Scotland's Baby Box pilot: development research

4. Main Findings

4.1 How Can the Scottish Government Make Sure that the Contents of the Baby Box are the Most Useful They Can Be?

4.1.1 Awareness

When survey respondents were asked if they had heard of the Baby Box initiative, almost half (49%) claimed that they were aware of Baby Box. However, when parents were asked the same question at the start of the qualitative interviews, there was little awareness. A few ABC1 parents had heard about Baby Box. Their sources included primary school teachers' forums, Facebook and Twitter, news coverage featuring the First Minister, and conversations with colleagues and friends. Amongst these few parents there was some awareness of the Baby Box's possible use as a sleeping space, its association with Finland and that country's perceived innovative approach to children and families.

" (On) Facebook...There was a spell when a lot of people were sharing an article from the news...it was a news clip...They were saying the mortality rate is lower because they have these baby boxes which I thought was really interesting. I thought it was really interesting. If someone had given me one of them it would have saved me a lot of hassle!" Edinburgh, B, Mum

4.1.2 Initial Reactions to 'Baby Box' Concept

The following statement was used to introduce the Baby Box concept to parents:

The Scottish Government plans to strengthen its support for new parents, babies and children by giving every newborn a 'baby box' of essential items, to help all children to get the best start in life.

Respondents' initial reactions to the outline concept of Baby Box were generally positive. Almost two thirds (63%) of survey respondents had positive feelings towards the initiative (48% very positive, 15% positive) and only one fifth had any negative feelings. The parents interviewed face to face were all generally positive, however, their enthusiasm was mostly muted when simply presented with the concept description. Parents who had had some prior awareness of Baby Box were more positive. Some parents praised the egalitarianism of Baby Box specifically that it gave every baby the same baseline good start to life in Scotland, or at least, symbolised this as a commitment by the Scottish Government and wider Scottish society. This social aspiration resonated with many more of the parents, once their awareness and understanding of Baby Box was raised further, later on in the interviews.

Parents did not express any negative reactions in the qualitative research. The reasons for the negative initial reactions of 20% of survey respondents were unknown as parents answered a 5 point scale of how positive or negative they were towards the Baby Box without opportunity to expand.

4.1.3 Expectations

Before any presentation of the example Baby Box, parents' expectations of Baby Box were low. When asked what they imagined a Baby Box might comprise, many listed a range of low value, disposable and basic items, for new born babies, only for the first few weeks. Typically, they imagined a small number of 'money off' vouchers for baby toiletries or formula, disposable nappies, wipes, cotton wool, baby wash, baby feeding bottles, dummies, and samples of formula milk. This idea generated moderate levels of enthusiasm or excitement. It became evident that these parents' expectations were based partly on the 'Bounty' commercial marketing pack. (This contains free samples, money off vouchers and parenting information).

4.1.4 Reactions To Example Baby Box and Contents

As well as demonstrating examples of the types of proposed content for the Baby Box, researchers also showed photographs of the full range of proposed items (see Appendix for details). To facilitate meaningful discussion and to enable parents to consider a manageable amount of items at one time the proposed items were introduced to parents in the following categories:

• Clothing
• Bathing and health
• Feeding
• Bedding
• Miscellaneous

Parents were also asked to prioritise items for inclusion in the box.

When the example Baby Box was presented in person to the parents, they were surprised and very impressed. Its visual impact was immediate. Whereas parents' reactions to the Baby Box concept beforehand had been muted, the parents, having seen the box, were visibly excited and engaged by the Box and its contents. Typical comments were 'It is a large box , full of products . Very generous', 'The products , particularly the clothes , are of high quality', 'The contents go beyond the basics', 'The box is strong and sturdy , not cheap' and 'The box is bright and colourful , attractive'.

In the interviews all parents were very happy with the contents of the box. They would gladly accept a Baby Box like this one, if it was offered to them. First time parents, and parents in social economic groups C2DE, seemed particularly impressed and excited by the example Baby Box.

In summary, the Baby Box clearly exceeded parents' expectations, by a long way.

