Scotland's Baby Box pilot: development research

Executive Summary and Recommendations

Summary

Overall, the parents interviewed and surveyed across Scotland gave a positive response to the Baby Box initiative. Almost two thirds (63%) of survey respondents reported positive feelings towards the initiative (48% very positive, 15% positive). The parents interviewed were all generally positive, especially once they had seen the example Baby Box.

Awareness of Baby Box seemed low, or at least, superficial. When survey respondents were asked if they had heard of the Baby Box initiative, almost half (49%) claimed that they had. However, when parents were asked the same question at the start of the qualitative interviews, few of them had heard of Baby Box and those who had, usually via social media, were aware of only a few aspects relating to it such as: the idea being associated with Finland; that Finnish babies often sleep in the boxes and that the First Minister had announced the initiative for Scotland.

Parents recounted how a baby's birth and first few months of life were a challenging and potentially stressful time, particularly for first time parents. To them, Baby Box demonstrated the Scottish Government's commitment to help and support all babies in Scotland and their parents, at this stage and beyond, regardless of background. Parents acknowledged and agreed with the underlying principal that all babies should get a fair, equal start. They believed that Baby Box would somehow help towards this.

All parents were surprised and very impressed by the comprehensiveness, value and quality of the Baby Box, which was shown to them as an example. After examining its contents, they believed that the Baby Box initiative was genuinely supportive of babies and parents. They all would have been glad to receive a Baby Box themselves.

The interviews illustrated that Scottish households vary widely in how much they spent preparing, materially, for their baby's arrival. Some parents, especially first time parents, were unsure what new babies needed. They spent money sometimes on new, branded and non-essential or unnecessary baby items. In households with more than one child parents had sometimes amassed the baby clothes and equipment required for a new baby but this was not always the case, particularly if subsequent children were of different genders or there had been a lengthy gap between births. A few parents suggested that the Baby Box initiative would guide new parents-to-be as to what they really needed, encourage parents to be more selective, and reduce expenditure on baby goods generally - as well as saving them money on the specific items provided by the Baby Box.

The research identified a small risk of Baby Box being seen as a 'benefit' or 'hand out'. This could be addressed by an emphasis on the equality and universality of Baby Box, for instance, by stressing that the same Box is offered to every newborn baby across Scotland. Another minor risk emerging from the research was that Baby Box might mistakenly be taken as a sign of a population where many parents cannot afford to provide even the basics for their babies. An emphasis on Baby Box's presentation as a 'welcoming gift' for all would counter this

A minority of parents thought they would be likely to use the Baby Box as a sleeping space for their baby, particularly for daytime naps, but there were other parents who strongly resisted this idea. Parents expressed a range of practical and emotional barriers to using the Baby Box for sleeping.

However, some parents considered that the provision of the Baby Box and its bedding could save some parents the cost of buying a new Moses basket or travel cot. A few also thought that the Baby Box would enable them to keep their baby near to them, whichever room of the house they were in due to the portability of the box.

Parents believed that most of the items proposed for inclusion were important essentials, and therefore should feature in the Baby Box. They liked that the items included 'handy spares', such as multiple bodysuits and sleepsuits, as well as things first time parents might not know that they needed. There were also expensive items that C2DE and lower income parents might try to do without, such as the in-ear body thermometer, the room-and bathwater- thermometer and the sling.

Parents liked how the example Baby Box effectively balanced practical items, such as the range of good quality clothing, baby towel, and 'travel' changing mat, with more emotional or aspirational gifts, such as the comforter toy, the baby book and the sling. Several parents (both fathers and mothers, across socio economic groups) mentioned the importance of attachment and interaction with their baby, which could be facilitated by the latter items. Parents fully accepted, and seemed to appreciate, the gender neutrality of the baby clothing and other items.

