The Economics of Change

It’s a bunny,” exclaims Adnan Racaj with delight. “No, it’s an elephant,” corrects his partner, Heidi Lempiö, as she unpacks a sizeable box they’ve just collected from their local supermarket. The colourful cardboard box is crammed with items for their first baby, due in February. This year, there are 63 items in the box.

“Kela wishes you happiness and congratulates the whole family,” says Lempiö, 38, reading from a card inside the box. She is a lawyer and her husband Racaj, 36, is a technician. They live in Espoo, not far from the Finnish capital Helsinki.

The box is not a present from a generous aunt or a friend. Kela is the government’s social security agency. Expectant parents across Finland all receive the same box from the state.

But who pays for it and what does the gift aim to achieve? And has the baby box programme brought economic benefits for the whole country?  

Village births

When the baby box was first introduced in 1938, its value was around 450 Finnish markka  (about £2, $2.6), about a third of an industrial worker’s monthly wage. Its aim was to improve maternal and infant health, and to combat low population growth between the two world wars.   

In 1936, Kela statistics show, 4,543 children died before turning one, equal to 66 deaths in every 1,000 births. Influenza, pneumonia, diarrhoea, whooping cough and tuberculosis were the most common causes of infant mortality. 

Back then 80% of the population lived in villages in what was a mostly poor, agrarian nation. Health services were limited and mothers mostly gave birth at home, not always in hygienic conditions, so the first baby boxes included a clean sheet of paper on which to give birth.

Ordinary people also had a “very low level of knowledge” about pregnancy-related health issues, says Reija Klemetti, research manager and an expert on sexual and reproductive health from the National Institute for Health and Welfare in Helsinki.

“One simple thing was syphilis,” she says, something that was common at the time. “It was important to get pregnant women to antenatal care before 16 gestational weeks to find out whether the woman had syphilis and to give treatment and avoid serious harm for the baby and the mother.”

Growing tax-payers and soldiers 

Another rationale for the box was the pressing need for Finland to produce more babies. Early in the 20th Century, after the deaths in World War One, population decline was a significant worry for European politicians.

“Healthy babies would grow up to be healthy tax-payers,” says Finnish ethnologist Sanna Särkelä. “They also wanted potential soldiers for the possible new world war.” In the 1930s, the government feared a new generation of Finns would be needed to staff an army against duel threats from Hitler’s Germany and Stalin’s Soviet Union.  

The first baby boxes came with strings attached: the mother had to visit a doctor, a midwife or pre-natal health clinic for a medical check-up. It incentivised women to seek pre-natal healthcare, a practise that continues today.   

Healthy babies would grow up to be healthy tax-payers -Särkelä.

According to Karoliina Koskenvuo, head of the research team at Kela, the direct link between medical care and the baby box has saved lives by detecting problems early in both mothers and babies. In 2017, Finland had 3.9 infant deaths per 1,000 live and stillbirths, a more than 10-fold reduction on the 1930s. Maternal mortality has also fallen significantly, from 71.8 per 100,000 live births in 1960 to 5.7 in 2016.

Of course, it wasn’t just the baby box – medical facilities and immunisation programmes also developed rapidly during this period, and more women gave birth in hospital. Living standards rose and knowledge about nutrition and health increased, all contributing to reduced deaths. 

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Shared experience

From 1949 the baby box was being distributed to all prospective parents in Finland. It has since become a shared experience connecting generations and even part of Finland’s national identity. “My parents still have my own box,” says Heidi. “They keep Christmas decorations in it.”  

Even President Sauli Niinistö received a box this year, after the birth of his son in February. “How could he refuse the box?” asks sociologist Anna Rotkirch, who heads the Population Research Institute at the Finnish Family Federation. “It’s very Finnish. It helps create cohesion and trust in society by giving all children a similar start in life.”

It is a kind of symbol of Finnish equal society. Everybody gets the box, whether you are rich or poor - Särkkä.

Generations of Finns have grown up playing together in exactly the same outfits from their baby boxes. Some feel it reflects Finns’ egalitarian approach and a sense of shared social responsibility.

“It is a kind of symbol of Finnish equal society. Everybody gets the box, whether you are rich or poor,” says new mother Heini Särkkä. “The box has everything that a baby needs. It gives a good start in life even to poor families.”

Outfits in the box change every year, so it’s easy for mothers to spot babies born around the same time. “It often becomes the subject of conversation, and you connect with mothers with children of the same age,” says Särkkä.

Advocates such as Rotkirch also suggest that having clothes in the box acts as a leveller. Parents don’t need to think about which brand to buy or how their relative affluence is reflected in their baby’s clothes.

From box to cradle

When they were first introduced the boxes were a home-from-home for new babies and used instead of cots, but this has changed.

“Growing affluence has meant that many parents now can afford to have a separate room and a separate cradle for the baby,” says Rotkirch.

According to Statistics Finland, 87% of dwellings now have more than one bedroom. The baby box has as a result become a secondary sleeping place, where a baby might nap during the day. Kela’s statistics show that in 2011 42% of parents used the box as a bed, dropping to 37% in 2017.  

“It’s a cute idea to have your baby sleep in the box,” says Heidi Lempiö. “But I don’t fancy bending down to the box at night to lift the baby to breast feed. We are planning to have a special cradle by our bed so that baby sleeps on the same level as us.”

President Niinistö also recently confessed that his baby boy did not sleep in his box. 

