Baby boxes allow mothers to drop-off unwanted children

But experts fear they are making the problem worse

From the outside, it looks like a post-box. Inside is a metal container, lined with a thin mattress. Few would guess what lies inside this hole in the wall of the Berea Baptist Mission Church, located on a quiet street in Johannesburg. Yet for some mothers, it is a lifeline. In fact, boxes like these are where thousands of struggling mothers around the world have placed their newborn children for adoption.

Originating in the 12th century in the form of “foundling wheels” — revolving doors in churches where mothers could secretly hand over babies — the idea has returned in the modern form of “baby boxes” or “baby hatches.” Since the first in South Africa in 1999, more than 20 countries have introduced the boxes, including the USA, Japan, Austria, India, Belgium and Malaysia. In Germany, there are now around 100 “Babyklappes”.

Largely located in hospitals, churches, fire stations and medical centres, the trend has been adopted by organisations all over the world. Practitioners claim boxes offer a safe and anonymous way for mothers to hand over their babies for adoption. But they have come under scrutiny from child rights and health experts, who have raised serious concerns about ethics and safety.

Are the boxes a much-needed alternative to avoid infant mortality, or a danger to mothers and children that actually promote abandonment?

Doors of hope

In South Africa, around 10,000 children are abandoned each year, said Nadene Grabham, Operations Director at the Door of Hope Children’s Mission. And only one in three children survive the abandonment.

That’s why, in 1999, Cheryl Allen, pastor of the Berea Baptist Mission Church, decided to do something about it. The solution? To establish the “The Door of Hope” — the world’s first modern baby box. Anytime day or night, mothers can put their child through a hatch in the church’s wall, prompting the door to automatically lock and triggering a signal to care workers inside.

The Door of Hope baby box in South Africa (Credit: Wikimedia Commons)

Since then, according to Grabham, they have saved close to 1700 babies. Some 14% of these have been through the baby box.

According to South African law, any form of anonymous abandonment of children is a crime. With no “safe haven” laws, even if a baby is left in a safe place such as a hospital, police station, fire station — or a baby box — mothers can be arrested. “We need safe haven laws that allow mothers to safely relinquish their babies without facing arrest or prosecution,” said Grabham.

Babies have been found in shocking locations, from dustbins, to public toilets, to train tracks. Grabham described how many mothers told her that, before hearing about the Door of Hope, they were considering abandoning their babies “wherever they could.”

“Our baby box is definitely not the answer to child abandonment in South Africa but it at least offers a safe alternative for desperate but loving caring mothers,” she explained. “A baby box is worth all the sweat and tears, even if it saves just one life.”

Anonymous solution

The Foundation for Abandoned Children, or “Statim”, have installed 76 baby boxes in hospitals in the Czech Republic since 2005. To date, 176 children have been retrieved from the boxes. And Statim plan to install four more — one in every district of the country.

It’s not possible to give birth in the Czech Republic without disclosing your identity. At the same time, stigma can prevent mothers from openly seeking support — especially in cases of rape, incest or teenage pregnancy. Emil Machálek, a spokesperson for Statim’s BabyBox project, described the boxes as an important tool for helping mothers in difficult situations.

A Baby Box in the Czech Republic (Credit: Wikimedia Commons)

And the project has gathered strong support. Machálek said that, of the 446 Czech people surveyed, 96% agreed that baby boxes were beneficial and save the lives of unwanted newborns.

What works

But do they really save lives?

According to Maria Herczog, chair of the Family, Child, Youth Association in Budapest and senior policy analyst at The Institute for Human Services in Ohio, and Natasha Phillips, founder of Researching Reform — a project dedicated to child welfare in the family justice system, the answer is no.

Research shows no drop in infant mortality rates since the introduction of baby boxes, Herczog pointed out. But Machálek from Statim rejected this research: “every life we manage to save, every child for whom we are able to find new parents is important.”

It’s an “illusion” that a pregnant woman in crisis would know or be in a position to work out where to find the boxes, said Herczog. Grabham from Door of Hope argued that this is why they need the support of other organisations and the public to raise awareness.

However, in their 2018 annual report, Safe Haven Baby Boxes told the story of one woman who drove 51 miles to place her child in a box “so she didn’t have to look anyone in the eye”.

“Identity is only important for a living child”

And it is the anonymity of the boxes that causes concern amongst experts, both for mothers and infants.

Under the 1989 UN Convention on the Rights of the Child, children are entitled to the right to an identity. While baby box practitioners maintain that the right to life is more important, Phillips pointed out that not knowing who a child’s parents are can prevent families from reuniting in the future and cause long-term developmental challenges. “Identity is only important for a living child,” said Machálek.

For mothers, with anonymity comes limited support. Though many programs offer helplines and additional support services, Dawn Geras, president of the Save Abandoned Babies Foundation, argued that it’s not the same as a face-to-face interaction. “There is something on an emotional level when, as a mum is handing me her baby, I can pat her on the shoulder and hug her and say ‘thank you, your baby will be taken care of, you’ve taken responsible action,’” she said.

And the evidence shows that mothers need support. According to a study by the European Commission, mental illness, substance misuse and rape are among the main causes of abandonment.

But Grabham from South Africa’s Door of Hope argued that forcing mothers to disclose their identity creates “even more emotional stress.” She warned that this could drive them to leave their baby somewhere unsafe instead — especially since many choose to remain anonymous due to difficult circumstances such as rape, incest or teenage pregnancy.

Meanwhile, in the US, when a mother calls the Safe Haven Baby Boxes support number, they are first encouraged to hand over the child in person. Their website explains that this is “for the sake of their rights and health” and describes the boxes as a “last resort option.”

baby boxes do provide a uniquely anonymous solution for mothers in need

Some even argue that the boxes promote abandonment. Studies have recorded a rise in the number of abandoned babies since the boxes launched, said Natasha.

Mothers in desperate circumstances risk making decisions they later regret. Geras claimed that her organisation found that around 25% of those who came to relinquish a child, after meeting someone in person, changed their mind. Meanwhile, critics cite the 14 out of 38 babies reclaimed from a hatch in Hamburg. However, Machálek from Statim’s BabyBox project explained that this has only happened once in the Czech Republic. She said that the mother was allowed to retrieve her child after leaving it in the box a few days before.

Prevention over cure

Despite concerns, baby boxes do provide a uniquely anonymous solution for mothers in need: even the harshest of critics are yet to find an alternative fix that doesn’t require any face-to-face interaction.

But are baby boxes enough?

They may be a good “last resort,” argued Atsushi Asai & Hiroko Ishimoto, professors of Bioethics at Kumamoto University, in a BMC Medical Ethics report. But, in the words of Phillips, “prevention is always better than cure.” And, if there’s one thing that baby boxes show, it’s that there are mothers — faced with desperate situations — who are not accessing existing support systems.

From parental training and family planning, through to sexual violence prevention and fighting stigma, a broad approach is needed to tackle the root causes of anonymous abandonment. Then maybe one day, we will get to the stage where we no longer need baby boxes. — Anna Goulden

(Picture credit: Unsplash)

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