The Problem
Improving provision of postnatal care and health information for mums in Nairobi
The pilot of Child.org's Baby Box pilot programme ran in 2018, our first programme to aim to keep newborn babies safer. Encouraging and improving access to postnatal care is key to protecting more mums and babies - our Baby Box programme was designed to do that for mums living in informal settlements in Nairobi.
The reports from the pilot were incredible. We're now seeking funding to scale the programme and find new ways to use the box to support mums.
Goals
Child.org handed out 483 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 had not been thoroughly tested in a low-income environment.
The Baby Box we distributed for our pilot programme was a much more simplified version than the packed box a mum would receive in Finland or Scotland. We were investigating whether the Box could encourage mothers to come back for their postnatal check-up after they had given birth. We would also find out if using the box as a cot would help the mother and the baby in the first three months of the baby’s life.
Our goals for the pilot programme were:
- 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 Latest
Baby Box Pilot - a report
Posted on 11th Mar 2019
The results are in and the report is out. You gave us the money to run a Baby Box programme, here's what we achieved with it.
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.
The aims
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.
What next?
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:
Postnatal care
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.
Postnatal depression
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.
Safe sleeping
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.
Evidence
What are Baby Boxes?
A Baby Box is an inexpensive alternative to a crib made with cardboard material. The concept originated from Finland in the 1930s initially targeting women affected by poverty in order to increase attendance of antenatal care sessions and skilled delivery.
The programme in Finland was extremely popular and since the intervention was introduced, the infant mortality rate in Finland has decreased from 65/1000 to 2.4/1000 (BBC, 2013). Of course this success cannot solely be attributed to the Boxes; they were utilised as an engaging and useful intervention for mothers whilst further investments were made into maternal health which ultimately led to better health outcomes. That said, they have proved an effective vehicle through which to provide potentially life-saving equipment to new mothers, improved uptake of maternal health services and to disseminate vital health information.
Baby Boxes are now given as incentives in Scotland, some states in the U.S, parts of South Africa and Mexico among other countries, but there are few projects in developing countries, and where they are, little data is being collected on their efficacy in a low-income setting.
What did we want to learn through the pilot?
Prior to the start of the programme we knew that we wanted to assess the efficacy of the Box on access to vital maternal health services. We undertook significant research to assess three main areas of understanding before the pilot was designed:
1. Where were maternal services a particular challenge for women in Nairobi?
2. Which services were most in need of improvement?
3. What value could the box have in and of itself?
To read more about the evidence we used to design the programme and the evidence we collected through our surveys, download our pilot programme report, below.
Evidence based on:
Further reading
Where we work
The extensive research we conducted when designing this programme indicated that the perfect place to test the efficacy of baby boxes was 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 were mothers living in Kangemi and Westlands in Nairobi, where most mums fail to attend any postnatal care sessions at all. Our research indicated that this group could benefit hugely from some extra, specifically targeted support, particularly around the safety of a newborn.
Methodology
In our pilot programme, Child.org partnered with two health facilities to hand out Baby Boxes.
During their final antenatal visit to the clinic, mothers were given a little baby hat and a voucher to collect the full Box. They received the Box when they returned to the health clinic, with the voucher, for their postnatal mother and baby check-up. In this way we tested to find out whether the Box worked as an incentive for the mothers to come back for their postnatal care check-up.
Data
As with all of Child.org’s programmes, the Baby Box Pilot needed to provide us with learning; about the effectiveness of our
work alongside a greater understanding of the needs and opportunities within maternal health programming.
The project design included multiple surveys to inform us of the situation in the region we identified, the perception of the interventions we presented and the change they made. We conducted three key surveys within a six month period: the baseline, the midterm and the end line evaluations.
We also engaged with the Monitoring and Evaluation department from the Nairobi County Government to help inform us of the Ministry of Health’s processes and to assist us in developing project indicators that aligned to the ministry’s own. This ensured we could share findings easily and contribute to the Ministry of Health’s own objectives in Maternal Health. The department also shared their knowledge and experience of the digital data collection tool used by development partners; Kobo Toolbox. This tool allows for easy data collection, sharing and analysis and has been adopted by the Child.org Programming Team across multiple programmes as a result.
Our surveys
Our surveys provided 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
For further information please don’t hesitate in getting in touch with the team to discuss the programme.
To request any of our research on Baby Boxes, please email programming@child.org.
As our portfolio of Maternal and Neonatal Health project portfolio grows, we’re looking for partners from a wide range of sectors and fields of expertise. If you think you could complement or add value to future MNH programming with us, please email our Head of Programming,
Martina Gant at marti@child.org.
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.
