File photo: New Jersey became the first US state to send newborn babies and their parents home with a box that doubles as a crib and full of necessities, with the aim of cutting back on sudden infant death syndrome. Picture: AP

Washington - Although Ella Mae Formel works full time in Great Barrington, Massachusetts, money is tight for the new mother.

Her baby, Oliver, was born at the end of March, and making sure she had everything she needed to take care of him was important to her. So when she read a newspaper article before his birth about a programme offering free baby boxes, she jumped at the opportunity.

Her gift – a cardboard box where the baby can sleep for his first six months – came loaded with swaddles, a first-aid kit, a rubber duck thermometer to test water temperature, and diapers, as well as tea and sanitary pads for her.

Baby boxes, which were started in Finland 80 years ago and helped to substantially reduce the country's infant mortality rate, according to the government, are now coming to the United States through nonprofits, community health organisations and private entities.

"I'm a first-time mother, and I work full time, but I'm actually low-income," says the 24-year-old Formel. She received her box through the nonprofit Berkshire Baby Box organisation, which connects new moms and dads to local resources.

In Finland, all families are given baby boxes – or cash grants if they prefer – as long as the mother is receiving prenatal care. The country's infant mortality rate decreased from 65 deaths for each 1 000 children born in 1938 to an estimated 2.5 deaths per 1 000 births in 2016, less than half the US rate of 5.8.

The programme, enacted in 1937, was initially meant for low-income mothers. The Finnish government was looking for a way to better support babies and families when the child mortality rate was high and the birthrate had dropped, said Kiti Laitinen, coordinator of family benefits at Finland's social services institution, known as Kela. The baby boxes not only provided material support but also helped connect families with health care and social services.

Formel received her box after taking part in several online tutorials offered by Baby Box University, an educational offshoot of the for-profit Baby Box Co, which uses nonprofits to distribute the boxes.

The tutorials include information on safe sleep, nutrition and prenatal health. Once Formel completed the training sessions online, she received a voucher and was able to pick up her baby box, distributed in her region by community organizations and hospitals.

"For someone who is super financial insecure, what are you going to do if you can't afford a crib or a bassinet or something?" she says.

Rachel Moon, a professor of pediatrics and a SIDS researcher at the University of Virginia School of Medicine, notes that the baby box in Finland is tied to the national healthcare system, which includes free health care for the mother and child as well as home visits by health-care professionals during the first weeks of life. But a similar arrangement is not available in the United States, she said, and because the boxes have never been studied, it's unclear what factors are most important in improving child health.

"This is a vastly different programme than what the Baby Box Co. is doing," she said of the Finnish programme. "It may be the prenatal care or the national health care or the home visits, or all of these or none of these. However, we will not know because nobody wants to study this. This is very frustrating."

Although there have been no studies tying the boxes to reducing sudden infant death syndrome or other hazards, Fares Diarbakerli, an OB/GYN in New Jersey, said the boxes are a way to help ease new moms into motherhood. Diarbakerli said he doesn't believe there are any risks associated with the box as long as the parents are educated on proper ways for the infant to sleep in the box.

The Baby Box company says that the opportunity for parent education offered along with the boxes is a useful way to improve child and maternal health.