MANSFIELD – When looking for a safe sleep environment for a newborn baby, probably the last thought to come to mind is a cardboard box.
In fact, a 2013 survey showed that 40 percent of parents in a United States test group felt uncomfortable putting their baby in a box to sleep – even a box covered with adorable cartoon animals.
But a follow-up to that survey, distributed by The Baby Box Co., showed that after two months of a baby box in their possession, 80 percent of these same parents were using the box as a sleep space for their baby. Less than 5 percent were not using it for safe sleep.
It’s exactly what founder Jennifer Clary envisioned as the safest sleep option for an infant.
“When I first started out, infant mortality rates were our driving factor, our driving star,” Clary said. “It’s a bassinet alternative, a safe sleep environment that doesn’t require assembly.”
The Baby Box Co., based in California, is modeled after a Finnish tradition that encourages safe sleep. Studies have shown the boxes have helped Finland achieve one of the lowest rates of infant mortality in the world, and the baby box movement has become increasingly mainstream in the U.S. as more and more families are turning to this safe sleep option.
Keeping with the ABC’s of safe sleep – alone, on their back and in a crib – the box includes a firm mattress with only enough room for baby. Each box also comes filled with baby essentials like onesies, burp cloths, sleep sacks and various baby toys.
Still, Clary considers The Baby Box Co. to be a program, not a product. Favoring a comprehensive approach, she considers the box to be an educational and engagement tool to promote safe sleep education.
“We are an education program first, and a baby box program second,” Clary said. “Just the box isn’t going to help infant mortality; we feel very strongly that education is what’s going to reduce infant mortality.”
To that end, Clary began Baby Box University as a companion to The Baby Box Co., an educational program about pregnancy and parenting available to all expectant mothers and their families. Baby Box University is focused on maternal health and early child development, and every baby box from the company comes with a membership card.
It is this program that Clary hopes to roll out in local hospitals across the country through community partnerships. By entering into an agreement with The Baby Box Co., every expectant mother in a partnering hospital would receive a baby box and a membership to Baby Box University before leaving the hospital.
“In our research, universal initiatives benefit more than targeting specific members of the population, like parents at a certain level of poverty or certain demographics,” Clary explained. “If you distribute to everyone equally regardless of economic status, the people who are most vulnerable are more likely to use the intervention properly.”
The program was recently introduced at Firelands Regional Medical Center, just north of Richland County in Sandusky. Alice Springer, director of development at Firelands, said theirs is the first hospital in Ohio to offer baby boxes.
“Last year, we had two families come to us looking for help because of infant mortality occurring within their families,” Springer said. “That’s why we were motivated and what got our team researching this.”
Erie County’s infant mortality rate was 8.8 in 2014, higher than Richland County’s rate of 7.3 in the same year. During a strategic planning session last November to address this problem, the idea of baby boxes was introduced. Baby boxes were first implemented at Firelands in February 2016.
The universal distribution proved to be the most effective method for Firelands, according to Springer. Other initiatives in Sandusky were aimed at giving boxes only to underprivileged mothers, but Springer didn’t want it to become the “box of shame.”
“They’re given to all new moms no matter their socioeconomic background,” Springer said. “By and large, everybody takes one. Only two moms have not, but they called back later and we delivered boxes to them.”
It’s too soon to track measureable changes on infant mortality rates, but the morale boost has been instantaneous.
“We put the boxes together as a team-building exercise within our division, and when the OB nurses call us to deliver them the employees are so proud walking through the hospital,” Springer said. “It’s caused quite a stir in our community.”
A similar partnership with The Baby Box Co. in Richland County is, in Clary’s words, “beyond possible.” She ran the numbers – according to Richland Public Health, there are approximately 1,200 births in Richland County each year. If the health department collaborates with The Baby Box Co. education department and utilizes the Baby Box University platform, Clary can provide a baby box full of goodies to every expecting mother in Richland County for a contribution of just $8.25 per unit, or $9,900 per year.
If the health department would choose not to work with The Baby Box Co. as an education partner, baby box units could be distributed independently starting at $12.50 per unit. Payment plans are offered for both scenarios.
“I’d say that a Baby Box Co. program is the most economical, accessible and impactful investment in families and community health outcomes,” Clary said.
The health community in Richland County takes the issue of infant mortality seriously.
The Ohio Department of Health’s annual Child Fatality Review for 2015 praised the creation of the Richland County Infant Mortality Community Conversation (IMCC), which organized in 2013 due to the high infant mortality rates in the county.
IMCC has four subgroups implementing recommendations for prevention of sleep-related deaths, prematurity and birth defects, and improving health system performance. It includes healthcare providers, Richland Public Health, the Community Health Access Project (CHAP) and other social service agencies.