In Finland Sudden Infant Death Syndrome (SIDS) is comparatively rare. There have been no definitive studies but some believe that the baby boxes have been at least partly responsible for the low figures as they provide a separate place for a baby to sleep on its back on a rather firm surface. 

Ideology in a box 

The government’s decision to provide all parents with a baby box makes the statement that it values the life of every child, says Rotkirch. Yet the architects behind such a significant national programme are not widely known.  

Perhaps this is a reflection of Finnish society: the box became part of a relationship between the state and its new generation, rather than being used by any single politician as a popularity-enhancing tool. 

And yet there were some important figures involved. Paediatrician Arvo Ylppö, for instance, fought for the establishment of maternity and child welfare clinics in the 1920s. Early baby boxes included a guidebook for mothers.

The box became part of a relationship between the state and its new generation

“Early maternity packages had nothing about family planning and presented giving birth to a healthy child as a patriotic act,” says Finnish ethnologist Sanna Särkelä. The handbook Äidille, written by Doctor Rakel Jalas, gave basic baby care advice but it also had an ideological message – “to make motherhood something holy, pure, desirable”.

“At that time production of healthy babies, and as many as possible, was presented almost like women’s military service,” she says. 

Nudge, nudge, nudge

But the contents of the box have changed along with Finnish society. All clothes are gender neutral, so boys and girls get the same. It sends the message that girls are equal to boys.

Finland has become one of the most advanced economies in Europe partly by proactively getting more women back into the workforce.

“In the 1970s mothers of small children entered the labour force in growing numbers due to increases in gender equality and policies intended to stimulate women’s labour force participation and men’s participation at home,” says Rotkrich.

This meant fathers had to take on more childcare. So around the same time midwife Leena Valvanne contributed to a new book for the box, inclusively titled “We are having a baby”.

Since 2011, baby boxes have not contained any brochures or books, but the items are still designed to send parents certain signals. “Every item in it is there for a reason, giving a message,” says Särkelä.

The box contained a dummy from 1995-2000, for example, and a baby bottle from 1998-2000. But when it was established that breastfeeding was best, bottles and dummies promptly disappeared from the box.  

I could almost trace the nudges in the box from my first child to the third - Rotkirch

Environmental issues have also had an impact. “I could almost trace the nudges in the box from my first child to the third,” remembers Rotkirch. By the third child, disposable nappies had been replaced by washables. “It really changed the way I did things with my third child.”

A committee meets each year to decide what to include. This year, it added items including felt booties in the Finnish flag’s blue and white, woollen trousers, leggings and a spoon.  

Condoms and lubricant also send dual messages to parents to avoid unwanted pregnancies while enjoying post-baby sex.

“It is a bit of a surprise really that these are included,” says Heidi. But there’s another ‘nudge’ she finds very useful: nipple cream for breast feeding and breast pads for nursing mothers.

Social contract 

If the box was a conceived as a response to poverty and disease, why keep it now Finland is a highly developed nation?   
 

Anniina Kuokka, coordinator of family benefits from Kela, says it’s because the government wants to give all children “an equal start in life”, regardless of parental income.

Investment in the box programme has remained largely unchanged at 9-11m euros ($10.5m-$12.5m, £8m-£9.8m) per year throughout the global financial crisis of 2008 and despite domestic impact caused by the downturn on key trading partner Russia.  

“We increased the value of the box twice recently, in 2001 and in 2017. The latest increase is by 30 euros, that is (up) by around 20%,” says Karoliina Koskenvuo, research director at Kela. 

Investment in the box programme has remained largely unchanged at 9-11m euros ($10.5m-$12.5m, £8m-£9.8m)

Rotkirch says concern over falling birth rates is partly behind it, and highlights that several parties in Finland are discussing an additional baby bonus for newborns or free child care. “Support for the welfare state is across all parties, from right to left,” she adds.

There are other important considerations too: the box serves as social glue between generations. Many people feel it has become a tool for fostering a certain set of values that make Finland what it is today. 

“I am in love with the baby box. It is like a Christmas present from the state,” says new mum Heini Särkkä.  

The box presents the Finnish state as a benign entity and fosters loyalty.  And this sense of loyalty, according to Rotkirch at least, may help explain other features of Finnish society, including social cohesion, trust and low corruption levels.

Going global

Researchers in Finland have identified almost 100 baby box programmes or projects around the world across about 60 countries, says Annariina Koivu, the principal researcher on the project from Tampere University. 

Most programmes have been started in the last three years, apart from one in Chile that has been operating for about 10 years.

The programmes are adapted to meet local conditions and needs. “The baby boxes sometimes include items such as a mosquito net for malaria prevention, condoms or femidoms for family planning and to prevent sexually transmitted diseases, or so-called clean delivery kit items, including a sterile blade and cord clamp to ensure safer deliveries in areas where the health systems may not be able to provide that,” says Koivu.

Projects in the Eastern Mediterranean Region, for example, are mostly for refugees and displaced people. In Za'atari refugee camp in Jordan, UN Women distribute a multipurpose maternity package. Refugee women produce items for the maternity package and thus earn income.

But not all baby box programmes outside Finland have been a success. The Qunita box programme in Argentina was introduced in 2015 but terminated the following year amid allegations of corruption. Some of the programmes are short-term by nature, like the one in Singapore to celebrate the nation’s 50th birthday.  

But the main benefit of baby boxes, wherever they are, has been in the link that they create between medical professionals and expectant mothers.  And more broadly, how they have helped welcome every child who has received one in to the world.

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