Identifying mothers at risk early in their pregnancy is a key factor in supporting a healthy pregnancy. An incentive should be offered to encourage women who qualify for the maximum rate of Family Tax Benefit and are on other income support to identify their pregnancy early on (8–20 weeks) to access antenatal services. The local community nurse or health organisation can then monitor and support the pregnancy. The following case study from Finland suggests a possible incentive.
Finland’s ‘baby box’ maternity package
In Finland, the government invests in helping parents to support their children’s development from an early age. Maternity packages were introduced in Finland in the 1930s in an effort to reduce high rates of infant mortality and declining birth rates. Initially, they were aimed only at low-income mothers. The benefits were quickly recognised and within 15 years maternity grants were made available to all expectant mothers. Maternity grants are available as the Maternity Package— i.e. ‘Baby Box’—or a one off tax-free payment of €140. Sensibly, the majority of mothers choose the Baby Box.
The Baby Box act as a type of starter kit for new parents and contain helpful information, clothes, sheets, nappies, bath products, picture books, a bath towel and small mattress so that the box can even be used as the baby’s first bed. It is claimed that these boxes help reduce infant mortality by promoting healthy sleeping patterns and providing a safe and secure sleeping environment for the baby. Finland currently has the fifth lowest infant mortality rate in the world: 3.4 for every 1,000 births. In Australia, the infant mortality rate for Aboriginal and Torres Straight Islanders is nearly twice as high as other Australians.
To foster a culture of reading, parents of newborn babies receive a gift of three books as part of the maternity package from their local mothercare centre. Finland produces more children’s books per capita than any other country. Early childhood education is accessed almost universally—98% of preschool-aged children attend at least the last year of early childhood education—even though it is not mandatory. Children can attend free day care from the age of eight months to five years. Day care includes both full-day care centres and municipal playgrounds with adult supervision where parents can accompany the child.
To be eligible, mothers are required to visit a doctor or prenatal health clinic and receive a medical examination before the fourth month of pregnancy has ended. The health clinic then issues a pregnancy certificate which is required to claim the grant. In this way, the Baby Box engages mothers early and provides families with useful tools to care for their new child. By 1979, 100% of new mothers were receiving prenatal care in Finland—up from 20% in 1940.
In Australia, a number of Aboriginal health organisations have already successfully run a similar approach; including, among others, Alukura in Alice Springs and Apunipima in Cape York. The intention is that the Baby Box attracts pregnant women to the clinic or centre for prenatal care and they continue on with postnatal care. This successful model run by experienced Aboriginal health organisations such as these could be applied more broadly.
There needs to be the capacity for flexibility in the design of the incentive. While a number of Aboriginal health organisations have implemented the Baby Box initiative, it might not be the right strategy in some places, and other approaches identified by the health workforce may be more appropriate to the circumstances. Aboriginal health organisations have been highly successful in reducing the infant mortality rate over time. The key for this review is that the Baby Box demonstrates a good take-up of a very simple, incentive-based, effective measure and, most importantly, a means to engage new and expecting mothers to help ensure that support services are rapidly deployed where they are most needed.