"We thought we were prepared, but we weren't, because the baby came two weeks early. We hadn't gotten a car seat yet because we were saving up for it. But babies don’t care if you don’t get paid ‘till Friday."
"I had no idea what I would need right when we got home – diapers, yes, but I had no idea how many or that I needed pads too."
In 2021, President Biden signed Executive Order 14508 to improve the customer experience of accessing and utilizing federal services and benefits during important life stages, including when families welcome a new child. To achieve that goal, an interagency team of designers and policy experts led by U.S. Digital Service, the Department of Health and Human Services (HHS), and other federal partners conducted four months of research to more deeply understand the pain points parents face and develop solutions. We looked closely at the challenges new parents face when they try to enroll in federally-funded benefits and programs designed to support the health and development, of families in the United States. Our team heard over and again about the need for physical goods and resources at the time of birth.
Becoming a new parent can be a joyous and wonderful experience. It can also be stressful. For many families, bringing a child into this world creates a lot of uncertainty and anxiety, and it’s understandable:
- Research has shown that the average out-of-pocket cost during the early years of having a child is $18,865.
- Childcare, supplies, and other necessities can cost between $20,000 to $50,000 during the first year after birth. Diapers alone account for the 4th highest monthly expenditure. To have an adequate supply of diapers will cost about 8% of a parent’s gross income.
- After the birth of a child, many new parents experience an average income decline between $14,850 to $16,610 per year, with single mothers seeing the largest decrease (decline of 36% of income) at the time of birth.
Co-Designing the Newborn Supply Kit with Families
Our research included a thorough landscape analysis of historic and existing efforts to support parents with key supplies during the early postpartum period. In Finland, new parents are presented with a “baby box” to ease some of these financial and parenting burdens, particularly in those vulnerable first few days and weeks after delivery. First developed in 1949, this idea has spread to over 91 countries worldwide and has been adopted in numerous communities and programs across the United States. A systematic review of these initiatives found that a baby box can provide important support to families during the vulnerable times of pregnancy and birth. Further, including health education and psychological support elements can expand the value of the baby box far beyond the box or items.
Building from this model, we conducted co-design research sessions with parents and community leaders to learn more about what should be included in the Kit to meet families’ immediate needs. “Co-designing” means creating a concept with, not for, the end user of that concept – treating mothers and families with respect and as equal partners in the design process. In these sessions, we gathered input directly from families on a few priority questions:
- What do caregivers and community leaders consider the most valuable supplies we could provide to families?
- How could these supplies be delivered in the most valuable way?
- What are the success criteria when it comes to implementation -- logistics, delivery, operations, and funding?
What we learned:
- The most valuable goods we could provide are ones that are not otherwise covered by federal programs, like Medicaid. These include items like diapers, wipes, and clothing essentials.
- The best time to receive these resources and supplies is in the first few days or within the first week after giving birth.
- The kits should include the essential items for families to get through at least the first month after birth.
- Supplies can be paired with educational resources to have sustainable impacts.
"When TANF families’ money runs out at the end of the month, the need for formula and diapers is constant."
- Community health worker
"It makes a difference in mom’s mental health to have these supplies."
Building on What’s Working Already
We also wanted to build upon what’s already working, and to better understand the existing programs in the United States that provide physical resources to new families at the time of birth. We spoke with twelve organizations currently implementing similar programs. The organizations differed by geography, population served, mission, and organizational structure – including non-profit, grassroots and private companies – but they also all shared many similarities. Nearly all of the organizations focus on serving underserved populations and those most in need of physical goods.
As we spoke to the organizations, we discussed the most essential items to include in a Kit, the ideal timing for Kit delivery, and operational and implementation aspects to distributing kits. A recurring theme across each of our conversations with these organizations was that these boxes make a real, meaningful difference in people’s lives, and are universally met with gratitude and positive testimonials. We also heard about the importance of forming partnerships with a wide variety of entities – including providers, hospitals, community-based organizations and state governmental leadership - to ensure success.
We gained valuable logistical insights that informed our partner selection and program design process. For example, we heard from most organizations that relying on donations to generate inventory often posed challenges in terms of quality control, reliability of supply, and program sustainability. We also heard about the importance of ensuring data privacy and security for the people receiving kits. Organizations and their partners shared best practices and insights about storage and distribution considerations, timing of delivery, assembly of the kits, working with trusted messengers such as community-based organizations to deliver the kits, and educating families on the supplies included. We also heard from nearly all of the organizations that funding limitations was the primary factor preventing further spreading and scaling their programs.
