Scotland's Baby Box pilot: qualitative research

2 Views on the Baby Box concept

Key Points

• There was enthusiasm for the idea of 'trying to give everyone the same start'
• Among both parents and health professionals, views were divided on the principle of providing Baby Boxes universall, to all families in Scotland.
• One View as that it would be better to limit the scheme, either to those on low incomes or to first time parents.
• Reservations about making the scheme universal were linked to concerns about the percieved level of resources currently available to health and other services for young families.
• There was a desire for more information on the aims, intended benefits, and evidence behind the scheme.

2.1 This chapter explores parents' and professionals' views of the aims of the Baby Box scheme and their general reactions to the concept.

What do parents see as the aim of Baby Boxes?

2.2 Parents were asked what they thought the Scottish Baby Box scheme was trying to achieve. Where they expressed a view (some parents were unsure what the aims were), they identified two main aims they associated with the Scottish Baby Box scheme:

• First, parents talked about the intention of 'trying to give everyone the same start' or ensuring 'every child has an equal opportunity' . There was enthusiasm for this aim - 'love the theory behind it that every baby starts on the same foot'. Parents welcomed extra help for new parents, with one mother stating that receiving the box made her feel the government 'cares ' about families.
• Second, some parents mentioned a perceived link between the Scottish scheme and the Finnish Baby Box scheme, and believed that both schemes were intended to prevent 'cot death'. At the same time, this perceived link (with the Finnish scheme and a perceived aim of preventing 'cot death') led others to question what evidence there is for Baby Boxes impacting on infant mortality. ^[9]

Universalism versus targeting

2.3 Although in general parents were enthusiastic about the idea of 'trying to give everyone the same start' parents' views were nonetheless divided on whether or not the scheme ought to be rolled out universally. On the one hand, there was support for the idea that all families would qualify, whatever their income.

We are quite delighted. Sometimes we feel we are penalised in a way for maybe being in a higher income bracket, but we have a huge mortgage to pay and we feel that when things are income related or means-tested then we miss out a bit, but we don't have any spare money as such.

(Orkney parent)

2.4 On the other, there were questions about whether or not providing a box to all parents was the best use of public money in the context of over-stretched resources. Although views were not neatly divided by parents' own income (there were higher income parents who supported universalism and lower income parents who opposed it), some parents who were more affluent expressed guilt about having received the box when they felt they could easily have bought everything in it themselves. A recurrent view was that it would be better if parents could only register for those items they needed.

2.5 It was suggested that the scheme could be delivered more cheaply if it was either means-tested and limited to low-income families, and/or restricted to first time parents.

I do think it's a wonderful idea, but I think - and one of the other mums said the same thing - that it should be for first time mums … Because if this was my third box, I would be like 'what am I going to do with that?'

(Orkney parent)

2.6 However, parents also discussed the potential for means-testing to lead to stigma which might prevent those parents who would benefit most from the box from claiming it. For example, one parent was adamant that she did not need the box and that Baby Boxes should only be given to those who ' really need it', yet at the same time she also felt that:

There are lots of families who really need it, but if you ask them, they'll say no, because they don't want to feel like they can't afford it.

(Clackmannanshire parent)

2.7 The views of health visitors and midwives on the Baby Box scheme divided along similar lines - support for universalism contrasted with reservations about whether a universal scheme was the best way of improving outcomes for the families that need the most support. Parents, and to some extent midwives and health visitors, expressed a desire to understand more about the rationale for the Baby Box scheme, including why it was universal rather than targeted.

2.8 Reservations about universal roll-out were linked with concern about the perceived level of resources available to other services for young families. This view was shared among both parents and midwives:

I will be brutally honest with you, me and my husband don't agree with the scheme. The money, in our view, we feel could be spent a lot better elsewhere. When the NHS has no money for all these different things, and, you know, maternity (services) are so strapped.

(Orkney parent)

Linking the scheme to antenatal education

2.9 In addition to variations in views on whether the scheme should be universal, parents also expressed differences of opinion on whether or not the scheme would be more likely to achieve improvements in child outcomes if it was more explicitly tied to participation in antenatal education. Although women in Scotland must register for a Baby Box through their midwife, it was suggested by some parents and health professionals that receiving the box could be more closely tied to attendance at antenatal appointments or classes, or to other educational activities aimed at improving understanding of how to look after a new baby. ^[10] However, the case against linking the scheme explicitly to antenatal engagement/ education was strongly argued by a midwife:

You've got more likelihood of vulnerable people being turned off by that than actually working with you. You give something with one hand and then say 'but that's on condition' … that can be a shutter coming down before you've even started working with a family.

(Midwife)

Policy implications

2.10 While there was enthusiasm about the idea of trying to give everyone the same start in life, opinion in the pilot was divided on whether this ought to be achieved through a universal, rather than a targeted scheme. In this context, the Scottish Government may wish to consider how it communicates the rationale for key elements of the scheme's design, in particular:

• The case for making the scheme universal rather than targeted
• The reasons for making the box unconditional rather than linking it more explicitly to engagement with antenatal checks or education
• What Scotland's Baby Box is trying to achieve
• The evidence for the scheme's effectiveness.