Baby Box: evaluation

Footnotes

1. A full list of items included in baby boxes in Scotland at the time of the research is provided in Appendix A.

2. The leaflet provided with the box advises that "When your child can roll over, sit, kneel or pull themselves up, the Baby Box should no longer be used for sleeping"

3. Anonymised registration data provided by APS, the contractor for delivering baby boxes.

4. The Baby Box Evaluability Assessment was conducted on behalf of the Scottish Government by the Evaluability Assessment Collaborative between January and March 2018. A wide range of stakeholders, including Scottish Government officials, midwifery and academic experts in safe sleeping and infant mortality, took part in three workshops to plan for the evaluation of the Baby Box scheme, and to determine the outcomes this should ideally address.

5. Analysis of anonymised Baby Box registration data for February to August 2019 was conducted to determine these quotas and weights, to ensure data was representative of all parents who had registered for a baby box, not just those who had opted in to be contacted for research purposes.

6. In order to reduce the number of surveys staff were being asked to complete at the same time, this survey was combined with another survey conducted by Ipsos MORI on behalf of the Scottish Government, covering health visitors' views of the Universal Health Visiting Pathway. The order of the two topics was randomised, so half were asked Baby Box questions first, and half the UHVP questions first.

7. The Health Board areas were: Fife, Grampian, Greater Glasgow and Clyde, Highland, Lanarkshire and Lothian.

8. Although around one in ten parents did not take up the baby box, there was no obvious route for identifying or recruiting these parents. More fundamentally, it is very likely that those who decide not to take up the baby box differ significantly both in respect of their characteristics and attitudes to those who do take up the box – meaning that any comparison of impacts between the two groups would likely be confounded by these other differences. Another option for comparing impacts would be to take an interrupted time series analysis, where longitudinal data on child and family outcomes is used to model the effect of an intervention (in this case, the introduction of the Baby Box scheme), using statistical modelling to account for any pre-intervention trends. Such a study may provide useful data on whether there have been any changes in child and family outcomes from before to after the introduction of the Baby Box scheme. However, it would nonetheless be complicated by the number of other interventions that may impact on maternal and child health in Scotland – including the Universal Health Visiting Pathway – introduced at around the same time as the Baby Box scheme. Establishing definitive impacts from the Baby Box scheme on observed outcomes is thus challenging, whatever design is used.

9. From anonymous registration data provided by APS, the Scottish Government's contractor for providing baby boxes and figures from the Scottish Government.

10. Live births and still births as recorded by NRS Scotland – see https://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/vital-events/general-publications/vital-events-reference-tables/2019/list-of-data-tables#section3

11. Including both live and still births. Note that this is not a perfect measure – ideally, we would divide the number of registrations by the number of parents with a due date in each year (since registration and delivery is based on due date not actual date of delivery), but this data is not readily available.

12. Using registration data (from APS) and data on deliveries by SIMD provided directly to Ipsos MORI Scotland by NRS.

13. The difference in responses between the surveys may be explained by differences in the way this issue was asked about in the surveys of parents and health professionals. Parents were asked 'Who completed the Baby Box registration form?' and it is possible that some respondents whose midwife had filled in their section of the form and given it to them to post viewed this as 'I/my partner completed it jointly with my midwife'. Professionals, on the other hand, were asked which of the following usually applies: I arrange for the form to be posted, once the mother has filled out her information; the mother takes the form away and posts it back herself; or sometimes I send the form off, and sometimes I give the form to the mother to return.

14. Of course, a limitation of the sample is that we were only able to survey parents who had registered for a box – we do not know from this if there are parents who did not register because they had problems with registration process.

15. The full list of contents is also available online at https://www.parentclub.scot/baby-box

16. There could be a range of reasons for this, but as we did not interview any birth parents in this situation, this report cannot comment on why this occurs.

17. A list of the contents of the baby box at the time the research was conducted is included in Appendix A. For a full list of the current contents of a baby box, see https://www.parentclub.scot/baby-box

18. 34% of 30-34 year-olds and 35% of parents aged 35+ chose the clothes as one of the most useful items, compared with 26% of parents under 30. Similarly, 29% of 30-34 year-olds and 30% of parents aged 35+ said the box itself for sleeping was one of the most useful items, compared with 22% of 16-24 year-olds and 23% of 25-29 year-olds.

19. 37% of first time parents, compared with 33% of those with older children in each case

20. 45%, compared to 40% of first time parents

21. 33% compared with 29% of first time parents

22. 40% of those with household incomes of £52,000 or more, compared with 28% of those on less than £15,599

23. 42% of those with household incomes of £52,000 or more, compared with 27% of those on less than £15,599

24. 76% of those under £15,599, 78% of those on £15,599-25,999 compared with 66% of those on £52,000 or more

25. 10% of parents aged 16-24 said the emery boards were among the 'least useful', rising to 20% of parents aged 35 or older. Similarly, 7% of parents aged 16-24 identified the bath sponge as among the 'least useful' items, rising to 20% of parents aged 35+.

26. Sleeping safely | Ready Steady Baby! (nhsinform.scot)).

27. 38% of those on £15,600-£25,999; 45% of those on £26,000-36,399; 40% of those on £36,400-£51,999, and 39% of those on £52,000 or more.

28. https://www.nhsinform.scot/ready-steady-baby/early-parenthood/going-home/sleeping-safely. Exact wording is: You should never sleep with your baby on a sofa or armchair as they can easily slip into a position where they are trapped and can't breathe. It is dangerous to share a bed with your baby if you or anyone in the bed has recently drunk any alcohol, smokes or has taken any drugs that make you feel sleepy or if your baby was born prematurely (before 37 weeks of pregnancy) or weighed under 2.5kg or 5 ½ lbs when they were born.

29. https://www.nhs.uk/conditions/reflux-in-babies/

30. Note that these positive comments about using a baby box for daytime naps after a C-section stand in slight contrast with concerns about bending down to pick up a baby from the box at night. These comments were made by different parents, so may just reflect differences in their experiences. It may also reflect differences in the perceived effort involved in getting out of bed and bending down at night, versus doing the same during the day, when parents are already more mobile.

31. Royal College of Psychiatrists "Postnatal depression - key facts" (2017). Available online at: https://www.rcpsych.ac.uk/mental-health/problems-disorders/postnatal-depression-key-facts

32. NHS Inform "Post-natal depression" (2020). Available online at: https://www.nhsinform.scot/illnesses-and-conditions/mental-health/postnatal-depression

33. Figures provided by the Scottish Government.

34. While we have grouped health visitors and family nurses for analysis purposes, the lower level of experience among this group will be driven by health visitors rather than family nurses.

35. Contents of the box: among health visitors/family nurses, 65% would like more training and 72% more information, compared with 37% and 49% respectively of midwives

The registration process: among health visitors/family nurses, 58% would like more training and 56% more information, compared with 23% and 20% respectively of midwives

The delivery process: among health visitors/family nurses, 51% would like more training and the same proportion more information 51%, compared with 17% and 20% respectively of midwives

36. It is worth noting, however, that only 2% of all parents who took part in the parents' survey mentioned any changes relating to means testing when asked if the scheme could be improved in any way – suggesting that concerns about the cost of providing baby boxes universally are not top of mind for most parents.

37. Due to some parents selecting 'don't know' or 'prefer not to say' options, not all characteristics total 2236.

38. Note that this does not sum to 36, as two participants in the qualitative research neither agreed nor disagreed with this statement when presented to them in the survey.

39. In our survey of 2200 parents in 2019, a very small percentage of parents (4%) expressed this view.