"Wow! I can't believe there is so much. It's really good quality too" Mum, D, Glasgow

"It's all good quality , yes...It's not cheap cheap . It's quite thick isn't it? That's nice (bodysuit). It would be a great help for some people...That's quite cosy ." Mum, D, Dundee

"Wow! Is this actually what it's going to be like? This is great, the stuff is really nice . I thought it would be cheap and a bit throw away ." Mum, C2, Aberdeen

"I'm happy to take any clothes. It's all useful!" Mum, C1, Aberdeen

"I'd be excited to go through it and see what's in there ." Mum, Edinburgh, E

"I'd have got use out of most of the things in there…I wouldn't have had to buy some things." Mum, Edinburgh, E

"It's a starter, to get you started...Quite useful. It would save us the hassle of thinking about what we needed." Dad, Dundee, D

"(It's) good to get an idea of the things you would maybe need." Mum, C1, Edinburgh

"Overall it's fantastic. The volume of items is surprising. You think it will be the basics but you're really covered with this." Mum, B, Aberdeen

"I like that it's a mix between practical and emotional items in the box." Mum, C1, Aberdeen

4.1.5 Clothing

Parents rated the baby clothes as the most useful element of the Baby Box. They saw them as both practical and desirable. From their experiences of parenting, all recognised a need to have to hand several sets of the same basic clothing items so that young babies can be changed frequently and easily. The clothing items in the Baby Box helped meet this need, for the first few months after birth.

There was a strong consensus that by far the most useful clothing items were the bodysuits (also known as vests) and sleepsuits. These were core essentials. Until around age 6 months, or when they started to crawl or shuffle, their babies typically wore a bodysuit with a 'sleepsuit' on top, all day, every day. Parents preferred the sleepsuits over the romper suits because they enclose the feet, a key need for young babies. Many parents also reckoned that a small knitted hat was essential, and required for taking new babies home from hospital. For some parents mittens were also important items to stop babies' nails scratching, although many said that this need would be met by the fold-over mittens on the sleepsuits and these also had the advantage of not falling off.

Parents highly valued the quilted suit. They advised that one of these was needed to keep babies warm, on top of a body suit and sleepsuit, when going outdoors or when travelling by car, and sometimes indoors, too. Parents praised the suit's functional style. However, some pointed out that this would not be a substitute for a weatherproof, 'snow' suit which was also deemed essential but was not included in the proposed items.

The parents rated the leggings and tights as not useful, or less useful, for babies of this age, partly because they were difficult to get on and keep on. Some parents viewed socks similarly, although others thought socks were 'nice to have'. Additionally, parents perceived tights to be 'not for boys' and thought other parents may not dress boys in these. One mother in Edinburgh did dress her six month old son in tights but discussed how this was unpopular with her wider family and friends.

"It's good to have three: one on, one in wash, and one spare." Mum,C2, Dundee

"Babies can practically live in babygrows. Little babies don't need to be dressed up in fancy outfits." Mum, C2, Dundee

"It's great to get all these cloths. You really do need a lot." Mum, D, Aberdeen

"I love it. There is everything here." Dad, E, Glasgow

"Everything would be really useful as you just use so much clothes and they are constantly growing..." Dad, E, Glasgow

"Please put a cardigan in, too!" Mum, B, Edinburgh

"I think they're lovely!" Mum, B, Edinburgh

The parents all fully accepted or liked the distinctive gender-neutrality of the Finnish Baby Box items, in their colours, patterns and designs. (Parents usually implied, rather than explicitly reported this.) A few pointed out that, in Britain, the most basic bodysuits and sleepsuits are quite often 'gender-neutral' until at least size 3 months. There were just one or two queries about whether the Scottish Government would provide different Baby Boxes for girls and for boys, but apparently, parents had no preference for gendered Boxes.

A few parents commented on the sizes of clothing which would be contained in the Scottish Baby Boxes. Generally, they agreed it was most useful for the Box to contain clothes to fit babies aged zero to six months. Some queried how the varying sizes of newborn babies, including premature babies, might be provided for.

Overall, parents suggested that the range of clothing was very comprehensive and desirable but that there were two notable omissions from the clothing provided in the Baby Box: a cardigan and a weather-proof snowsuit. Parents who already used these items saw them as necessary for keeping babies in Scotland warm. However, not all the parents had them or used them.

Table 4.1: Overview of parent reactions to Clothing

Must haves	Nice to haves	Not necessary	Missing
Light quilted suit	Romper suits	Leggings	Cardigan or warm top
Knitted hats	Socks	Tights	Snow suit
Body suits
Sleep suits
Sleep suits with mittens
Mittens

4.1.6 'Baby Care' Items, Including Bathing, Cleaning and Health Accessories

Generally, parents considered most of the baby care items included in the Baby Box to be useful.

