Improving provision of postnatal care and health information for mums in Nairobi
Child.org's Baby Box pilot programme began in 2018, our first programme to aim to keep newborn babies safer. We believe that encouraging and improving access to postnatal care is key to protecting more mums and babies - our Baby Box programme is designed to do that for mums living in informal settlements in Nairobi.
Child.org have been handing out baby boxes to new mothers in informal settlements ("slums") in Nairobi, Kenya. Baby boxes have been provided to new mothers in Finland for over 75 years. In Finland, a box includes everything you need for a newborn baby, all contained in a box, which is used as a cot. This baby box concept is used all over the world, from USA to Scotland, India to Mexico! However, the possible impact of this approach has not been thoroughly tested in a low-income environment.
The box we've been giving out to families in the pilot programme is a much more simplified version than the packed box a mum would receive in Finland or Scotland. We're investigating whether the box encourages mothers to come back for their postnatal check-up after they have given birth. We'll also find out if using the box as a cot will help the mother and the baby in the first three months of the baby’s life.
This pilot programme is all about finding out the impact that the boxes can have in a city like Nairobi. Our goals for the pilot programme are:
- To measure the impact of the baby box on the mothers' lives in the first three months
- To better understand the needs of the mothers and their babies in the first three months after birth
- To find out if the baby box is a successful incentive for mothers to access postnatal care services in a health facility with the help of a skilled health professional.
Baby Boxes - A first look at some results!
Posted on 02nd Nov 2018
Since the launch of the Baby Box program in May 2018, our team have handed out 380 boxes. We're now getting the first results back that tell us how the boxes are being used, and the impact this is having on families.
The story so far...
Back in May, at the start of the programme, Child.org trained four research assistants to conduct a baseline survey in informal settlements in Westlands, Nairobi. The women surveyed were from Kangemi, Kibagare and Githogoro. This survey consisted of preliminary questions asking the expectant mothers about their knowledge of childcare, maternal health and prenatal care (you can read about the results in Marti's blog here).
In July we started registering pregnant women to receive the boxes when their babies were born. Over a period of three weeks we had 500 women registered. So far we have handed out 380 boxes and will continue until they have all been allocated. We are working itwo health centres in Nairobi.
As with all our new programmes, Child.org worked in an agile way - responding quickly to solve problems. For example, the health centres we were working with initially had some challenges when it came to postnatal care service delivery. We worked quickly to address this to make sure that all women would receive postnatal check ups before they receive the baby box to guarantee their attendance. Thirteen women did not receive the postnatal care at the start of the programme, so for these mums, Child.org organised for two nurses to conduct home visits. We conducted a postnatal care training session, in collaboration with the ministry of health, for the nurses and health care volunteers. This was designed to help build the capacity of their teams, and bridge any gaps in their knowledge which applied to our programme.
After a slow start, things started to pick up in August and we have received a constant flow of women collecting boxes ever since.
We originally expected to have given out all the baby boxes by the second week of October as we were registering women already in their third trimester. However, we now know that this will not be possible due to various reasons, including:
- There are sometimes long queues for the postnatal check ups (some women go home instead of waiting)
- Many mothers do not know their correct scan or due dates, so our estimates about when boxes would be collected were not always correct
What's happening now?
Now that so many boxes have been collected, the team have been visiting families at home to find out how they have been impacted by the programme. (You can read about some of the first mums we visited in this box post.) We have been collecting data on three core areas:
Use of the baby box
- Support structures / groups for mums
We have conducted 78 home visits to date, and these are already giving us extremely useful information about the impact of this pilot programme. The results below are from our findings on these home visits, we will collect more in-depth data and information through our endline survey.