A member of the IMCC, Lavonne Downing said simply having representatives from so many county agencies in one room was helpful in itself.
“We didn’t even know about some services of the county until we were sitting across from each other,” she said. “If the medical offices don’t know about the services offered, you might as well not do them. We need to know so we can send people to them. Interaction between the different agencies is lacking.”
Dr. Mark Redding also cited community collaboration as a critical part of reducing infant mortality rates. The Community Health Access Project (CHAP) is a natural partner in collaboration.
“At its best if we’re collaborating in Richland County, the community care coordinators who reach out to these folks at risk end up being an integration point,” Redding said. “They are the navigators who know where everything is, and if they can work as closely as possible with the infant mortality task force and other related agencies, we need to continue that.”
The IMCC has eight official objectives: lengthen the interval of time between births to at least 18 months, reduce unintended and teen pregnancies, promote male involvement in reproductive health, promote early and adequate prenatal care, provide smoking cessation and reduce substance abuse for women of childbearing age, reduce rate of infections in women of reproductive age, develop links to reproductive health needs, and disseminate knowledge on infant mortality in Richland County.
The objectives were broken down into manageable chunks with various agencies tackling individual problems. Downing is focused on preventing premature and pre-term births, by far the leading cause of infant mortality.
“I would like having more all-inclusive practices where everything that person needs to seamlessly get through their pregnancy is right there, like a one-stop shop,” Downing said. “Just having more guidance and more education for the patients so they know what’s there, and then having it more accessible.”
Safe sleep practices are being addressed locally by Richland Public Health. Public Health Nurse Jennifer Crotty said often times the hardest person to convince of the ABC method is the grandmother, who laid her babies on their stomach to sleep and they turned out just fine.
“I tell them it’s been all these years, they’re doing all this research and these are the facts they’ve discovered,” Crotty said. “There are different things you want to put into their knowledge. I can’t tell you how many people I go see and it really impacts them.”
The most tangible safe sleep help offered by Richland Public Health is their “Cribs for Kids” program. If a parent qualifies for the Women, Infants, Children (WIC) nutrition education program, and has no safe sleep environment, the health department can provide a free “pack-and-play” crib.
Similar to CHAP’s high community involvement to provide comprehensive care, former Public Health Nursing Director Peggy Sutton yearns for the resources to provide every single mother with a newborn home visit.
“It’s evidence-based that if you get in the home and talk to the mom in their habitat, moms ask the questions that need to be asked and you can offer the help,” Sutton said. “To implement that, we need change in the total thought process with everyone thinking that everyone gets a newborn home visit. I think we could make a big difference if we could get into every newborn’s home.”
It’s clear solutions to infant mortality are constantly in the works in Richland County. Still, it’s not an overnight process.
“It’s a little daunting,” Downing said. “We tried to come up with reasonable objectives we could promote within the county that would make a tangible difference. We’re making progress but it’s slow; it will probably take 10 years before we see real, exciting change.”
Eleven years after the death of her infant daughter, Shanay Crawford now finds herself part of the solution. She currently works with the Ohio Infant Mortality Rate Initiative as part of Third Street Community Health Workers, an agency of CHAP.
Working primarily with the minority community, Crawford pushes for mothers to go to their prenatal appointments by helping with transportation, food, finances or even education. Her goal is to meet a mother’s basic needs so that focusing on their pregnancy is their top priority.
Occasionally, Crawford works with mothers who have lost their babies. Rather than shy away from cases that hit close to home, Crawford pays it forward by becoming that mother’s support system.
“When my daughter passed, I had so many people around me that loved and cared about me,” she said. “I couldn’t imagine not having that, I would probably still be under a rock somewhere. I want to be able to offer that to other people and share that I had the same experiences.
“Just to know somebody for a second has stopped what they’re doing to be in that moment with you is very important, because you do feel very alone and you feel like nobody else understands.”
Crawford and her two children, 14-year-old Iyiana and 10-year-old Xavier, visit Jesselyn at Mansfield Cemetery to mark holidays or her birthday. She takes special care to clean the headstones of the babies neighboring her own whose parents have moved away or find it too painful to visit.
Though she is missing a child, Crawford firmly believes losing her daughter was in God’s plan. It’s made her family stronger, it’s made her a more appreciative mother, and it’s made her an all-around better person, she says.
“Sometimes I cry about it, sometimes I don’t,” Crawford said. “But I can rest well knowing I took her to all her appointments, when she passed she was in a safe sleep environment, and I know I did everything I could.
“Yes it still happened, but I don’t feel as guilty because I know as a parent I did everything I could.”