This story originally appeared on Stateline.

The pitch feels noble, visceral: Prevent newborns from being discarded in dumpsters, and do it in a way that shields the mother and protects her anonymity while safeguarding the baby’s health and future.

In a growing number of states, the answer to the rare occurrence of illegal infant abandonment is a baby drop-off box. It’s an infant incubator secured behind a small door in the exterior wall of a public facility such as a hospital or fire station. A person can walk up to the box, open the door, place an infant into the bassinet inside, close the door and walk away.

The bassinet is temperature controlled, ventilated and equipped with alarms that alert emergency responders, who arrive within minutes. The baby is placed into foster care or for adoption, and the parent is not prosecuted for abandonment.

Installing baby boxes has become increasingly popular as lawmakers, including those in states with the most restrictive abortion laws, look for ways to show support for pregnant women and new parents.

But a growing chorus of experts and adoption advocates argue that however well-intended, baby boxes are a gimmick, unsupported by scientific research, that won’t address the real problems facing parents and newborns. They also worry about the inability to establish informed consent or medical histories.

“I think what legislators hear is, ‘If you don’t do this, there will be dead babies abandoned on the streets of your city,’” said Gregory Luce, a Minnesota attorney and founder of the Adoptee Rights Law Center who has been a vocal opponent of baby boxes.

“They don’t want that to happen on their watch, whether they’re Republicans or Democrats, so they pass it without further investment in prenatal or postnatal services for women, or mental health services, or services for women in crisis.”

At least 19 states now allow the use of newborn drop-off boxes, though more than half the incubators that have been installed are in Indiana, the home state of the company that makes them. Lawmakers have introduced bills this legislative session in 15 more states: Colorado, Georgia, Idaho, Indiana, Maryland, Michigan, Minnesota, Nebraska, New Hampshire, New Jersey, New Mexico, South Carolina, Tennessee, Washington and Wyoming.

Baby boxes have proven surprisingly bipartisan, despite their ties to the conservative anti-abortion movement. And they’re media-friendly: The surrender of infants into the boxes regularly makes the local news, and cities often hold ribbon-cutting-style ceremonies when a box is installed.

“We know [baby boxes] work because we’ve seen it,” said Tennessee Republican state Rep. Ed Butler, the sponsor of a baby box bill in his state. “My objective is to save a baby’s life, end of discussion.”

But Lori Bruce, a bioethicist at Yale School of Medicine, described baby boxes as a poor solution to infant abandonment, “because we know things like prenatal care are more integral to the health of an infant, as well as to the birthing parent.”

She would like to see states consider allowing women to labor and deliver at hospitals anonymously — as Jane Does — so they can relinquish their newborns in a safer setting.

Babies in boxes

The overwhelming majority of the more than 200 active baby boxes currently in place in at least 15 states are provided by one company: a nonprofit called Safe Haven Baby Boxes Inc.

Monica Kelsey is the founder. An adoptee herself, she is closely aligned with the anti-abortion rights movement and travels around the country, speaking at news conferences when infants are surrendered, holding “blessing” ceremonies to dedicate new boxes, and spreading baby box awareness to more than 800,000 followers on her popular TikTok account.

“I do think women and men are scared when they get into a moment of crisis and they freak out, not knowing what to do,” she told Stateline. “We’re out there in the public every single day, educating and bringing awareness that they have options, so when they do have a crisis, they will come to us.”

The nonprofit says 42 babies have been surrendered to its baby boxes since the first one opened in Indiana in 2016. There’s no national database of infant abandonments — legal or illegal — and many states don’t track those numbers.

The National Safe Haven Alliance, another nonprofit dedicated to infant abandonment prevention, estimates that more than 4,500 babies have been relinquished under safe haven laws since 1999. Those laws allow parents to surrender newborns to safe spaces such as hospitals and fire stations, placing the infant in a recipient’s arms, without risk of prosecution for abandonment. The group estimates that another 1,610 babies were illegally abandoned; fewer than half of those were found alive.

States began passing so-called safe haven laws more than two decades ago. Texas passed the first safe haven law in 1999, and soon every state had its own version. For some in the anti-abortion rights movement, safe haven laws — and by extension baby boxes — are an answer to critics who say restricting abortion rights will lead to more unwanted babies. U.S. Supreme Court Justices Amy Coney Barrett and Samuel Alito both cited safe haven laws during the landmark Dobbs v. Jackson case that ended the constitutional right to abortion.

Michelle Oberman, a law professor at Santa Clara University in California who has studied state safe haven policies, said states have different rules for drop-off locations and how old a surrendered infant can be, and varying protections for parents when an infant tests positive for illegal substances. Some laws require surrendered infants to be placed into foster care, while others fast-track them into adoptions. Few, if any, require the kind of oversight that would ensure the infant surrenders are truly voluntary and not coerced, she said.

“It feels to me like such a limited and heartless response to say, ‘We don’t care that you’re unhoused, addicted or mentally ill — just drop off your baby and we’ll let you go on your way,’” Oberman said. She wants states to gather better data on newborns who are surrendered, including where and under what circumstances, and use that data to write bills that would support parents in crisis.

