What the ‘baby box’ initiative can do for infant health in Ontario

By Shannon Clarke - Published on Aug 02, 2016
Baby boxes, like this Finnish one, containing some essentials for newborns will be available to Ontario families starting this month. STR / LEHTIKUVA / Roni Rekomaa

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For expectant mothers in Ignace, the Mary Berglund Community Health Centre Hub is the first stop. It’s the centre of medical care for the town’s 1,200 people — from diabetic care to mental health services — and where pregnant women receive prenatal care before they deliver at hospitals in nearby Dryden or Sioux Lookout. The nearest neonatal intensive care unit is in Thunder Bay, two and half hours away in good weather. There is no local midwife, though not for lack of trying.

A small railway town along Highway 17 in northwestern Ontario, Ignace’s population has always fluctuated, and its economy is dependent on natural resources. With the introduction of the Resolute Forest Products sawmill nearby, it’s experiencing a population boom. In the past four years people have been moving in from across the province: people from northern communities like Mishkeegogamang First Nation, retirees and young families from Thunder Bay.

Gloria Pronger, executive director of Mary Berglund, is a passionate advocate of the community health model and sees what it can do for small towns like hers. But for newcomers, starting a family in Ignace has its challenges.

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“We have had a lot of people in the last two to three years having babies,” says Pronger. “Local stores only provide the basics, so when you start looking for baby supplies to get started with a new infant coming home, you have to travel to Thunder Bay or to Dryden.”

Three years ago, Pronger heard about a baby box program run by the Finnish government, and filed it away in her memory. Since 1938, Finland has provided new mothers with cradle-shaped boxes filled with essentials, including mattresses, bath thermometers and unisex clothing — so long as they sought care at a hospital. (Families could opt for cash instead.)  A couple of years later, Pronger and a colleague contacted a U.S.-based manufacturer of Finland-style baby boxes, and worked to bring the boxes to Ignace. The Finnish program was a success, they figured; perhaps it could do some good here.

Baby Box Co. was founded by Texas-born childhood friends Michelle Vick and Jennifer Clary after Vick became a mother in 2013. Inspired by the Finnish project, they set out to provide the same service to families closer to home, spending a year in product development to create a patented box that met safety standards for bassinets, cribs and cradles in Canada, Europe and the United States. According to its website, Baby Box Co. — which has its main offices in Los Angeles and the United Kingdom, and facilities in Australia, Singapore, Texas and Toronto — ships to more than 50 countries.

The company helped the Ignace health centre secure a grant to purchase 21 baby boxes in February. The goal, Pronger says, is to guide families toward local services and provide parents with basics that are difficult to attain in Ignace, such as fitted bassinet mattresses and thermometers. 

“There were so many different hospitals and community groups and agencies [in Ontario] that reached out to us that we realized there was really a need,” Clary says. Inquiries about the project came from urban centres before rural and remote communities began to get in touch.

A larger baby box initiative launches in Ontario this month, and includes more than 60 agencies across the province, from midwife practices to family resource centres. Non-profits, charities and the organizations themselves will contribute resources, says Jennifer Weber, chief education officer at Baby Box Co., some through in-kind contributions such as transportation services, product storage and more. 

Based on birth estimates for the province, the program will distribute 145,000 boxes to families through organizations such as Generations Midwifery Care in Brockville and Regional Food Distribution Association in Thunder Bay.

The initiative highlights a concern in maternal and infant health in Canada: how best to connect communities marginalized by geography, social status or both to local support and reliable information? Weber says the intent is to use the boxes to reach parents before they become overwhelmed by the transition to parenthood.

The baby boxes have caught on around the world, including in South Asia and the U.K. A BBC documentary on Finland’s program and the gifting of a box to the Duke and Duchess of Cambridge in 2013 likely helped their popularity. Earlier this year, a Slate report on a similar Texas startup suggested that with the introduction of the boxes, the state could “start to look a little more like Finland.” But some experts say tying such projects to lower infant mortality rates (and citing Finland as an example of this success) is somewhat misleading. It’s an attractive premise, but reducing newborn deaths in industrialized countries today involves much more than access to essential products and a bassinet.

“Most of these deaths now are related to things like extreme prematurity, extreme low birth rate, genetic causes or congenital anomalies, congenital heart defects, things like that,” says Shaun Morris, a clinician-scientist at Toronto’s Hospital for Sick Children. “Finland in 1900 is not Canada in 2016.” 

