We are a bioethicist, an adoptee rights advocate, and a pediatrician writing in response to op-eds in the Hartford Courant and the New Haven Register which support “baby boxes.”
These boxes are modern versions of foundling wheels from medieval times. They are metal boxes (usually installed in fire stations or hospitals) to give a mother the means to anonymously surrender an infant when they are unsure they can care for the infant themselves.
These boxes represent good intentions. However, they are an inadequate and ineffective policy response which introduces many ethical, legal, and medical problems. This is especially concerning given Connecticut’s SB 1310 seeking to legalize these devices.
The boxes are unregulated, meaning they have no governmental oversight. If their alarms fail, the infant can die. This is not just a hypothetical: a healthy baby died last month after being placed in an abandonment box and not having been found until days later.
Two other deaths are associated with boxes over the last year. One woman died of an overdose after placing her child into a box. Another baby was found dead in an abandonment box after a teen mom gave birth alone, outside of a hospital. These deaths point to the need for upstream intervention: we need policies that intervene earlier and are already proven (unlike abandonment boxes) to help the mothers. These include accessible contraception, properly funded maternal and child health programs, affordable childcare, and “supported (confidential) birth.”
We aren’t the only ones concerned about these boxes; 100 co-signers of our November open letter to U.S. Department of Health and Human Services agree that these devices are unsafe and inappropriate, similar to a statement by the Maryland chapter of the American College of Obstetricians and Gynecologists.
Misperceptions
There is a misperception that these mothers do not wish to be with their children – and only need a box to “drop them off.” However nearly all women who surrender a child want to keep them, yet feel they may have no other option. Relinquishment is associated with unrelenting grief – and finances are the main reason relinquishment in 80% of the cases within the U.S. Even enough money to cover the cost of a car seat can make the difference for some families so they could keep their child.
Abandonment boxes don’t reduce unsafe abandonments
Other countries with a longer history with boxes know that the boxes do not reduce the rates of unsafe abandonment. This is even true in Germany where they have nearly 100 boxes (installed not in response to a rise in abandonment, but by advocates wishing to offer an alternative to face-to-face surrender). This could mean that even though boxes might be used, those mothers would have otherwise surrendered in-person. This means boxes could prevent the mother from potentially receiving post-birth medical care, crisis counseling, and informed consent; proven care that helps mitigate mental and physical effects of child relinquishment.
Boxes curtail informed consent
There are even more problems with boxes. Training videos from the sole manufacturer (who holds a patent on the boxes) direct providers to never ask the mother if she would like to know about other options, such as temporary placement and kinship care.
Additionally, the manufacturer’s contract disallows providers from altering the signs around the boxes to, for instance, inform at-risk parents of family preservation funds or in-person help at nearby hospitals. The contracts also forbid providers from announcing the receipt of a child until a company representative visits the locations to run their own press conference. During that time, the mother (sometimes a younger girl or teen) is not offered medical care, crisis counseling, or reunification with her infant but instead is assured she did “the right thing.”
However, without knowing her options, how could she have the confidence her decision supported her values and wishes? These contract terms tie the hands of our first responders by withholding legal options from at-risk individuals.
The manufacturer’s signs also don’t mention how the law rapidly terminates parental rights – so mothers face an uphill and often impossible battle to reclaim their child.
Additionally, the signs on the boxes fail to inform mothers of legal risks if they do not follow the letter of the law. For example, if the infant is positive for a toxicity screen, or older than Connecticut’s 30-day limit, the mother is not immune from prosecution for child abuse or abandonment. The mother can also be prosecuted if the child shows any signs of harm. Since these mothers tend to give birth alone, outside a hospital, harms might be common. The boxes also fail to comply with the federal Indian Child Welfare Act which requires that tribal children stay within their communities. None of this information is shared on the box labels, placing mothers at legal risk.
There are also concerns that boxes facilitate human traffickers to offboard children of those they traffic.
The box manufacturer also integrates religion within their processes. For example, each abandonment box receives a blessing ceremony by a local Christian priest. Some may receive comfort from this. However, a religious affiliation for a public service risks alienating others, especially in a state like Connecticut which is home to many religions (and agnostics). State funds may be best reserved for neutral service providers.
A better option
While boxes provide the location to surrender, they do not provide a safe means to give birth.
Instead of leaning into the false narrative that these women are unworthy to raise their children, and don’t trust the system, and should therefore be given an anonymous means to surrender, we should work hard to repair trust.
We should also offer supported (or “confidential”) birth, which allows a mother to deliver in a hospital without revealing her identity. This approach has already proven to reduce unsafe abandonments and helps to keep families together. When recently implemented in Japan, nearly 40% of the women ended up keeping their children. This is likely because “supported birth” promotes informed consent, connects families to resources, and provides crisis counseling.
Women experiencing crisis pregnancies should be given resources, not encouragements to relinquish more children into the overburdened and problematic child welfare system.
Relinquishment is deeply painful and associated with lifelong trauma in both the mothers and the children. Other countries with a longer and traumatic history with abandonment boxes have foundling museums filled with thousands of handmade trinkets carefully created by parents who would pin them to their child’s clothes in their final moments together, perhaps in the hope of someday referencing them to reclaim their child.
We do not wish for a similar museum here in Connecticut. Children have a right to their identity and to live with their parents whenever it can be made safe and feasible. For these reasons (and in light of likely cuts to federal funding which may increase pregnancies-in-crisis) we urge policymakers to reject SB 1310 and instead provide more support to struggling families as discussed above, perhaps even through support for HB 6568 for confidential birth. Please join us in rejecting this SB 1310 through written testimony.
Lori Bruce is a bioethicist at Yale University. Patrice Martin is a child welfare advocate. Mark Mercurio MD is the Founding Director of the Yale Pediatric Ethics Program at Yale New Haven Children’s Hospital and former Chief of Neonatal-Perinatal Medicine at Yale. Views expressed are their own. They are members of the Connecticut Scholars Strategy Network.