Parents expected there would be some products in the Baby Box related to baby care, especially cleaning, bathing and grooming. However, they mainly anticipated FMCG-type products like the sample-sized sachets of branded baby soaps, creams and lotions, nappies and wipes received in Bounty Packs.

Their expectations were surpassed. They were pleased that the items were durable ones they could keep, rather than just low-cost consumables. In particular, the in-ear thermometer was seen as an expensive item that they would usually not necessarily have thought of buying, or been able to buy due to cost, themselves.

"I've never thought of buying one of those [in ear thermometer]." Mum, D, Edinburgh

"As soon as you phone the doctor they ask for the baby's temperature, and it's better to know than to guess." Mum, C2, Dundee

"It's everything you would need." Mum, D, Edinburgh

"Again, this is all really useful stuff." Dad, E, Glasgow

"(In-ear thermometer) Something could be really wrong and I've judged that thinking 'Oh they're a wee bit warm, I'll give them a bit of Calpol', or he's felt really cold and I've just thought 'I'll wrap him up'…But there could be situations where they could be genuinely ill…I think I saw that one and it was about £40 which is quite expensive and it wasnae really something I thought I'd get just in case I needed it - I thought I didn't need it…A lot of people aren't going to say they'll get one 'just in case they need it'" . Mum, D, Edinburgh

In the case of most of the other baby care items, parents debated as to whether each of these was useful enough to be included in the Box or not. Responses were fairly mixed.

For example, some parents thought the hooded baby bath tool was an 'essential' and basic because they bathed their baby daily, but other parents considered it to be superfluous. They explained that, in their experience, any bath towel at home could be used to dry a baby, baby bath towels were often received as gifts, and towels were affordable for most parents, anyway. However no parents would have rejected a towel in the box.

Many parents thought that a hair brush was 'nice to have', but others considered it 'unnecessary' because their newborns did not have enough hair to need brushing.

Parents were largely unfamiliar with reusable nappies; almost all parents had never heard of them in their contemporary form, and moreover, a few were unaware of the use of reusable, terry towelling nappies in the past. All the parents were using disposable nappies, exclusively and referred to these as 'normal' nappies. This was the norm and they had not considered there being any other option.

All parents regarded the reusable nappy included in the Baby Box as non-essential, with no obvious benefits and on balance not useful. They voiced many negative perceptions of reusable nappies, vis a vis disposables, including reusable nappies being:

• 'Old fashioned' and outdated, for past generations, only;
• Unhygienic, unclean and therefore unsafe.
• Inconvenient and impractical
  • Involving changing and washing all the time;
  • Some imagined carrying around a dirty nappy, when away from the home;
• Bulky (a few parents, only). Would they fit under baby clothes?
• Less absorbent, less effective.

Many parents predicted that the single, reusable nappies included in Baby Boxes would go in the bin, unused or used once and then treated as disposable. A few other parents conceded that they might try the resusable nappy, once, if included in the Baby Box, but they did not foresee converting from disposable nappies to reusables. A few parents queried how many reusable nappies a household would need to buy to supplement the one provided by Baby Box, to make a full set, and how much this might cost. This was difficult for parents as they had no effective frame of reference relating to how many reusable nappies would be needed or how they are used.

Very few parents identified any advantages of using reusable nappies rather than disposable nappies. Environmental impact was rarely mentioned with any degree of confidence. However, a few parents questioned whether would cost less to use reusable nappies than disposables. If so, reusables might be advantageous for lower income households such as theirs, or other people's but the barriers outlined above seem to be too large for the financial argument to overcome them.

