Finnish baby boxes work in tandem with progressive social policies
“Though the rich of this earth find no difficulty in creating misery, they can’t bear to see it.” -- Bertolt Brecht, The Three Penny Opera
The Finnish Baby Box has been around for over 80 years. It’s a box given to parents of newborns containing a wide range of infant clothing, bathing products, diapers, bedding and a small mattress.
Because Finland is a social democratic welfare state, the baby box was purposefully decommodified to protect parents from market influence and dependency.
Unfortunately, the message and meaning were corrupted when governments, corporations, and media outside Finland began promoting the box as a viable means of reducing the likelihood of infant mortality and sudden infant death syndrome (SIDS).
Canada – via provincial and territorial governments, England and the USA chose to promote the unsubstantiated claim that using the box as baby’s first bed would lead to lower infant mortality. Additionally, the contents were a highly corporatized, inadequate version of the Finnish box.
Between 2016 and 2020, Finland’s already impressive infant mortality rate of 2 per 1,000 live births, dropped to 1.8 per 1,000. It ranked 3rd in the OECD behind Norway (#2) and Estonia (#1).
Marketers in Canada, England and the USA attributed Finland’s ongoing success to newborns sleeping in the baby box.
Scotland and Wales stayed truer to the original intent, content and messaging around the Finnish innovation. The decommodification of quality products provided in sufficient quantity, is attributable to these countries being governed by more socially progressive governments.
Alexi Blair-Hamilton, Undergraduate Research Assistant at York University and Dennis Raphael, Professor of the School of Health Policy and Management at York University, deconstruct the Finnish baby box in their soon to be published research paper, A Critical Analysis of the Finnish Baby Box’s Journey into the Liberal Welfare State: Implications for Progressive Public Policymaking
Their research showed liberal welfare states, including Canada, UK, and the USA, distorted the messaging around the box by promoting it as a means of preventing SIDS.
These countries then commercialized the box using product from the private for-profit sector, severely pared down the contents, and failed to embrace, or mention, the compliment of Finnish welfare state policies in place to support families with children.
Because health care falls under provincial and territorial jurisdiction, baby boxes vary across Canada. But a typical box would be promoted by health care facilities as a safe-sleep space. The ‘gift’ requires the parent to sign-up to a commercial website and the box contains trials of commercial products and discount coupons along with a mattress and sheet.
The Ontario government – Liberal at the time -- entered into an agreement with The Baby Box Company to distribute 145,000 boxes to new parents from August 1, 2016 until August 1, 2017.
News media delivered the message that free baby boxes containing product samples, commercial coupons, a mattress, water-proof cover, fitted sheet, and a onesie were available to new parents. The approximately $200 value assigned to the box included the value of the coupons and was a far cry from the Finnish model containing no commercial samples or coupons.
Most provinces, including Ontario, have discontinued this service. Instead, boutique baby boxes that are purchased online have taken over the market.
Blair-Hamilton and Raphael found that Scotland and Wales recognized, and implemented, the decommodification and equity roles inherent in the original Finnish baby box.
Scotland evaluated the success by providing phone and online surveys to parents, midwives, and other visiting health professionals. They also linked the initiative to broader public policy aimed at improving living conditions for young families.
The success of the Scottish and Welsh models can be attributed to their left-leaning governments and the overarching goal of promoting the well-being of new-borns, their mothers and their families.
A country’s infant mortality rate is an excellent indicator of the overall health of a population because it’s informed by the quality and distribution of the social determinants of health.
Canada’s infant mortality rate is among the highest of the Organization for Economic Cooperation and Development (OECD) nations.
Infant mortality is defined as the number of deaths of children under one year of age, expressed per 1,000 live births. Still births are not included in the count.
In 1980, Canada ranked 10th out of 34 OECD countries. By 2005, Canada had dropped to 24th.
In an interview with Small Change, Raphael explained, “Canada had 5.3 deaths per 1,000 live births. While overall infant mortality rate declined, Canada’s ranking dropped from 10th to 24th. That’s because the decline in deaths failed to match the pattern for other OECD nations.”
By 2011, Canada’s ranking slipped to 26th.
Between 2016 and 2018, the infant mortality rate was 4.7 and Canada ranked 32nd.
In 2021, there were 4.5 deaths per 1,000 live births in Canada which gave it a ranking of 30th out of 38 nations.
The problem exists across the entire population, yet main stream media repeatedly restricts it’s reporting to the exceptionally high rate among Indigenous populations.
According to Raphael, “By doing so, the media, while highlighting the continuing effects of colonization upon Indigenous peoples, essentially explains away the numerous other factors behind Canada’s relatively poor performance on this important indicator of population health.”
Canadian media’s skewed reporting of infant mortality rates actually draws upon concepts of media logic, otherness, and cultural supremacy.
Media logic requires the idea to be concrete, immediate, and something that is already familiar to the audience. That prevents reporters from introducing new concepts and ideas. That, in turn, distorts the truth and keeps the real issues from being discussed.
Raphael says, media logic leads to reporting on individual issues and solutions rather than thematic examinations of social forces and structural issues.
That’s why reporters stick to things like the link between alcohol and cancer, but won’t cover Canadian infant mortality rates.
Raphael points out that reporting on structural determinants of health is difficult because the root causes of health disparities are complex, controversial, less politically safe and provide fewer immediate suggestions for actions.
He wants Canadians to understand that this isn’t just an Indigenous issue. It is, in fact, about the social determinants of health and the reality that Canada’s social spending is ranked amongst the lowest for OECD nations.
Think federal, provincial, and territorial spending on education, employment training, social assistance, family supports, pensions, health and social services, and housing.
Raphael points out that in 2014, Canada allocated 17 per cent of its gross domestic product (GDP) to social spending. That earned it a ranking of 26th out of 34 OECD countries.
Finland, France, Belgium and Denmark all assigned 30 per cent of their GDP to public expenditures at that time while the USA allocated 19.2 per cent of its GDP.
By 2022, it appeared that Canada was doing much better at allotting funds to social safety nets. A closer analysis of the actual amounts distributed and spent on social safety nets, shows just how deceiving that conclusion was.
Canada ranked 9th out of 38 OECD countries in 2022 because it apparently allocated 25 per cent of its GDP to ‘social spending.’
Closer examination reveals that much of Canada’s increased spending was related to emergency relief spending for labour markets – subsidizing businesses and employees during COVID.
That expenditure of 4.8 per cent of GDP gave Canada a ranking of 1 out of 38 OECD nations.
At the same time, Canada spent very little on families – only 1.8 per cent of GDP -- earning it a ranking of 27th out of 38 OECD countries.
The extremely low spending on families paired with the high spending on businesses raised Canada to 9th place. That ranking is expected to drop dramatically once cuts to COVID spending are factored into future rankings.
“Canada does not assure economic and social security for those on assistance, kids in families, seniors living on pensions, and people living with disability,” observed Raphael.
And, no baby box is going to fix that.
Great job Doreen!