Parents commented that the value, range and quality of items, especially the clothing, and the inclusion of the comforter toy and book elevated Baby Box far beyond the Bounty Pack which parents had received from the maternity hospital at birth. Many parents, from all social economic groups, welcomed the inclusion of a baby book. They recognised books' value as developmental tools, and would appreciate there being more than one in the Baby Box as well as additional developmental items such as rattles or other noisy toys.

Despite parents' positive reactions to Baby Box, there was much evidence that the Box's contents did not reflect the full reality of these parents' experiences of looking after babies. Other than baby clothes, the most basic essential daily items these parents needed and used were formula milk, baby bottles, disposable nappies and baby wipes. None of these were in the Baby Box.

Some lower income and C2DE households in particular, although not exclusively, reported that their regular, ongoing purchases of formula milk, baby bottles, disposable nappies and baby wipes used up a considerable amount of money each month, at the very time when their household incomes dropped markedly. This decrease in income and increase in expenditure was precipitated overnight by the arrival of a baby. For the lowest income households, buying formula, nappies and wipes meant that paying for rent, heating, food and travel to work became a real struggle.

A small number of mothers in the qualitative sample were or had been breast feeding and others who were bottle feeding had attempted breast feeding but the majority of mothers were bottle feeding. The absence of bottles as a bare minimum provision of essentials was an issue for most parents. All parents felt that bottles were an immediately association with new born babies and parents acknowledged that it was difficult to accurately predict whether they would be able to successfully breast feed or not, until they had tried. Women who had or were still breastfeeding were aware of others in their peer group who had either tried and were not able to breastfeed or chosen to bottle feed and they displayed a noticeable degree of empathy with this group of mothers. The absence of bottles in the Baby Box therefore proved somewhat problematic for most parents. In some cases the absence of bottles was thought to merely present practical issues and parents would value the easy availability of a bottle in the Baby Box however, more significantly for some parents, the lack of a bottle represented an extension of the perceived overly stringent recommendation to only breastfeed. Mothers in particular were generally aware of the guidance around breast being best but felt that feeding method was still a personal choice for them to make. By not including bottles and only including supporting information on breastfeeding there is an apparent risk that the positive and palpable sense of universality and inclusion of Baby Box is somewhat diminished.

The bibs included in the box were regarded as nice to have but parents would also like to see weaning related items such as a spoon and information on how to approach weaning.

Parents initially expected a range of consumables would be included in the Baby Box and the absence of items such as cotton wool, wipes, bath wash and nappies was noted. However most of the items relating to health and bathing were strongly welcomed by parents.

The exception to this was reusable nappies. Mostly, parents did not know anyone who was using reusable nappies nor had they seen or heard of reusable nappies in a contemporary context and the use of disposable nappies was seen as a clear norm and expectation. Disposables, usually referred to by parents as 'normal' nappies, were an accepted convenience, and, generally, parents could not see any benefit in using reusable nappies instead. Just a few parents in lower income households thought that saving money might be an incentive for themselves and others who were struggling financially. But these potential savings were far outweighed by the many perceived barriers to using reusable nappies. Environmental concerns were not mentioned.

By only including reusable nappies rather than disposables (or 'normal' nappies) the Baby Box, as with the absence of bottles, could be interpreted as being designed by people who do not fully understand the reality of being a parent.

On balance, parents saw the midwife as the best 'messenger' for communications about Baby Box. This became clear to them once they had seen the scale of the Box and its contents for themselves. Midwives were intrinsically linked to pregnancy and birth, were highly trusted, and already had relationships and routine meetings with pregnant women.

The findings suggested that the best time for parents to learn about Baby Box in detail, and how to sign up to receive one, was around 20 weeks into a pregnancy. From parents' accounts, this staging would give expectant parents time to include the anticipated provision of Baby Box in their planning, preparations and purchases before the baby's arrival, and prevent duplication of baby items.

