Intended for healthcare professionals

Views And Reviews No Holds Barred

Margaret McCartney: Cool and cute—but cost effective?

BMJ 2017; 357 doi: (Published 10 April 2017) Cite this as: BMJ 2017;357:j1766
  1. Margaret McCartney, general practitioner
  1. Glasgow
  1. margaret{at}

Scandinavia: home of IKEA, cycling, good jumpers, excellent television dramas, and fika. Confident enough in nationhood to welcome refugees and to generally interact intelligently with the rest of the world. We all want a little bit of Sweden, Finland, or Denmark for ourselves.

Now, the Scottish government has pledged “baby boxes” for newborns, emulating the famous Finland scheme. These cardboard boxes come with a mattress so that they can double as a bed, as well as various other products—a toy, a book, a thermometer. Some clothes, too, which are Scandi-cool: no gender constraining pink for girls and blue for boys.

First Minister Nicola Sturgeon has said that, “by providing every newborn with a baby box, we can help child health—and by providing greater support to new families, we will also help tackle child poverty and improve the chances of some of our most deprived children.”1 True, other pledges in the package include increased nursery provision. However, the cost of the pilot scheme, initially estimated at around £100 a box, ended up nearer £500.2 It’s likely to fall as savings are made by scaling up the project—but is it really the best use of taxpayers’ money?2

What academic research has the Scottish government commissioned to show that the box will help child health and deprivation? None

Finland started out with baby boxes 75 years ago. The aim was to engage women in antenatal care, when infant mortality rates were relatively high. Reija Klemetti, a researcher, tells me that many women didn’t engage with the health service, which was keen to screen women for syphilis early in pregnancy, when treatment outcomes are better. However, she mentions a dearth of research since then (one paper in the 1950s). Furthermore, pregnant women in Finland have had a comprehensive health service—in other words, it’s not all about the box.

So, what academic research has the Scottish government commissioned to show that the box will help child health, poverty, and deprivation? None, and none is planned. Instead, a poll by Ipsos MORI will assess the impact (here’s a time and money saving tip: people like free things, especially when they come with a hint of Scandinavia). Yet the Scottish government has told me, “We are committed to doing everything we can to give our children the best possible start in life.” The first thing should be obtaining and using evidence, to find what to do to achieve this.

The baby box phenomenon has spread to Hackney,3 Ohio,4 and Calgary (which at least recognises that research is needed).5 Numerous companies have recognised the boxes’ coolness and are selling them to the world.

I have some other, less cute, suggestions for Scottish government spending. Support breast feeding: it shows a clear social gradient,6 while the health benefits it brings are clear and improve with support.7 And more council spending on social care, which has seen significant and unsustainable cuts,8 and on district nursing. The best health interventions may come without gift wrapping.


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