"(Reusable nappy) That could encourage people to use them…I've never thought of using them…but you're constantly washing the nappy out…I'd probably just stick to disposable nappies but if it was in the box I'd probably try them." Mum, D, Edinburgh

"With these you'd have to wrap it up (the poo) and take it with you. That wouldn't appeal to me." Mum, B, Edinburgh

"If you come home and you've got five poo-ey nappies to wash you'd think, Oh for God's sake!' I would just fire these in the bin and I wouldn't have the hassle to deal with when I get home." Mum, B, Edinburgh

"I probably wouldn't be bothered to use it. I'd just stick to the disposables for convenience." Mum, B, Edinburgh

"I'm not sure how good that it for the skin. With the disposables, they take the moisture away from the baby's skin." Mum, B, Edinburgh

"Personally I would never use them…it just seems like too much hard work…I suppose the money you would save would be good but for me it's more about time and I wouldn't have the time to do it. It would probably be a waste [to have them in the box] as I wouldn't use them…I've never known my friends to use them as well." Mum, B, Edinburgh

"I would never use something like that (reusable nappy). I'm used to using normal nappies…You'd need loads of them…In this day and age no one would use something like that, they'd just use normal nappies." Mum, E, Edinburgh

Some parents thought that some of the baby care items in the Baby Box were 'must have' items. Other items were just 'nice to have', and some were considered 'unnecessary'.

Table 4.2: Overview of parent reactions to Baby Care

Must haves	Nice to haves	Not necessary	Missing
Bath towel	Hairbrush	Reusable nappy	Disposable nappies
Bath / room thermometer			Sponge
In-ear thermometer			Baby wash / shampoo
Travel changing mat			Wipes
			Cotton wool
			Tooth brush + tooth paste
			Teething ring / gel

4.1.7 'Feeding' Related Items

This was the smallest group of items presented to parents consisting of bibs, an attachment sling and breastfeeding information. Parents recognised that this was too focused on only breast feeding and lacking essential and desirable items. The provision of items in this category felt basic and purposefully excluding mothers who did not or could not breast feed their baby.

The inclusion of breast feeding information was a further indication that bottle feeding was not being acknowledged - parents felt that this was duplication of information as most recognised it from information leaflets and packs they had been given by their midwife or other health professional.

The most significant omission was of bottles which were regarded as essential items across the whole sample. Mothers who were breast feeding felt that they also required bottles, for expressed milk and for when they were transitioning to mixed or bottle feeding. They also felt that there should be information provided about bottle feeding and how to make the transition from breast to bottle. However there was also a strong emotional response to this category insofar as mothers general felt that feeding method is a deeply personal choice and sometimes mothers need to feed their babies by bottle even if they had wanted to and intended to use breast. Mothers were keen to share experiences and anecdotes from their own and their peers early experiences of feeding as often being stressful, at times even traumatic, and they objected to the Baby Box potentially contributing to this stressful environment by focusing only on breast feeding. The absence of bottles felt to most parents that the needs of the majority of parents were being ignored by the Scottish Government.

"You have to have bottles if it's 'essential things for everyone', don't you? I don't get why they wouldn't." Mum, C1, Aberdeen

"We did try to breast feed for the first 3 weeks but it just wasn't happening so we had to use the bottle. I'd expect it to be in there, everyone will use it at some point" - Dad, E, Glasgow

"They could maybe include one bottle?...It's a personal choice - it's what everyone decides. ..I'd just choose to bottle feed anyway". Mum, D, Edinburgh

"I think there should be more on it about bottle feeding…most people I know have never breast fed. Some people cannot give milk." Mum, E, Edinburgh

"It's surprising that it's not got bottle feeding in it…I know obviously they're trying to get people to breast feed but some people just dinnae want to do it." Mum, E, Edinburgh

"When you say 'feeding' I automatically think of a bottle brush and bottle and dummies even." Mum, B, Edinburgh

"My friend had a wee girl and said she'd breastfeed. It didn't work out and her husband had to run out late in the day and literally didn't know what he was looking for and scrambled around asking for advice. 'What bottle should I buy, what formula should I get?'. And it was all a big stress. So I suppose as much as the Scottish Government says 'Breast is Best' I suppose if you're giving them the Baby Box, just for peace of mind you would put in a pack of bottles and a bottle brush..." Mum, C1, Edinburgh

"Especially, with her I started breastfeeding in the night but it was a 'no' so the hospital had given me one of those little bottles…which I used when I was struggling breastfeeding during the night." Mum, C1, Edinburgh

"From minute one with the midwife they are pushing for breastfeeding…There is certainly a pressure and if you're already feeling pressure that it's not working for you and you've got all this (breastfeeding information) in the box, it's going to make you feel more guilty that things aren't going your way and that you've given up and have to go to bottle." Mum, C1, Edinburgh

It is worth noting that amongst parents who were using bottles there were several enthusiastic accounts of the best, most supportive gift for parents being the new Tommee Tippee Closer to Nature formula milk bottle preparation machine, which quickly and conveniently provides sterile bottles and warms milk. Parents who used this were keen to encourage others to use it, by word of mouth and by giving the machine as a high-value present to expectant parents.

