Impact of the Finnish Maternity Grant on infant mortality rates in the 20th century: a natural experimental study

McCabe, R., Katikireddi, S. V. , Dundas, R. , Gissler, M. and Craig, P. (2023) Impact of the Finnish Maternity Grant on infant mortality rates in the 20th century: a natural experimental study. Journal of Epidemiology and Community Health, 77(1), pp. 34-37. (doi: 10.1136/jech-2022-219488) (PMID:36302615) (PMCID:PMC9763162)

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Abstract

Background: Baby boxes provide goods to new parents and a space for infant sleeping. They were first introduced in Finland, and it has been argued that the policy helped reduce infant mortality. We evaluated the impact of the Finnish Maternity Grant (which includes the Finnish Baby Box) on infant mortality rates (IMRs) at the points of introduction (disadvantaged mothers only) in 1938 and universalisation in 1949. Methods: Maternity Grant introduction and universalisation were evaluated as distinct natural experimental events, using interrupted time series analysis. The outcome was IMR per 1000 live births. We analysed national data on all infants born in Finland between 1922 and 1975, estimating step and trend changes in the outcome following the point of intervention. Sensitivity analyses included truncating the pre-intervention period and a double break point model, incorporating terms for both introduction and universalisation. Results: Maternity grant introduction in 1938 was associated with a step-change increase (β=14.59, 95% CI 4.30 to 24.89) in Finnish IMRs. Maternity grant universalisation in 1949 was associated with a step-change decrease (β=−14.35, 95% CI −20.94 to −7.76) in Finnish IMRs. Sensitivity analyses produced corresponding associations. Conclusions: While we observed changes in IMRs associated with Maternity Grant introduction and universalisation, these changes cannot be disentangled from the impact of the Second World War or other relevant policy developments on infant mortality. Consequently, the relationship between the Finnish Baby Box or comparable contemporary interventions and infant mortality remains unclear.

Item Type:Articles
Additional Information:RM, SVK, RD and PC acknowledge funding from the Medical Research Council (MC_UU_00022/2 & MC_ST_00022) and the Scottish Government Chief Scientist Office (SPHSU17). SVK also acknowledges funding from a NRS Senior Clinical Fellowship (SCAF/15/02). MG acknowledges funding from Invest Research Flagship and University of Turku, Finland: FLUX Consortium ’Family Formation in Flux - Causes, Consequences and Possible Futures, funded by the Strategic Research Council, Academy of Finland (DEMOGRAPHY 345130).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Craig, Professor Peter and Katikireddi, Professor Vittal and McCabe, Mr Ronan and Dundas, Professor Ruth
Authors: McCabe, R., Katikireddi, S. V., Dundas, R., Gissler, M., and Craig, P.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
Journal Name:Journal of Epidemiology and Community Health
Publisher:BMJ Publishing Group
ISSN:0143-005X
ISSN (Online):1470-2738
Published Online:27 October 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in Journal of Epidemiology and Community Health 77(1): 34-37
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
3048231Inequalities in healthAlastair LeylandMedical Research Council (MRC)MC_UU_00022/2HW - MRC/CSO Social and Public Health Sciences Unit
3048231Inequalities in healthAlastair LeylandOffice of the Chief Scientific Adviser (CSO)SPHSU17HW - MRC/CSO Social and Public Health Sciences Unit
172690Understanding the impacts of welfare policy on health: A novel data linkage studySrinivasa KatikireddiOffice of the Chief Scientific Adviser (CSO)SCAF/15/02HW - Public Health