After a BBC article highlighting the decades-old Finnish practice of providing moms-to-be with a sleep-safe box went viral in 2013, companies began popping up to take advantage of the interest.

Over the last year or so, local governments in New Jersey, Alabama, and Ohio have gotten on board with baby box distribution programs, driven in part by the hope of emulating the decline in infant mortality rates that followed the Finnish program’s introduction in 1938. Today, Finland has a rock-bottom rate of two deaths per 1,000 live births, among the lowest in the world.

Now, some skeptical experts are pointing out that the Finnish program has likely been successful because of the health care and support systems that have been part of the initiative there – not necessarily because of the box itself.

In order to get the Finnish baby box, which is filled with clothes, sheets, and other baby necessities, expectant mothers must attend prenatal checkups. Moms in the Nordic nation also benefit from universal health care, extended parental leave, and home visits with health professionals. And a 2011 poll suggests that only around 42 percent of Finnish women actually use their baby boxes as bassinets, further bolstering the argument that Finland's low infant mortality rate is the product of a robust health care system, not the baby boxes themselves.

In the U.S., on the other hand, parents receiving a Baby Box Co. box are required to complete an online video course about safe sleep before receiving a box. And of course, the American health care system and parental leave policies are significantly different from those in Finland.

The Baby Box Co. argues that its programs are about education, rather than the box itself.

“We have every reason to believe that arming parents more universally with vital information will have a positive impact on infant and maternal health in these states given the proven correlation between maternal education and improved infant health outcomes,” the company said in a statement.

Still, some health officials are raising concerns about the safety of the boxes, which are not regulated by the Consumer Product Safety Commission in the same way that cribs are.

“I don’t think that we can be gung-ho, let’s do baby boxes,” Dr. Rachel Moon, a University of Virginia pediatrician who chairs the American Academy of Pediatrics Task Force on SIDS, told USA TODAY. “Because the evidence just isn’t there.”

Some doctors are asking whether the box might provide less ventilation than a crib and whether it might be prone to getting hot or damaged when exposed to heat or water, USA TODAY reported this week.

The Baby Box Co. points out that it has voluntarily submitted to the government standards testing usually done for bassinets. “Child safety is the reason our company exists,” the firm said in a statement. “Our Baby Boxes have been extensively tested for water resistance, air flow, flammability, and durability as well as standard bassinet structural compliances.”

Advocates of the new baby box programs also defend the safety of the boxes. Dr. Kathryn McCans, a pediatrician and chair of a New Jersey board that helped launch the state’s program, said there was no evidence the boxes presented a safety risk and said using them is “equivalent to putting a baby in a basinet.” The program is an affordable way to reach families that might otherwise bed-share with their infants, a risk factor for SIDS, she said.

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Is Putting Babies in Boxes Really the Solution to Infant Mortality?