Safe haven laws aren’t tailored for the communities most likely to use them, nor designed for people who don’t feel comfortable walking into a hospital, Bruce said. People with low incomes and communities of color are disproportionately affected by the kinds of crises — housing instability, domestic violence, lack of access to treatment for mental illness or substance use — that might influence a person to surrender their infant.

A 2019 study from the University of Southern California’s Keck School of Medicine and Children’s Hospital Los Angeles looked at infants who had been safely surrendered in Los Angeles County and found the majority were surrendered in lower-income communities. More than half of the infants had medical issues requiring monitoring or specialized care.

Using taxpayer dollars

The initial cost of a baby box is about $20,000. That price includes the leasing of the box from Safe Haven Baby Boxes, which owns the patent and contracts with a manufacturer, as well as costs for installation, electrical and alarm system hookups, and staff training on how to use it. There’s also a $500 annual service fee, paid to Safe Haven Baby Boxes, to ensure the box continues working properly.

Safe Haven Baby Boxes are typically paid for through private donations and nonprofit organizations, though local municipalities may be on the hook for continuing annual maintenance and fees.

Most state baby box laws simply allow the boxes, but some legislators are pushing their states to spend taxpayer money to fund them.

In Tennessee, lawmakers this year introduced a bill that would require a “newborn safety device” such as a baby box to be installed at a safe haven location in each of the state’s 95 counties. As currently amended, the bill would create a $2 million grant program to help each county pay for leasing and installation — about $21,000 per box.

An average of six or seven newborns are surrendered each year under Tennessee’s safe haven law, according to Tennessee’s Department of Children Services. The state currently has three baby boxes, one of which has received a surrendered infant; the rest have gone to hospitals, fire stations or other safe havens.

“I support face-to-face handoff because that’s likely the best option,” said Butler, the Tennessee lawmaker who sponsored the bill. “But what I don’t want to happen is that because the mother is in a bad place, she’s leaving her baby in a dumpster or behind a shopping center somewhere.

“I believe Safe Haven Baby Boxes provide an anonymous, private moment for that mother to surrender that child with nobody asking why they’re doing it, with no shame,” he said.

Lawmakers in Nebraska sponsored a bill that would set aside $15,000 in grants to help safe haven locations install baby boxes, plus another $50,000 for the next fiscal year and $10,000 per year after that for a public awareness campaign about the state’s safe haven law.

Wyoming lawmakers filed a bill that would allocate $300,000 for a one-year grant program to help safe havens such as police and fire departments purchase and manage baby boxes.

And a bill in New Jersey sponsored by a Democrat would require all newly constructed police stations, fire stations and hospitals to provide a baby box.

Marley Greiner, a co-founder of the adoptee rights organization Bastard Nation who also runs a site dedicated to tracking and opposing baby box legislation, argues that baby boxes can create a parallel child welfare system that doesn’t allow for informed consent for the birth parents nor a full record of identifying information and social and medical histories for the newborn.

In contrast, Greiner said, when a parent surrenders an infant to a worker at a hospital or fire station, there is direct interaction with a professional who can ask for medical information about the infant and can assess whether the parent needs medical care or other supports.

A parallel system

With 115 baby boxes, Indiana accounts for more than half of the nation’s 205 baby boxes. The home base for Safe Haven Baby Boxes Inc., is Woodburn, Indiana, where Kelsey’s husband, Joseph Kelsey, the company’s chief operating officer, is the town mayor.

In 2022, Indiana legislators approved $1 million to help communities install and promote Safe Haven Baby Boxes.

In April 2023, they passed another law that, among other things, allows baby box operators to place surrendered babies directly with a private adoption agency, skipping state child protective services. Last August, officials at a fire station in Carmel, Indiana, placed a baby that had been surrendered in their baby box with an adoptive family within 12 hours. Officials said it cuts out a layer of bureaucracy and gets the baby to a family more quickly.

“This creates an avenue of off-the-record surrenders, a problematic issue that could obviously lead to corruption,” said Luce, the attorney with Adoptee Rights Law Center.

Even Kelsey is concerned about the intersection between private adoption agencies and her baby boxes. She cut ties recently with an Alabama nonprofit that had provided funding for the lease and installation of several baby boxes in that state, after learning the nonprofit also facilitates adoptions.

“Some of the adoption agencies might get ticked off at us, but we’re not here to supply babies for them,” Kelsey said. “We’re here to help moms.”

In New Mexico, lawmakers are scrambling to change the state’s safe haven law after learning officials there tried to find the parents of each of the four infants surrendered in New Mexico baby boxes, as directed by that law. State officials also noted that the Federal Indian Child Welfare Act requires the state to attempt to identify any infants with Indigenous heritage and return them to their tribes, a further challenge to baby boxes’ promise of anonymity.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: [email protected]. Follow Stateline on Facebook and Twitter.