also distributes boxes commercially. Sudden infant death syndrome (SIDS) killed about 1,600 US infants in 2015 and has no one clear cause. However, pediatricians agree that parents can reduce the risk of infant suffocation by following the guidelines of the American Academy of Pediatrics (AAP): Babies should sleep alone on their back with nothing—not even a blanket or pillow—in their vicinity. Since the AAP issued these tips in 1992, the annual rate of SIDS in the United States has decreased by more than 60 percent. Now the US baby box program is using the incentive of free supplies to bring the message to even more parents.

“Step into any baby store and you’ll see hundreds of products that are not safe for babies. My oldest child’s nursery contained multiple products which have since been recalled or deemed unsafe,” says Dyann Daley, a pediatric anesthesiologist and child maltreatment prevention executive. “In my experience leading a citywide safe infant sleep initiative in Fort Worth, Texas, we learned early on that some hospitals were modeling unsafe sleep practices in the hospital setting or providing parent education which was in direct contradiction to the AAP guidelines.” Daley hopes that Baby Box Co.’s courses (also available outside the company’s free distribution areas) can provide better training for US parents.

Changing parents’ behavior will be critical to the US program’s success. Since the Finnish government introduced baby boxes in the 1930s, the country’s infant mortality rate has fallen from nearly one in 10 to 2.42 for every 1,000 live births. But experts attribute the decline less to the boxes than to the support associated with them. “The baby box program is tied to maternal health checkups,” says Sissi Penttilä, a public policy researcher and representative of the international company Finnish Baby Box. “[T]he reduction in mortality rates also had to do with economic growth and a decrease in income inequality.”

Other experts warn that the cardboard cribs have not been proven safe for infants and that research has yet to definitively show they prevent suffocation. For this reason, Dr. Thomas Hegyi, director of the SIDS Center of New Jersey, recommends traditional cribs, noting that nonprofits such as Cribs for Kids and Keeping Babies Safe can provide them to families with limited means. According to Hegyi, infants most often suffocate not because they lack a safe crib but because parents bring the infant into their own bed, for reasons such as “parental fatigue and fear of danger in a high-crime area.”

Still, American parents such as Lauren Taylor from Kansas appreciate the baby boxes. Taylor’s daughter slept in one for about three months before outgrowing it. “This is more or less the same timeframe a person would use a bassinet, and it worked out great for us,” says Taylor. “I thought the box was far safer than many products parents in the US have become accustomed to and what is considered normal.”

What is considered normal, though, may be changing as the US baby box program takes off.

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