"(New Formula Bottle Maker Machine) It's a godsend...It's the first thing I'd advise any parents to get. I'd buy it for them myself." Dad, C1, Dundee

"(Tommee Tippee Machine) That's the one thing I couldn't do without." Mum, E, Edinburgh

Table 4.3 Overview of parent reactions to Feeding

Must haves	Nice to haves	Not necessary	Missing
Drooling bib	Sling	Breast feeding information	Bottles / Teats
Feeding bib			Sterilizing tablets / equipment
			Formula
			Breast feeding apron
			Nipple shields / shells / cream
			Spoon / fork
			Breast feeding pillow

4.1.8 Miscellaneous Items, Including Hospital Bag

Parents were enthusiastic about most of the other, miscellaneous items which might be included in the Baby Box, especially the various small, practical things and had numerous suggestions of their own for items to include.

Many parents particularly liked the proposal to include a 'hospital bag', for putting relevant Baby Box and other items in to take to hospital for the birth and immediately afterwards . They commented that bag would need to be large enough to hold all the items a mother-to-be has to take into hospital. Recipients would need to be clearly advised that they should pack further items into the bag themselves. Useful hospital bag contents would include a baby blanket, a going home outfit (bodysuit, sleepsuit, quilted suit), maternity towels, bra pads and muslin squares. Mothers suggested that it would be very helpful to add small bottles of toiletries for the mothers to use in hospital.

Mothers explained that a partly pre-packed bag could be very helpful, for several reasons:

• It was easy for a new mother-to-be to not fully realise what she would need to have in hospital, or the quantities or types of items required;
• It was also easy to forget, or not get around to packing items in advance;
• Mothers who gave birth earlier than expected were often unprepared and unequipped, for essential items;
• It was a common experience for mothers to run out of items when in hospital. Once in hospital, it could be difficult to source some basic items;
• It would save mothers-to-be the effort and expense of trying to find a large enough bag or case just to take into hospital.

"I like the bag. That's good. I completely forgot mine and was rushing around before going to the hospital." Mum, D, Glasgow

"(Hospital Bag) You could just have these things in the Box and supply an advice sheet that says: 'You may want to include this in your hospital bag...'". Mum, B, Edinburgh

Mothers were strongly positive about the inclusion of maternity towels in Baby Box. Bra pads were also seen as essential, but for some mothers only. (Some mothers who were bottle feeding needed bra pads, and others didn't.) Parents were not concerned whether bra pads were reusable or disposable, as long as they had sufficient. Many parents used muslin squares, and found them very useful for a range of baby care purposes. These parents thought muslin squares were essential.

Some parents, on reflection, also designated the example soother toy and baby book as 'must have' items. Some related this to equality, for instance, 'because all babies regardless of their background should have a cuddly toy at birth, as a gift to welcome them and comfort them'.

Many parents, from all social economic groups, saw baby books as essential for babies' interaction, stimulation and bonding with their parents and other family members. Some believed that all new babies in Scotland should have a chance to benefit from this, regardless of their background or whether their family household read books or not. For this reason, many parents rated the inclusion of the book in the Baby Box as 'essential'. They highly regarded the example baby book. However, other parents thought a baby book was not essential or top of mind as an item for very young babies.

"I love the book. I'd like more of that. We use them all the time." Mum, B, Aberdeen

"They should include at least one toy. Lots of people just put their baby down, and there's no stimulation or interaction. But if they add a book or toy in the Baby Box, all babies will have something." Dad, C1, Dundee

"(Scot Gov should add) A rattle. Something they can hold, grasp, shake." Mum, B, Edinburgh

"A teether is an essential. Daniel's been teething since he was 3 months old." Mum, B, Edinburgh

Parents began by thinking condoms might be acceptable or useful to have in the Baby Box, but several then concluded that condoms were:

• Inappropriate in a Baby Box which is associated with the needs of a baby (not the adults)
  • Some concern was expressed that this may have potential to cause relationship conflict or put pressure on the mother;
• Unnecessary (the health visitor will distribute condoms to new mothers, during routine visits);
• Not highly resonant with a 'gift' for women who have just given birth.

