Dani Garavelli: Baby box must be more than a gift to cynics

Above left: the Scottish baby box, featuring a winning design by Edinburgh Napier University student Leanne Young. Picture: Scottish Government
Above left: the Scottish baby box, featuring a winning design by Edinburgh Napier University student Leanne Young. Picture: Scottish Government
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SPECIFICATIONS for a cardboard crib are far less important than the resources and commitment to mothers that lie behind it, writes Dani Garavelli.

As a piece of symbolism, the SNP’s baby box policy is pitch-perfect. A parcel of goodies given to all new mothers – rich or poor – sends out the unambiguous message: “Every child is cherished by the state.” It’s a relatively inexpensive gesture which suggests a level playing field and appears to tie in with the party’s top priority: the eradication of social inequality.

Nor is the fad for baby boxes confined to Scotland; in the past few years the idea has swept across America and Europe, with many US states and NHS trusts in England running pilots. Why then, as the Scottish Government prepares to roll it out across the country, is it attracting such widespread hostility?

To an extent, the emotive debate over baby boxes is reminiscent of that over the Named Person provision, where a well-intentioned and potentially positive measure was sabotaged by an orchestrated campaign and an inability on the part of the Scottish Government either to counteract it, or to communicate its aims effectively.

From the launch in January, ministers allowed a particular narrative to take hold: that the boxes, which double as sleeping spaces, were responsible for reducing infant mortality in Finland and would do the same here. Surely, they ought to have foreseen that this claim would be impossible to substantiate; and that making such a link would create a hostage to fortune.

Finland has one of the lowest infant mortality rates in Europe (it has dropped from 65 per 1,000 live births in 1935 to two per 1,000 in 2015). Baby boxes, which have been handed out to all new mothers since 1938, have no doubt contributed to that, but only as part of a pioneering maternity and early years service.

In Scotland, the context is very different; infant mortality is already relatively low (3.7 per 1,000 births, with around 40 deaths a year from Sudden Infant Death Syndrome or SIDS). There is research linking SIDS to co-sleeping, but none – as far as I can ascertain – proving baby boxes lead to a reduction in co-sleeping.

Last week, the cot death charity, the Lullaby Trust – which previously had been enthusiastic about baby boxes – said there was no evidence they reduced the incidence of SIDS, and that there were no specific safety standards for the use of a cardboard box for sleeping infants.

Cue the usual Twitter rammy, with critics claiming the statement proved the Scottish Government had rushed headlong into a policy it couldn’t justify and SNP MPs and special advisers insisting Scotland’s Baby Box was the first non-commercial box in the world to get British Safety Standard accreditation as a crib for home use.

The binary nature of this argument suits those for whom all of Scottish politics revolves around the Yes/No, pro/anti SNP axes. But it is reductive, risks putting new mothers off, and militates against a more nuanced discussion of the pros and cons of the wider policy.

The boxes are – or should be – about more than providing somewhere safe for babies to sleep; they should be about more, even, than providing babies with the things they need to make a good start. Ideally, they should act as a gateway into services capable of addressing inequality not merely at the point of birth, but throughout their lives.

Though critics have implied the SNP adopted the baby box policy on a whim, it has been on the party’s radar since at least 2009. Nor is it fair to suggest it is being implemented in isolation. In the past decade, the Scottish Government has invested heavily in maternity and early years services. Baby boxes fit with Getting It Right For Every Child (GIRFEC), its flagship programme aimed at improving outcomes for children and young people, its Best Start grants, to be given to low income families, and Ready Steady Baby, its pre and post-natal information guide.

However, in Finland the baby boxes are tied to engagement with ante-natal services. They are seen as an opportunity to forge links with hard-to-reach women, and to capitalise on the “golden moment”, the point in a pregnancy where mothers-to-be are most receptive to the idea of change.

In Scotland, all you have to do is to register with a midwife and wait for the box to be posted out to you; there is no obligation to do anything in return.

The SNP is quite clear about its reasons for this. It hopes – and believes – the boxes will encourage greater engagement with health visitors, but says denying them to women who refuse to engage merely compounds their alienation and makes it less likely they will do so in the future.

However, according to the Scottish Government’s own pilot scheme evaluation, some midwives have already expressed concern that unless more information on the contents of the box and the aims of the scheme is disseminated, “there could be a missed opportunity in terms of engaging parents with wider safety and health messages”.

There are other gripes about the policy. Some opponents believe handing out babygros and nappies to all, regardless of need, is a waste of resources that could be targeted at the most disadvantaged or invested in frontline services.

Then, there are questions over the provision: why have the costs of providing the boxes increased (from £6m to just under £9m)? And should the SNP have run longer pilots before rolling the policy out across the country?

Personally, I believe universalism makes for a more cohesive society; too much focus on the most disadvantaged stigmatises them and makes them more, not less, disenfranchised from the rest of society. As for the debate over SIDS, it is a red herring; a whipped-up argument aimed at discrediting the SNP at the expense of a detailed analysis of the policy and its wider aims.

The key question on the baby boxes is this: are they just a one-off gift or an integral part of an all-out assault on child poverty? If it’s the former, then their symbolism – however appealing – is empty; they are just a gimmick trading on a middle-class need for conscience-salving.

Unless they can be used to increase engagement with early years services, and unless those early years services are well-resourced, baby boxes will do no more than tinker round the edges of social deprivation.