Scotland’s Baby Box Scheme: a mixed-methods public health evaluation

McCabe, Ronan (2022) Scotland’s Baby Box Scheme: a mixed-methods public health evaluation. PhD thesis, University of Glasgow.

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Scotland’s Baby Box Scheme (SBBS) was introduced by the Scottish Government on the 15th of August 2017 and made available to all parents in Scotland. The scheme is universal, unconditional, and non-commercial, and is modelled on the Finnish Baby Box. SBBS can be understood as a non-monetary transfer. Despite potential implications for infant and maternal health, the scheme’s public health impact has not been evaluated. This thesis aimed to provide a mixed-methods public health evaluation of SBBS using three distinct approaches. In the first approach I used a theoretically derived framework to analyse the political discourse surrounding SBBS introduction. This discourse featured the claim that the Finnish Baby Box (a component of the wider Finnish Maternity Grant) reduced infant mortality. For the second approach I addressed this claim using natural experimental methods. Applying interrupted time series and synthetic control analyses to international life-table data, I found no clear indication that the Finnish Maternity Grant had any effect on infant mortality rates; estimates were challenged by outcome variability and potential history bias. In the third approach I evaluated the introduction of SBBS as a natural experiment, applying interrupted time series analysis to linked administrative health data. I estimated the impact of SBBS on a range of infant and maternal health outcomes. SBBS had potential beneficial effects on infant and maternal tobacco smoke exposure, with a possible narrowing of inequalities by area deprivation in the former. A beneficial association with exclusive breastfeeding was also observed in younger mothers. SBBS had no observed effect on infant and maternal hospital admissions or infant sleeping position. Strengths of this thesis include the use of robust causal methods and linked administrative data with near complete population coverage. Limitations include a lack of long-term outcome measures. While non-monetary transfers such as baby boxes may have other benefits, policy makers and healthcare bodies should not assume that they reduce infant mortality. Policy makers should also plan for quantitative outcome evaluation when feasible. Further research is needed to confirm the health impact of SBBS, understand whether this impact persists over time, and understand the causal mechanisms involved.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Subjects: R Medicine > RA Public aspects of medicine
Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO Unit
Supervisor's Name: Craig, Professor Peter and Dundas, Professor Ruth and Katikireddi, Professor Vittal
Date of Award: 2022
Depositing User: Theses Team
Unique ID: glathesis:2022-83142
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 23 Sep 2022 15:39
Last Modified: 23 Sep 2022 15:47
Thesis DOI: 10.5525/gla.thesis.83142

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