"(Condoms) I would feel quite put under pressure that you've got to use them straight away because 'We don't want you to have any more babies'" Mum, E, Edinburgh

Table 4.3: Overview of parent reactions to Miscellaneous

Must haves	Nice to haves	Not necessary	Missing
Hospital bag + contents	Soother	Condoms	Rattle / toy / toy mirror
Maternity towels			Dummy
Books			General parenting tips/advice/information
Reusable bra pads			Spare hospital underwear / nightwear
Muslin squares			Shower gel for Mum

4.1.9 Bedding and Sleeping Space

About one third of survey respondents online thought they would be likely to use the Baby Box itself for their baby to sleep in and around half felt they would be unlikely to do so. However only 14% thought they would be likely to use the Box for a baby to sleep in at night time.

Similarly, many of the parents interviewed face to face found the concept of using the box as a sleeping space challenging, for several reasons, practical (mostly to do with safety and durability) and emotional.

Practical objections:

• How strong or stable would the Box be?
• How sturdy would the Box be, over time - would it be damaged if it was tripped over?
• The Box might somehow fall when raised up and parents felt leaving it on the floor was impractical.
  • They wondered what surfaces the Box could be raised on, particularly in bedrooms?
• Would it be draughty, if left on the ground?
• How would damp, or baby fluids, affect the Box? How likely would it be to get soggy?
• Animals, including pet cats and dogs, might get at the baby, if the Box was on the ground.

"They're only in the Moses basket for about three months so it would take away another expense. A good solution." Mum, AB, Dundee

"I don't know if I'd personally use the box for sleeping -it's cardboard. If they're sick a few times…it would go a bit mushy." Mum, D, Edinburgh

"A toddler could come in and rip it up or destroy it!" Mum, D, Glasgow

Emotional objections:

• A cardboard box did not fit with the idealised images some parents had of babies sleeping, particularly first time parents.
  • They desired 'the best', and would be embarrassed if visitors saw their baby sleeping in a box.
  • For several parents, it felt strange to have the Box and baby on the floor.

"I'd be mortified if someone came round and I had my baby in a box" Mum, C2, Glasgow

"Many really needy people would screw their nose up at using the box as a bed. And maybe take offence at the bed aspect. But some would really appreciate it." Dad, D, Dundee

More survey respondents thought they would be likely to use the Baby Box for daytime naps (58%) or as a travel cot (48%).

Some parents interviewed, with the example Box, mattress and bedding in front of them, thought they would consider using the Box for a secondary sleeping space for their baby. They began to see advantages:

• The Box would be easy to move round the house, so would be handy for keeping a napping baby close by. This implied that they would carry the box around the home with the baby asleep inside.
• The Box would be easy to transport in a car, and could even carry babies' clothes, nappies and other items, when going on trips away from home, or when the Baby was staying at grandparents' and other relatives' houses.

"Here's a safe way for putting your baby to sleep, if your child is off to stay at Granny's." Mum, D, Edinburgh

"Maybe for during the day…I would never have thought of using something like that…I think it's more comfy than a travel cot!" Mum, E, Edinburgh

"I would definitely use it…I'd like her in it next to the telly so she could see all the things…but not at night." Mum, E, Edinburgh

"If anything, it would probably feel more secure to a baby as it's quite high and enclosed." Mum, B, Edinburgh

A few parents thought that if parents-to-be knew in advance that they were going to receive a Baby Box from the Scottish Government, they might decide not to buy a Moses basket or a travel cot and just use the Box instead. (Almost all babies slept in a Moses basket, for the first few months only.) For some of the households who would otherwise buy new baskets and travel cots for their firstborn babies, this would save a significant amount of money.

"(Box as bed) I really like this. It's a great idea. It would save you money." Dad, E, Glasgow

"That's quite a good idea…replacing a Moses basket…I think it would feel quite strange putting your baby to sleep in a box…I'm used to having a cot and Moses basket and it would feel strange." Mum, D, Edinburgh

4.2 How and When Should Parents Hear About and Sign Up To, the Initiative and Receive the Baby Box?

4.2.1 Preferred Ways of Hearing About Baby Box

Across the quantitative survey and the qualitative interviews, on balance, parents saw the midwife as the best messenger for communications about Baby Box (57% of survey respondents). However, survey respondents also rated hospital staff (37%), advertising (32%), websites (27%) and GPs letters (25%) as potential communication channels.

