Baby Boxes have been making news in the UK for a few years, with research and debates ongoing into how they help families in Scotland and Finland (or shoppers at Lidl). But there's been precious little research into whether this innovative intervention might be useful in a low-income country like Kenya. Our small pilot programme provides a glimpse into their potential.
The Baby Box Pilot was Child.org's first mother and newborn programme, and the first delivered direct by our Team in Nairobi. It was also funded by our first ever Christmas appeal - £6000 raised from individual donations from UK supporters and matched by the Bush Hospital Foundation.
Between June and December 2018, Child.org used that money to deliver 483 specially-designed Baby Boxes to mothers with newborn babies living in informal settlements ("Slums") in Nairobi County, Kenya. Each box included a mattress, two sheets, a cellular blanket and a mosquito net, and was printed with safe sleeping advice.
Using the baby boxes, Child.org wanted to:
- Encourage more mums to access postnatal care services
- Provide new mums with safe sleeping information and a safe place for their baby to sleep
Our research and programme development aims were:
- To initiate maternal health programming for Child.org
- To learn about potential opportunities for Child.org to make a significant constructive contribution to maternal and neonatal health programming in Kenya
- To assess the efficacy of the Baby Box as an incentive to access services from a government health facility in Kenya
- To assess the potential impact and value of the Box itself in the Kenyan context to determine whether a Box could be a useful intervention for Kenyan mums and babies
The results of this pilot were astounding
More families accessed vital health services, and life threatening infections were identified earlier. Mums had a far better understanding of the safest way to put their baby to sleep. Our extensive surveys and the experience of running the programme also highlighted some key opportunities for Child.org to improve the lives of mums and babies in Kenya in the future. Here are some key successes:
- 96% of mothers accessed postnatal care services following the birth of their baby, compared to only 15% at baseline. The project saw an 81% increase in women and babies accessing life changing services.
- Improved postnatal care uptake with the provision of the Baby Box meant that health problems were detected early; out of the 11% of mothers that reported a health problem being identified during PNC, 22% were diagnosed with an umbilical cord infection. Cord stump infection is one of the causes of blood infections such as sepsis and tetanus. These contribute to17% of newborn deaths in Kenya.
- 95% of mothers that received the Box are using it as a place for their baby/babies to sleep either during the night or during the day.
- Parents are using the Boxes a lot more consistently during the day (93%) and only 2% are putting their baby to sleep in the Boxes at night. This is because co-sleeping is encouraged by medical professionals in Kenya to facilitate breastfeeding. Child.org did not discourage this practice in favour of the Boxes as a place to put baby to sleep at night. (For more information on why this is - download the report, link below.)
- Before the programme, just 7% of mothers knew that the safest position for a baby to sleep is on their back. After the programme, 43% of mothers knew this.
- 80% of newborn babies were being exclusively breastfed
- The number of mothers and babies sleeping under a mosquito net at night increased from 71% to 80%
Surprising facts from the Baby Box report
1. Child.org worked directly with the the Ministry of Health on this programme, and when we discovered gaps in provision of postnatal care - we ran our own training session with staff and volunteers. We also made sure we were using monitoring and evaluation tools and measurements that would work with the data used by the Ministry of Health, so we could share and compare data easily.
2. We initially registered 478 mothers, reserving 22 of our 500 boxes in case any of the mothers had multiple births. This turned out to be prudent because nine mothers in the project had twins. Only one of these mums had a scan, and her scan was inaccurate - so none of those mothers knew they were expecting more than one baby!
“It has helped me a lot, especially the mosquito net from preventing diseases by malaria.” - Gentrix, mother of twins, Prince and Ashley.
3. In an early focus group, we showed local young mums a prototype of the box and they were shocked, saying that it looked like a sanduku/coffin! To ensure mums wanted to collect and proudly use the box, it had to look like a beautiful crib for a baby, so we worked with illustrator Jaqueline Fryers to create beautiful boxes in a cost-effective black and white. The boxes were printed and manufactured in Kenya.
4. Mums told us that the boxes were most useful as a safe place to put the baby during the day, while they were working or cleaning up. Imagine the impact on your day-to-day life when you're given a safe place to put your baby down, in an environment where that wasn't possible before.
Read the report
Our report outlines the whole story of the programme: the challenges we faced, the things we learned and the families we met.
Right now, Child.org are fundraising to deliver a brand new Baby Box project in Kwale, Kenya, reaching 500 new mums. In this area, there remain major gaps in service provision and uptake, safe sleeping for infants, and partner involvement through pregnancy and delivery. More than just a sleeping device, Baby Boxes tackle all three issues concurrently by acting as a vehicle for for information and an incentive to take up support services.
The Team Mum appeal is raising funds for this right now.
Having learned so much from the Baby Box Pilot, Child.org are always reviewing the opportunities presented and how we can act next. For example, here are some aspects that our team are keen to explore further:
Considering the significant gaps we found in the provision of postnatal care while we were delivering this programme, we’re keen to keen to increase the scope of our potential impact on postnatal care rates in Kenya.
We also want to capture more data on the mental health of new mothers. We conducted a small survey of women using the Edinburgh Postnatal Depression Scale during the endline evaluation and found that 36% of mothers were found to have symptoms of depression. Mental Health is a much-hidden topic in Kenya and postnatal depression is not discussed with mothers at any time during pre and postnatal care.
We want to address the deficit of data regarding safe sleeping for infants living in informal settlement environments in Nairobi and beyond, through academic study of safe sleeping studies in collaboration with universities in the UK and in Kenya. There is huge scope to find out more about whether sudden infant death syndrome (SIDs) really is leading to more baby deaths in Kenya, and assessing what interventions could save more lives.
Fund our mum and baby programming
If you like what Child.org are doing to support mums and babies, please consider joining Team Mum Monthly. Your donation will help us reach mums and babies who need our help, and we'll keep you up to date with all the cool stuff you're helping us to do.