Open the door and a silent alarm alerts emergency respondents that a child has been left inside.

It’s a sound that’s gone off eight times since the first baby drop-off box was installed in the country in 2016.

Fitted with temperature regulators and sensors, the hatches keep newborns safe until they are rescued – usually within three minutes.

There were none in America until Monica Kelsey, founder and CEO of Safe Haven Baby Boxes, fought to change people’s perceptions ‘about leaving a baby in a box’.

She wanted to give women in desperate situations the option to anonymously surrender their unwanted children ‘rather than abandon them in dumpsters’.

The drop-off boxes are a choice her biological mother – who abandoned her in the hospital hours after she was born – did not have.

Monica Kelsey set up the Safe Haven Baby Boxes after finding out why her biological mother abandoned her (Picture: Safe Haven Baby Boxes)

’I was 37 when I met my biological mom,’ explains Monica. ‘It was the best and worst day of my life.’

She discovered her birth mother Sandy was brutally raped and left to die on the side of the road when she was 17.

Six weeks later and after pressing charges against her attacker, she found out she was pregnant.  

Sandy’s family pulled her out of school and kept her hidden. Shortly after she vanished from hospital, police tracked her down and charged her with child abandonment

‘She went through hell, literal hell,’ says Monica, 47.

‘This is in the 70s where it didn’t matter the circumstances regarding being pregnant [if you weren’t married]. Everyone was looked at the same in a shamed way. The entire family was.’

The boxes are usually installed on the side of fire stations and hospitals (Picture: Safe Haven Baby Boxes)

A demonstration of how the Safe Haven Baby Boxes work (Picture: Safe Haven Baby Boxes)

Monica always knew she was adopted but says she struggled to come to terms with how she was brought into the world. She was still healing emotionally when she went on a trip to South Africa in 2013, where she visited the only church in Cape Town with a baby box scheme – a coincidence she calls ‘divine intervention’. 

‘I had to deal with the fact of feeling worthless and also unwanted. I could’ve wallowed in it and done nothing or taken what tragedy happened to my birth mom and made it better for someone else,’ says Monica, a mother-of-three.

She designed her own hatch on a napkin on the flight home and within three years the first one was installed at a fire department in her hometown Woodburn, Indiana. 

Now, there are 41 Safe Haven boxes in the mid-western state, as well as three in Ohio and one in Arkansas. 

Monica aims to install them in every US state within five to seven years – but not everyone thinks it’s a good idea. 

The hatches are fitted with temperature regulators and sensors to keep the newborns safe until they are rescued (Picture: Safe Haven Baby Box) 

Critics say baby boxes could encourage child abandonment, while fathers’ rights groups say they allow only one parent to make the decision. 

The UN has said the boxes violate the child’s right to know who their parents are and argues countries should offer more family planning and support to address the root causes of abandonments, such as poverty.

Though perceptions are changing in the US, some politicians have argued there is enough provision for women who want to give up their babies in secret. 

Child abandonment is illegal in the country but almost every state has some form of Safe Haven Law which decriminalises the act if the baby is passed into safe hands – typically only in the first couple of days of its life. 

But Monica says the boxes go one step further in offering 100% anonymity for mothers who don’t want the face-to-face interaction of having to hand their baby over.

She says stigma, fear of being recognised or fear of prosecution due to misunderstanding the Safe Haven Law means many babies – around 150 a year – are abandoned illegally instead. 

The Safe Haven law decriminalises child abandonment if the baby is passed into safe hands (Picture: Safe Haven Baby Boxes)

She argues boxes save the lives of unwanted children who would otherwise be dumped in trash cans. She believes proof of their success lies in their use, with the organisation receiving eight babies through the boxes since they were installed. 

Since then, no children have been illegally abandoned in Indiana compared to an average of two per year previously, says Monica. 

Although pro-choice organisations have accused her of trying to stop abortions, she insists this is ‘not the case’. Most women get in touch with her charity after their babies are born, ‘usually in a bathtub when the mother is in crisis and doesn’t know what to do’.

Many are young, vulnerable or victims of sexual abuse, though the reasons vary and ‘there is never any shame’.

The organisation runs a 24-hour hotline which has helped hundreds of women access pregnancy crisis centres and assisted in several adoption referrals.

It says its mission is to end illegal child abandonment by educating people about the Safe Haven Law.

The hotline has resulted in 81 legal surrenders and only suggests the boxes as a last resort. ‘It’s just an option to give moms an anonymity peace who don’t want to do an adoption plan or don’t want people to know they’re pregnant,’ says Monica.

‘I know there’s people out there saying these children deserve to know their parents, but as a child who was abandoned, I would rather have my life than know who my parents are.’ Legislation must be passed for the boxes to be permitted in individual states.