In the qualitative interviews, parents were unanimous that the midwife was ideal for this role. Their certainty was shaped by their earlier detailed consideration of the Baby Box and its contents, in the light of their own experiences of having babies. They reasoned that midwives:

• Are intrinsically linked to pregnancy and birth, both generally in society and in individual cases;
• Are a highly trusted, expert source of baby-related information and support;
• Have routine, regular meetings with pregnant women at those key stages of pregnancy when it would be most useful to hear about, and receive baby box;
• Have the skills, knowledge and time to explain the Baby Box and its contents in detail to individual women, in person, in a personalised and practical way.

"You'd expect it to be the midwife or doctor when you're pregnant, probably the midwife as they're the one you see the most. They're the ones who give you all the leaflets and answer all the questions." Mum, D, Aberdeen

"Hopefully your midwife or Health Visitor would say something to you...Your midwife would help you through your pregnancy and they might ask you what you need and stuff." Mum, E, Edinburgh

4.2.2 Ideal Time to Find Out About Baby Box

When parents were asked when would be the best time for expectant parents to find out about Baby Box in detail, there was a general consensus that after 20 weeks into the pregnancy would be ideal. They explained that at this stage, the pregnancy was well established, many parents felt they could start to plan ahead for the baby, and the future arrival of the baby became real and acknowledged socially. Learning about Baby Box at this point would optimise parents' benefit from their future Baby Box, as they could take the provision of Baby Box into account through all their weeks of planning and preparation.

The 20 week stage also coincides with a routine midwife check-up and scan appointment. This midwife appointment could be used to deliver the communications efficiently and effectively, at least, to parents.

Parents considered that any time before 20 weeks of pregnancy would be too early for detailed communications: before 20 weeks, it was seen as inappropriate to plan ahead, partly due to the risk of miscarriage. Nevertheless, at this early stage of pregnancy, a more general awareness of Baby Box would still be beneficial. This early awareness could be raised by advertising Baby Box in GP surgeries, midwife clinics, and maternity units and on social media.

All parents were clear that communication and awareness of the Baby Box could and should happen prior to birth.

"to know it's available, so I don't need to worry about getting a Moses basket, or all the basics." Mum, C2, Dundee

"At an early midwife appointment so you know in advance before you've bought a lot of the stuff." Mum, D, Edinburgh

"(At 20 weeks) You're in a safer position, your baby is more developed...Most people I know started buying more at that point." Mum, D, Edinburgh

4.2.3 Signing Up For a Baby Box

The 20 week midwife consultation would also provide an ideal opportunity for the midwife to explain to parents how to sign up for the Baby Box. Generally, parents were happy, or accepting, about the proposal that they register to receive a Baby Box by themselves, at home. Parents considered registration by telephone or online to be the best methods, because they would be easy and allow some choice of delivery date and delivery instructions.

"If there were just posters and things…'Go to this website or phone this number to claim your new baby box' would be fine…" Mum, D, Edinburgh

"If you're getting a voucher or code and phone up and get a set date for delivery I don't see a problem with that." Mum, E, Edinburgh

"What would be in it…Sell it to me in a way." Mum, E, Edinburgh

4.2.4 Reactions to Possibility of Signing Up for Scottish Government Parenting Communications, via Baby Box

Parents across the sample reacted positively to the possible option of signing up to receive ongoing, online parenting communications from the Scottish Government, NHS Scotland or inter-agency body. Many mothers already received regular email communications from companies and organisations such as BabyCentre and Boots. Often, mothers had signed up to these during pregnancy. The communications then continued, with lessening frequency, after the birth. Some read parenting blogs.

Parents liked the idea of having ongoing involvement from the Scottish Government. The link to Baby Box made sense to them. No parent felt that the offer of a Baby Box might be conditional on them signing up for these ongoing parenting communications, and they did not think that other parents would either. Parents' typical suggestions for the frequency of emails about parenting babies were every week at the newborn stage, fortnightly until the baby was around 12 weeks old, then monthly or every two months.

