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These are external links and will open in a new window Close share panel Image copyright Alamy It's been claimed that Finland's baby boxes, given to every newborn in the country, help reduce cot deaths. But what evidence is there that they lower infant mortality rates, asks Elizabeth Cassin.

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It's been viewed over 13 million times and sparked global interest in the idea. The article explained Finland's year-old policy of giving every pregnant mother a cardboard box filled with baby products, such as clothes, sleeping bag, nappies, bedding and a mattress, and how the box itself could be used as a bed.

One reason it attracted such attention is that Finland has one of the lowest infant mortality rates in the world - two deaths per 1, live births, compared with a global rate of 32 in 1,, according to the UN.

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  • And they're incredibly popular not just with individuals but - more significantly - with governments. The promise of lower infant mortality rates is something to aim for.

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    But if you stop and think about it for a minute, this is a bold claim. How does getting a baby to sleep in a box and a few baby items bring down infant mortality rates?

    In theory, the boxes offer a safe sleep space for babies. Image copyright Alamy There are lots of reasons why babies die, from health problems to accidents.

    But there's one in particular that these boxes have been thought to help reduce - sudden infant death syndrome Sids , also referred to as "cot death", is the unexpected and unexplained death of an apparently healthy baby. Although it's difficult to always understand what causes these deaths, there are environmental factors that increase the risk - including being around tobacco smoke, getting tangled in bedding, or sleeping alongside parents - especially if parents have been drinking.

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  • This led to the last significant reduction in countries like the US and UK. But it's important to understand that nearly all countries have seen a dramatic reduction in infant mortality over the last century. Now it's less than 0.

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  • And Finnish academics and health professionals have been keen to point out that there is some misunderstanding about the box scheme. Image copyright Google To understand how policy changed in Finland, we need to go back to Although infant mortality rates had been falling across Europe, Finland's rate was higher than their Nordic neighbours.

    The government decided to offer baby boxes to low-income women. But the women didn't just get a box. The boxes were introduced "at the same time that the pre-natal care was started", says Prof Mika Gissler, a statistician at the National Institute for Health and Welfare in Finland. Women had to attend clinics early on in their pregnancy to qualify for the maternity package.

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    Their health could then be monitored throughout and after the pregnancy. Legislation in made it a legal obligation for municipalities to provide maternity and child health clinics. In , the care package, including the baby boxes, was offered to all women. Image copyright Getty Images Image caption A combination of factors are behind better infant health in Finland And that if you look at the decline in infant mortality, the thing that's driving it more than anything else is a combination of advancement in medicine, vaccinations, nutrition, hygiene and increased prosperity.

    Finland has reliable Sids data for the past three decades - and the rate is low. But the significant reduction in deaths has been in congenital anomalies and other diseases. And yet one of the leading baby box companies sells its products as an essential gift for new parents, claiming studies have proven the link.

    This item is used when parents go to spend their final moments with little ones, and also gives them a few extra days to say goodbye. So before you make this drastic change to his bedtime, work with your baby to make his cot a place where he wants to be.

    I asked the company if I could see these studies, but they said that studies showing positive results had not been published yet. Experts say that there are no studies showing the efficacy of baby boxes. Countries across the world have been trialling variations on the Finnish box, including Canada, Ireland, and Scotland - with many tying in additional education for parents. And while looking at the possibilities the baby box is interesting, there are bigger factors at play.

    Image copyright Getty Images One country where the baby box idea has received a lot of attention is the United States - because they are struggling with poor infant mortality rates - six per 1, births, which makes them comparable to Poland and Hungary, below the level you'd expect based on their income.

    She says the US does fairly well in the first month of life - but from a month to a year, "you can see the mortality rate in the US kind of accelerating away from the other countries in that period". When looking at women with a college degree - a marker for relatively high income - infant mortality rates were low and similar to the same groups in Finland and Austria.

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    Whereas that is not true in the US. Also, most countries in Europe have a pretty robust home visiting programme after birth. That's not something that has uniformly been true in the US. Governments and individuals should not see the box as solely effective, without improving care and education for parents also.

    After all, there are countries with the same infant mortality rate as Finland, such as Iceland, Estonia and Japan, that do not have baby box schemes.

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