Some early findings from our home visits
Just 5% (four women) told us they do not use the baby box
One of these mums mentioned that she fears visitors will judge her. Others mentioned that their baby was not comfortable in the box, and that it was not culturally acceptable for a baby to sleep in a baby box
87% only use the baby box during the day
Roughly 10% use the baby box during both the day and the night. This suggests that the boxes themselves do not discourage cosleeping at night. However many mums found the box incredibly useful during the day, particularly those who had to return quickly to work and took the box with them to keep the baby safely by their side. 91% of women told us that they slept with their baby at night.
54% of women use additional bedding when cold
40% of women only use the bedding provided by Child.org
82% percent of women read the instructions on the lid of the box about safe sleeping
Of these women, we found that 14 did not understand the intructions.
95% of mums received their postnatal check up
And most received it early: 42% of women came back for their post-natal check ups after two weeks, 30% after one week, 3% after three weeks, one percent at 4 weeks, 19% after more than 4 weeks.
96% of women are exclusively breastfeeding
However, 22% reported that they had trouble breastfeeding, with issues including painful breasts, not enough milk being produced, mastitis and the issues with latching the baby to the breast in the correct way.
33% of women lacked a support system around them
We're discovering more and more that mums, even in bustling Nairobi, lack a source of emotional support and advice.
We are hoping to have handed out all the baby boxes by November, if not before, and we also hope to begin the endline survey. This is the final question and answer feedback sheet we fill out by interviewing the women who received the baby box. This will be an in-depth survey on maternal and child healthcare that will help us find out the impact of the project, where progress can be made and difficulties solved.
We aim to have the endline survey completed by the end of November. We look forward to sharing the results with you!
You can read more about our Baby Box programme at child.org/babyboxes. If you like the way Child.org do things, please consider supporting us with a donation, so we can reach more mums and babies. Thank you!
This programme is all about collecting evidence.
Does having a box to sleep in help to improve infant safety in the home for families living in urban settlements in Nairobi? Does the incentive of a beautiful baby box mean that more women attend postnatal appointments? These are the questions that this pilot will answer.
Where we work
The perfect place to test the efficacy of baby boxes is in certain areas of Nairobi, Kenya.
Here, there is a high proportion of mothers who are severely affected by poverty and living in urban informal settlements ("slums"). Infant morbidity rates are high, so it's an area that needs more protection for the health of newborns and their mums.
All our participants are mothers living in Kangemi and Westlands in Nairobi, where most mums fails to attend any postnatal care sessions at all. Our research has indicated that this group could benefit hugely from some extra, specifically targeted support, particularly around the safety of a newborn.
If the baby boxes are effective, there is potential to scale up the programme in Kenya, and beyond! Already our team are in discussions about running a similar pilot in Sierra Leone and potentially Malawi.
In this pilot programme we are partnering with two health facilities to hand out baby boxes to around 500 women.
During their final antenatal visit to the clinic, mothers are given a little baby hat and a voucher to collect the full box. They then receive the box when they return to the health clinic, with the voucher, for their postnatal mother and baby check-up. In this way we are testing to find out whether the box works as an incentive for the mothers to come back for their postnatal care check-up.
We monitor the mothers with a full survey three months after they deliver their baby. We will also be collecting additional observations and interviews with a small group of women one month after giving birth.
Our surveys will provide us with information on:
- Usefulness of the baby box as a cot, and its contents
- If there is an increased usage of postnatal care services
- If there is an increased understanding among mums of their own and their baby’s healthcare
- If there is an increased understanding of their baby’s needs in the first three months of life
- Whether there is a need for additional training for mothers
How you can help
If our pilot is successful, we're going to want to scale this programme up. In future boxes, we would love to include items that will impact the rates of the most common child diseases in Nairobi: diarrhoea, pneumonia, malaria and malnutrition. Already, our design of the pilot has highlighted an urgent need for better postnatal care for young mothers, so we would love to design ways to tackle this gap in provision too.
We do what works. If this programme proves that baby boxes are effective, we'll want to go big. We hope to issue over a thousand boxes within informal settlements around Nairobi over a period of two and a half years.
We'll need more funding to make that happen. Each baby box currently costs us around £14.