"I'd enjoy emails about that. I get one from Boots already...It says things like 'Your child is now 8 months old. He should be doing X, Y, Z". Mum, C2, Dundee

"Any information... is good." Mum, D2, Dundee

4.2.4.1 Communication Messages

Many parents recommended that at 20 weeks pregnant, parents should be given a range of detailed information about Baby Box by their midwife. This information would be delivered both in verbal and written forms, and have inspirational, functional and instructional elements:

A. Inspirational Messages

The initial message by the midwife to the mother-to-be (or parents-to-be) in person would communicate the scale of the Baby Box and explain that the Baby Box is much more than the Bounty Pack.

Parents expressed a desire to know why the Scottish Government was undertaking the Baby Box initiative. It was important for them to know that the Baby Box is a gift from the Scottish Government, not a 'benefit', and that it was offered to all newborn babies alike. Parents generally supported and were enthused by the aspiration of showing that every child in Scotland is born equal, and has an equal start to life, regardless of their background.

Some parents considered Finland and other Scandinavian countries to be forward thinking with regard to parenting and children, and where they were aware of them parents expressed positive opinions about the cultural origins of the Baby Box concept. The few who had a little awareness of Finland's lower infant mortality and morbidity were particularly positive about Baby Box.

B. Functional Messages

To demonstrate the scale and comprehensiveness of the Baby Box to parents, midwives would ideally have an example Baby Box to hand. It would be important that the midwife also provide a full list with pictures of every item in the Baby Box to the parents, to keep and look through at home. The demonstration of the Baby Box and its contents would be likely to have a high impact, as, in the interviews, parents' expectations were exceeded in every case. It is likely to increase the number of parents-to-be who sign up to receive a Baby Box. It would also help parents avoid duplication when shopping for baby items, or requesting baby gifts.

C. Instructional Messages

Parents-to-be would require explanation for certain aspects of the Baby Box. Midwives would be ideally placed to provide this, because mothers-to-be reported that they paid attention to what midwives told them and that they found midwives to be credible.

Parents would require specific instructions and information to support the use of the Box as a sleeping space. Ideally, midwives would demonstrate the use of Baby Box for sleeping, including how to prepare bedding, how to carry the Box, and where to place it.

Specific information could be given about how to successfully use the items in the box with particular attention given to reusable nappies (if they were to be included), including any cost benefits, and benefits to babies, over using disposables.

Parents could be advised in detail how to pack the hospital bag, including some of the Baby Box items and an appropriate 'going home' outfit for the baby, plus other essential and desired items provided by themselves.

Midwives could demonstrate the use of other unfamiliar products, including the in-ear thermometer and baby sling. They could also demonstrate how to wrap a baby in a blanket, and which components of clothing would comprise a suitable outfit for a newborn.

4.2.5 Delivery of Baby Box

During the qualitative interviews, parents' views on when Baby Box should be delivered changed once they had seen the Baby Box and examined its contents. Before experiencing Baby Box, their views were mixed and ranged from 'just before' to 'just after' the birth. At this early point, they had imagined that the Box would be a small one with a few items to take home from hospital, or to be dropped off by the midwife, similar to the Bounty Packs they had received.

After seeing an actual Baby Box, parents were almost unanimous that receipt of the Box should be before birth and to their home, for several reasons:

• Parents would want to sort through and familiarise themselves with the many Baby Box contents, as part of their preparations for the baby's arrival
• Parents would require the hospital bag and its contents in advance of the birth, for practical reasons
• They understood that a Baby Box is not very portable.

Specifically, parents implied that Baby Box should be received at around 32-36 weeks pregnancy. Then, there would still be enough time left for expectant parents to go through and 'put away' the Baby Box contents, even in the case of early births.

Delivery of the Baby Box at this time would also coincide with the start of 'nesting', just prior to the start of maternity leave for many women. Parents recounted how this time was when they begin to focus on birthing and their trip into hospital. Only one mother, out of the whole sample, was slightly reticent about receiving a Baby Box before the birth. Generally, parents were not superstitious about this.

Overall, parents preferred delivery of the Baby Box by post. Some ABC1 parents would be willing and able to pick up the Baby Box themselves, by car from a distribution depot or NHS premises with car parking outside. However, some C2DE parents did not have a car and could not easily go to collect the Baby Box by themselves.

"Maybe it would be easier to be delivered then...I'd be happy to ring the depo to arrange for drop-off." Mum, C1, Edinburgh

"I'd want it delivered though, so you don't need to carry it home." Mum, D, Glasgow