Finland’s low infant mortality has multiple contributing factors
Articles in the international press have pointed to the maternity package (Baby Box) as the primary reason for Finland’s low infant mortality. This, however, ignores other factors. There are multiple factors contributing to Finland’s low infant mortality, including maternity and child health clinic services, family policy, medical advancements, improved nutrition and hygiene, and increased wealth.
Maternity package encouraged use of services
While the maternity package has probably not had any direct impact on infant mortality, family policy and legislation certainly have. The maternity package was introduced in 1938, being distributed to disadvantaged mothers after childbirth. In the early years, maternity benefits were awarded and distributed by the social welfare committee of the mother’s home municipality. At the time, there was concern about decreasing birth rates and high infant mortality: in Finland in the late 1930s, almost one in ten children died during their first year of life.
In 1949, the maternity benefit (a choice of the maternity package or a one-off maternity allowance) was extended to all pregnant women. From the earliest years, a pregnancy certificate, obtainable from a maternity clinic or a physician, has been a requirement for receiving maternity benefit. Such a certificate affirms that the holder’s pregnancy has lasted 154 days or more and that the holder has had a health examination before the fifth month of pregnancy.
The maternity package was conceived as a ‘welcome pack’ from the Government to a new family member. It was a means by which pregnant women were encouraged to use maternity welfare services, and mothers gained access to public health care services. Mothers were also encouraged through family policy to look after their own and their child’s health. Since 1994, maternity benefits have been the responsibility of the Social Insurance Institution (KELA). According to KELA, nearly every mother expecting her first baby opts for the maternity package over the maternity allowance, currently € 140; and overall only one third of all mothers select the latter.
Maternity and child health clinic services play a vital role
Finland’s first maternity and child health clinics were established in the 1920s. The Act on Municipal Prenatal and Child Care Clinics (224/1944) charged local authorities with the responsibility to provide maternity and child health clinic services as part of primary health care. Clinic services include regular health examinations at predetermined times and health counselling. Regular monitoring helps prevent illnesses and identify risks at an early stage, and the clinics also offer guidance and support to those who need them.
Parents are advised to use the cardboard box of the maternity package as the newborn’s first bed. The package forms a hygienic and safe bed for an infant, and the baby will not then be sleeping in the same bed as the parents.
For a baby to sleep in the same room as the parents but in a separate bed has been found to reduce the risk of sudden infant death syndrome (SIDS). SIDS is rare in Finland: only six infants died of it in 2015. One contributing factor in this is that parents have long been advised to have their babies sleep on their backs (see the guide We’re having a baby, THL, in press).
Even today, maternity and child care clinic services are offered to all families regardless of their socioeconomic status. The services are universally popular. According to the Finnish Medical Birth Registry maintained by the National Institute for Health and Welfare, almost all pregnant women (99.6%) used maternity clinic services in 2014. Of those who do not use public-sector services, some use private services, and thus the percentage of women who use no such services is extremely small.
According to Finnish legislation (Government Decree 338/2011), the authorities must survey whether those who do not use the services have a need for special support and provide customised support for those who need it. Such pregnant women are referred to a maternity outpatient clinic if necessary; nearly all babies are delivered at hospitals. The care given to premature babies is of a high standard, and everyone in Finland has access to high-quality health care services and guidance.
Following Finland’s lead
The Finnish maternity package is now world-famous, and the concept has been adopted in several other countries. In Japan, a modified version of the Finnish maternity package was introduced in the city of Urayasu in 2014. A modified version of the maternity package has also been distributed to Maori mothers in Waikato, New Zealand since 2015. In the same year, Mexico City began to distribute maternity packages to low-income mothers.
In 2016, the University of Calgary in Canada began distributing maternity packages to families expecting their first child as part of a research project addressing the strengthening of families’ resources. Maternity packages are also distributed to expecting parents in Texas, US and Scotland, UK.
In countries where the maternity package is introduced, it is possible to study the impact of the maternity package on the wellbeing of the parents, for instance their capabilities and how they cope, and the strengthening of the family’s resources. In Finland, it is difficult to study what the impact of the maternity package actually is, because it has been in use for decades and everyone who wants it can have it.
Improving neonatal health and decreasing infant mortality requires investments addressing a broad range of contributing factors such as family benefits (maternity benefit and maternal, paternal and parental leave), nutrition and all available maternity health services and services for families with children. The maternity package is only one cog in this system, albeit a vital one.
Research Manager, Adjunct Professor,
Children, adolescents and families, National Institute for Health and Welfare