The baseline is an in-depth survey we conducted right at the start of a programme - to find out more about what the situation is like for families before we provide them with a box. The data will help us see the impact of the pilot more clearly, and it also helps us identify other opportunities - other problems we can solve to keep babies safer.
It was an enlightening day and incredibly helpful for me to catch up with what we’ve learned by speaking to women directly. I wanted to share some of our findings because there is some surprising and frankly quite shocking content that will inform our activities from here.
What the team did
This is the summary of the baseline collection activity in numbers:
- 200 mothers interviewed
- 4 research assistants
- 5 different areas in Westlands, Nairobi
- 8 days
- 8 ministry of health staff trained by the Child.org team
- 1 digital platform used to collect and summarise the data
What we learned
We asked the women a lot of questions so we learned a great deal, but the most interesting findings were around safe sleeping practices and access to health information.
The boxes are designed as an incentive for women to access postnatal care from their local health facilities.
What the pilot is also helping us to achieve is a better understanding of safe sleeping practices. UK readers might recognise safe sleeping campaigns, designed to reduce Sudden Infant Death Syndrome (SIDS), sometimes referred to as "cot death". We know that education around safe sleeping in the UK reduced SIDS by half between 1989 and 1992 during the ‘Back to Sleep’ campaign but in Kenya there’s very little information on SIDS or how much of a problem unsafe sleeping practices are for small babies.
From our pilot, we’ve learned that there is a significant gap in knowledge about how to keep your baby safe while they sleep.
92% of women told us that they bedshare with their babies. Only 51% of the women interviewed had received any information about how to safely co-sleep. We wanted to check whether women could correctly answer some questions about safe sleeping and shockingly only 7% told us that the safest way to put a baby to sleep is on its back.
21% of mothers put their baby to sleep in a bed with a parent (them or their partner) who had been drinking, meaning a significant number of babies face an increased risk when they go to sleep at night.
43% of women told us that it’s not easy to find out info on their family’s health. We saw strong correlations with location here: unsurprisingly where there were health centres that provided decent services, the rate was much higher. Using a digital platform with geo-location analysis will help us to identify where the most significant gaps and where Child.org can focus on supporting mothers.
Less than 1% said they access health information from Community Health Volunteers (CHVs). This is hugely significant - CHVs are Ministry of Health positions that community members volunteer in. They are supposed to be trained and supplied with information, in order to help bridge the gap between the community and health facilities. They are vital for encouraging women to access the healthcare they need, and are entitled to, during pregnancy and beyond.
In a similar vein, almost 30% of the new mothers we spoke to hadn’t received the Antenatal Care Booklet they’re supposed to get on their first visit to hospital. This is the equivalent of the UK's maternity notes and red book for babies, combined into one accessible booklet by the Kenyan government. It’s a great resource, full of content to assist mothers in understanding what danger signs to look out for in pregnancy, breastfeeding and their child’s growth and development.
According to Mike, there is a problem with the distribution of these booklets from the ministry to the health centres, causing long delays with restocking when a facility runs out. This is a huge waste of a great resource and the gap can be plugged very simply by ensuring that Community Health Volunteers have a constant stock, so that every woman we work with has access to the booklet.
Other notable gaps in health education are that only 5% of women said they have access to information on water and sanitation. Our researchers witnessed people washing clothes next to open sewers so some simple health information could have a significant impact on the spread of disease in these regions. Also, under 1% of women had received information on nutrition and 27% hadn’t received any advice or education on family planning.
How it’s going to impact what we do
As we’ve said, the key driver of the Baby Box pilot is to assess the impact of the box as an incentive to improving access to postnatal care. We’re learning about this over the course of the pilot but we’re also learning about what other gaps and problems there are that we’re already beginning to help solve, or how we might tweak our activities to plug gaps we’ve discovered.
For example, Child.org are already providing safe sleeping information on the boxes themselves but we’re talking with the ministry of health about how we can arm Community Health Volunteers with more health information to disseminate to the women they meet.
Collecting valuable data is a key part of our work and the Baby Box baseline is a prime example of how knowing our audience can shape and improve our work. Funding such studies ensures that we’re developing the best possible solutions to real problems.
I’m so excited to be back in the office and working on this project again. In an environment where the international recommendation of putting a baby to bed in a crib next to mum isn’t feasible, because access to a crib is unobtainable, a baby box offers a mum a safe alternative to bedsharing. Perhaps most important though, is the information provided alongside the box - the knowledge of how to keep mum and baby safe and well.
You can read more about our Baby Box programme here. If you like the way Child.org do things, please consider supporting us with a donation, so we can reach more mums and babies. We'll use your donation to do what works. Thank you!