We want to thank each of the caregivers, community leaders, and organizations that took the time to speak with us and share their experiences, data, successes, and challenges they face in spreading and scaling this program, including:
- Baby2Baby who has distributed millions of critical items including diapers, clothing, and other essentials and to children in need across the country.
- Baby Box Co. who developed a product composed of essential baby items and distributed to mothers during the prenatal and postnatal stages through hospitals and attended evets, using the design of the box to promote safe sleep.
- Birth in Color RVA who is a birth, policy, and advocacy non-profit focused on raising awareness surrounding maternal health and reproductive justice.
- Boxes of Love who is a grassroot organization located in Oregon that provides babies and children entering foster care from local hospitals with a large box of new items to call their own after sometimes only having minimal items upon arrival.
- FinnBin Baby Box who developed a product based off the design and concept of the Finnish baby box coupled with the feeling of being an underprepared new parent, composed of all of the necessary items that new parents may need when bringing home a newborn to relieve those burdens.
- Jacobi Medical Center who serves families that fall below the poverty line with the assistance from Welcome Baby USA.
- Pip and Grow who strives to decrease infant mortality through promotion of infant safe sleep and increasing education to families’ around safe sleep.
- Room to Grow who supports parents and caregivers by working with social and health service providers to identify needs and distributing materials and social support resources to families post-delivery until the child turned 3 years old.
- Saving Mothers Giving Life which is a public private partnership with Every Mother Counts, Centers for Disease Control (CDC), and Merck Pharmaceuticals, who developed baby kits that included items for babies and their mothers that focused on primarily health and hygiene, as well as a list of the items and links to additional information and useful resources.
- Temple University who services mothers, and newborn children through their Sleep Awareness Family Education at Temple Program (SAFE-T) by distributing baby boxes and education to curb high risk behaviors associated with SIDs.
- Welcome Baby USA who serves women and families living below the poverty line who struggle to afford the most basic essentials on an ongoing basis.
- WestSide Baby who meets the basic needs of children to promote safety, security & healthy development by collecting and distributing baby essentials, including equipment’s throughout Western King County, Washington.
Launching our 2023 Pilots
HHS has launched a Newborn Supply Kit pilot under the Customer Experience EO portfolio of projects designed to support families having a new baby. Our initial pilots will be implemented as a public-private partnership between the Department of Health and Human Services and Baby2Baby, a 501(c)(3) non-profit organization that provides children with diapers, clothing, and other basic necessities. The Newborn Supply Kit is designed to be a package of supplies and educational resources delivered to new families during the immediate postpartum period, with the goal of supporting and promoting the well-being of newborns and their caregivers.
We have selected pilot sites in three states to start: Arkansas, Louisiana, and New Mexico. Each state was chosen with a few criteria in mind, including rates of maternal mortality, postpartum depression, and poverty—particularly in diverse communities—as well as high social vulnerability index rankings. In each state, we are partnering with both a hospital and community-based organizations to distribute the Newborn Supply Kit.
The initial pilot Kits will include:
- Supplies for diapering, feeding, clothing, hygiene, and postpartum.
- Infant clothing/supplies (blankets, swaddles, sleeper pajamas, socks, onesies, burp cloths, infant carrier)
- Diapering & hygiene (diaper, wipes, diaper rash cream, baby nail clippers, 2-in-1 shampoo/baby wash, petroleum jelly, thermometer, nasal aspirator)
- Postpartum supplies for mom (maternity pads, perineal cold packs, witch hazel pads, cooling spray, breastfeeding supplies)
- In addition to physical goods, the Kit will also include Federal resources and education collected from federal partners. There will be a link located on the one-pager that is included in the Kit to direct families to www.hhs.gov/newbaby, a Federal website housing additional Federal resources such as information on emotional and physical recovery for moms, developmental support for new babies, and potential benefits and programs they may be eligible for.
Moving Beyond the Pilots
After our initial pilots, we plan to collect and publish evaluation data on customer satisfaction with the Kit and its contents, as well as the impact of receiving a Kit on a new mother’s mental health and stress levels. The evaluation will also assess how receipt of a Kit impacts trust in government and institutions delivering the Kits to families. Lastly, we plan to use family feedback to continuously improve the Kit and how we deliver it to families over the course of our partnership with Baby2Baby – and hope to scale this program to include more partners and geographies in the coming years.