The existing 20 week midwife appointment might be effectively and efficiently used to provide information about the Baby Box to expectant parents, in both verbal and written forms, and ideally by demonstrating a real Baby Box. Parents also described how they would benefit from a combination of inspirational, functional and instructional information when hearing about Baby Box from midwives. Parents were confident that they would then be able to sign up to receive a Baby Box themselves, online or by telephone.

After seeing the example Baby Box, parents were unanimous that the Box should be received before birth. Around 32 to 36 weeks pregnancy was implied to be ideal. Then, there would still be enough time left for expectant parents to go through and 'put away' the Baby Box contents, as part of the 'nesting' process , even in cases of early labour. Delivery of the Baby Box by post or courier, direct to the home, would best facilitate receipt.

The research also suggested that many parents would like to sign up to regular online parenting communications from the Scottish Government or a related body, from before birth onwards. They would be glad to be supported in their parenting in this way, and it made sense to parents that this opportunity would be promoted through Baby Box. Parents did not think they would feel obligated or coerced to take part or that receipt of Baby Box was conditional on signing up to the communications.

Recommendations

Based on these research findings, it is recommended that:

• Baby Box should be clearly positioned as a gift from Scotland and the Scottish Government, for every newborn baby irrespective of socio-economic background and not just for those from a deprived background. The Scottish Government should clearly communicate that Baby Box's intention is to welcome each new baby and support the baby's first few months in a helpful and practical way.
• The contents of the Baby Box should be adjusted slightly, within Scottish Government policy guidelines. By including some of the items that parents recommended themselves as 'essentials' and as 'nice to haves' (and excluding some of those items which were rejected or regarded as 'not needed') the Baby Box will demonstrate a better understanding of parents' lives. The list summarising recommended inclusions and exclusions can be found below.
• The Baby Box could also contain 'how to' guides dealing with common baby parenting challenges such as (but not limited to): the first week; feeding; health and first aid; teething.
• All expectant parents should be given both verbal and written information about Baby Box, by their midwife, at 20 weeks of pregnancy, as part of the routine consultation. This information should be:
  • Inspirational - explaining why the Scottish Government is undertaking the Baby Box initiative, and tapping into the potential 'halo effect' from Scandinavia;
  • Functional - demonstrating in detail the Baby Box's contents;
  • Instructional - telling parents how to sign up to receive a Baby Box, showing them how to use the Box as a sleeping space, and how to use the items it contains;
  • This information should also be contained in the Baby Boxes.
• Parents-to-be should be instructed by their midwife how to sign up to receive a Baby Box, themselves. The most effective 'sign up' methods would be by telephone or online.
• At around 32 to 36 weeks pregnancy, the Baby Box should be delivered by post or courier to parents' homes. This would give parents time to familiarise themselves with the Box and sort through the contents, before birth.
• Also at the 20 week routine consultation, the midwife should offer parents the optional opportunity to sign up for regular Scottish Government parenting communications, by email.
• A diagram of the recommended Baby Box 'journey can be found below.

Table A: Recommended inclusions and exclusions

Must haves	Nice to haves	Not necessary	Missing
Blanket	Soother	Condoms	Cardigan or warm top
Light quilted suit	Hairbrush	Breast feeding information	Bottles / Teats
Knitted hats	Sling	Reusable nappy	Formula
Body suits	Romper suits	Leggings	Spoon / fork
Sleep suits	Socks	Tights	Teething ring / gel
Sleep suits with mittens			Tooth brush + tooth paste
Mittens			Disposable nappies
Bath towel			General parenting tips / advice / information
Bath / room thermometer			Snow suit
In-ear thermometer			Rattle / developmental toy / toy mirror
Travel changing mat			Dummy
Drooling bib			Spare hospital underwear / nightwear
Feeding bib			Shower gel for Mum
Hospital bag + contents			Sponge
Maternity towels			Baby wash / shampoo
Books			Wipes
Reusable bra pads			Cotton wool
Muslin squares			Breast feeding apron
			Nipple shields / shells / cream
			Breast feeding pillow

Figure A: Recommended Baby Box journey