Former firefighter Monica believes their widespread use will not only reduce child abandonment, but stop unwanted babies being neglected or abused by parents who reluctantly choose to keep them.

Though she faces an uphill battle, Monica says the more the boxes are used, the more people see the impact they are having.

‘The first baby was a game changer, people see that a little girl’s life was saved because of anonymity. To this day no one knows her [mother’s] identity. ‘Now, people aren’t just understanding the process, they are understanding the why. 

‘The criticism does continue to come, I am not going to sugarcoat that. But my skin is pretty thick, I can handle it. ‘ Although they may feel like a new concept, baby boxes have actually been around for centuries.

The system was widespread in Europe during the Middle Ages, when foundling wheels were put on the side of hospitals and orphanages to allow parents to abandon their children secretly. However, over the past 20 years many countries have revived such schemes.

Austria and Germany were the first countries in Europe to reintroduce baby boxes in 2000. In Switzerland, where the boxes appeared a year later, recent data showed the number of abandoned dead babies has fallen, but the number of children being abandoned has not increased.

Experts say figures on how often they are used are difficult to interpret as it’s impossible to determine what the babies fate might have been otherwise. While some may have been abandoned, others might have been put up for adoption and others might have been kept.

Pastor Lee Jong-Rak set up a baby box scheme in Seoul, South Korea, in 2010 (Picture: AFP/ Getty)

Support for the concept was boosted after 2015 film The Drop Box explored the life of a heroic South Korean Pastor Lee Jong-Rak, who has received more than 1,500 babies after building a box outside his church in Seoul in 2010.

Many credit the Door of Hope charity in Johannesburg with starting the first modern version in 1999, when a hole was built in the wall of the Berea Baptist Mission Church in response to the alarming number of child abandonments.

Since then, 232 newborns have been received through the baby box, though almost 2,000 have come into the care of the organisation after being abandoned elsewhere or being surrendered by their mothers who chose to ring the doorbell instead.

Over 200 babies have been saved through the Door of Hope box in Johannesburg (Picture: Door of Hope)

A demonstration of a baby box in operation in Johannesburg, South Africa (Picture: Door of Hope)

Child abandonment remains endemic in the country, but advocates of the baby box believe the crisis would be even worse without them.

It is estimated that about 3,500 children are abandoned each year in South Africa – and that’s just the ones who are found.

Babies have been found dead and alive in longdrops, open fields, train tracks, bushes, in rubbish bins and in plastic bags on the side of the road.

Door of Hope operations Director Nadene Grabham says in some of the worst cases dogs have been found eating the babies, while this year one infant was discovered buried alive.

A poster advertising the Door of Hope hatch in South Africa (Picture: Door of Hope)

‘There are some people who are against baby boxes, they say it takes away the right to an identity and/or culture and knowing one’s ancestors,’ she explains. ‘Door of Hope believes the right to life outweighs the right to an identity or culture or knowing your ancestors.

‘Besides, we give the baby a name and surname and when they get adopted they get a family name and a culture.’

In 2012, when the UN expressed concern about the revival of baby boxes in Europe, it was reported there were around 200 across the continent.

Despite the controversy they’ve showed no signs of slowing. Just last month, an organisation in Belgium won a three-year legal battle to have them installed in the Evere region.

The number of baby boxes around the world are growing so much that in 2018, Japan hosted a Baby Box symposium where representatives from different countries spoke about their schemes and the challenges they faced trying to make them legal.

But the idea has never really gained hold in the UK. There is no Safe Haven Law and a Parliament petition campaigning for one in 2016 got fewer than 500 signatures.

Door of Hope Volunteer Nikki Marriner, from Newcastle, says the work the organisation does is incredible and undoubtedly saves lives not just of babies but also of mothers who might be tempted to seek out unsafe abortions, which are commonly advertised on walls and supermarkets in South Africa.

But she does not think a baby box scheme is necessary in the UK, where child abandonment is low.

Door of Hope operations Director Nadene Grabham (Picture: Door of Hope)

Nadene, on the other hand, believes even in countries with low rates of abandonment, the boxes would still save lives.

‘Some of the countries [with boxes] may have only had three or four babies through their baby box over the years, so abandonment is not common, but like they say, those were 3 or 4 lives saved.

‘So even if abandonment is not common in a country, it does not mean it doesn’t happen.

‘If a mother wants to abandon her baby, she is going to do so, whether the baby box is there or not.

‘I don’t think many mothers would willing leave their baby somewhere to die, but if they are so desperate and do not have a safe place to leave their baby and remain anonymous for whatever reason, what other option will they have? A baby box is a safe option.’

Read more: metro.co.uk