Most of the babies dying in Canada today, Morris says, will not live long enough to use the boxes. Nor would they have survived at any other point in human history, because technology has allowed for the delivery of more premature babies and multiple births.

In a 2013 Save the Children report on infant mortality, Canada was second to only the United States in the number of first-day deaths among industrialized nations: roughly two in every 1,000 births. The rate of newborn infant deaths (those that occur in the first month) was four in 1,000, accounting for 43 per cent and 62 per cent of deaths under the age of five for Canada and the U.S., respectively.

But these numbers disguise important information, Morris says. There are disparities in first-day and newborn death rates across the country, for example, and infant mortality has been falling across the industrialized world for decades (hovering at around five deaths in every 1,000 live births in Canada, according to World Bank estimates). The absolute difference between wealthy countries is also small.

Additionally, rates of sudden infant death syndrome have been declining in Canada. In 1999 the federal government launched its Back to Sleep campaign and by 2004 reported that the rate of SIDS had fallen by half, accounting for five per cent of all infant deaths in the country. However, according to the Public Health Agency of Canada’s Joint Statement on Safe Sleep, SIDS occurs more frequently among “infants who are male, premature, or of low birth weight, as well infants from socio-economically disadvantaged and aboriginal populations.”

“I think that’s another thing that’s important for us not to forget: as a society there are very marginalized, disengaged communities right in the middle of our biggest cities,” Morris says.

The Ontario baby box initiative’s strength, then, is its commitment to community engagement and providing reliable information regarding infant health, particularly concerning safe sleep practices. The program follows the Welcome to Parenthood Alberta pilot project spearheaded by Karen Benzies, a professor at the University of Calgary’s faculty of nursing. As at Mary Berglund, the boxes are an “engagement tool” — a way to provide families and mentors participating in the research study with data-based education. Alberta Human Services is funding the project and Baby Box Co. supplies the boxes.

Families and mentors work with Parent Link Centres in Alberta and agree to participate in the study from 32 weeks gestation to six months after birth. Welcome to Parenthood hopes to evaluate how maternal health and community support influence child development. The results will be presented to the provincial government, with recommendations for a wider project. The study is accepting participants until the end of November.

Benzies questions the focus on infant mortality in Canada and the efficacy of some attempts at replicating the Finnish program: “We’ve done an amazing job in [providing] neonatal intensive care, reducing mortality,” she says. “Where we need to focus our efforts is morbidity.” That is, the likelihood of disease, illness and injury to infants. Like Clary, Benzies urges parents to carefully research baby box programs that have sprung up in Finland’s wake — albeit, many decades later — and if they choose to participate, go into such programs with the understanding that stashes of baby supplies can’t address the more systemic issues that affect infant health, such as health care access, poverty and infant care education. “They need to understand why people want you to sign up for something and what the expectations are for that.”

When asked about the threats to infant health in Ignace and nearby towns, Pronger mentions food security, poverty and the geographical barriers that prevent families from getting  emergency care or essentials such as cribs and bedding. In 40-below weather, the Mary Berglund facility itself can be difficult to reach, though they manage with home visits and flexible hours.

Our community has an advantage, whereas [others] don’t have a community health centre, even a community like Kenora,” she says. “They have a family team, they have a hospital — a big hospital — but they’ve got some real challenges [there].”

Kelly Graff is one of only two midwives in Kenora, which is more than two hours west of Ignace, near the Manitoba-Ontario border. “We have no obstetricians, so it’s [general practitioners] that are delivering babies and it’s us. So we’re the only people that do this full-time,” she says. Though clients’ reasons for choosing midwifery vary, Graff adds, many appreciate that the person who sees them through their pregnancy will also be there during and after the birth.

Kenora’s midwives are responsible for patients both in the city and occasionally those who come from outlying communities such as Red Lake, Fort Frances and Dryden. For the latter group, this means Graff and her colleague can’t provide the same prenatal and follow-up care, making problems difficult to detect, much less treat, before they become life-threatening.

In her practice, Graff says she sees social barriers to infant and maternal health more often than high-risk pregnancies requiring a neonatal intensive unit. Such barriers include housing concerns, low breastfeeding rates and a lack of resources that might be available in larger cities to deal with postpartum depression and other mental illnesses.

The Ontario baby box initiative aims to bridge the gap in some small way, taking the lead from communities – remote towns, new immigrants, young parents – to ensure the most success. “We’re not saying it will cure everything, but the families, they know who they can actually turn to sooner rather than later,” Baby Box Co.’s Jennifer Weber says.

Shannon Clarke is a writer from Toronto.

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