The neonatal period, from birth to one month, is a critical phase during which nearly half of all under-five deaths globally occur. Preterm birth is a major contributor—accounting for approximately 35% of neonatal deaths. However, a large portion of deaths among preterm and low birthweight newborns are preventable. Research suggests that kangaroo mother care (KMC) can significantly reduce deaths in newborns as well as the risk of hypothermia and severe illness. Furthermore, it can lead to improved growth, breastfeeding practices and mother–child bonding.
KMC comprises several components, including skin-to-skin contact between a mother and her newborn (kangaroo position), exclusive breastfeeding (kangaroo nutrition) and early discharge from hospital (kangaroo discharge). A supportive environment is crucial for these three pillars to achieve the intended results.
Even though it is a simple and low-cost intervention, adopting and scaling up KMC depends on the strength and resilience of health systems. A recent study conducted by Chan et al. systematically reviewed the barriers and enablers of KMC within a health system, where health facilities and health care workers (HCWs) were the two prominent implementation agents. The following themes emerged from their analysis:
- Buy-in: acceptance of KMC and its benefits
- Social support and empowerment: encouragement in performing KMC
- Time: time to train and implement KMC
- Medical concerns: health status of mother or newborn
- Access: availability of training and related resources
- Cultural norms: sociocultural factors of newborn care and norms of the facility
The researchers also identified key factors related to health systems that both supported or limited the implementation of KMC, as listed below.
Social support and empowerment
The researchers cited interest as critical to scale any health care intervention. However, HCWs often struggled to implement KMC due to lack of support from parents. For instance, some parents were not willing to help transfer the newborn in and out of the incubator to initiate KMC. This was a barrier for nurses with already limited capacity.
If the management of the facility expressed that newborn care using KMC was not a priority, it inhibited the uptake of KMC. Support from leadership is key for the adoption of KMC by health care professionals and parents. Unfortunately, nurses and other members of the health care workforce often faced challenges negotiating more resources and space for implementing KMC.
Access to training
In the case of HCWs, lack of training in KMC led to conflicting information about time and duration of skin-to-skin contact even in the same facility. For health facilities, having inadequate ambulatory services was a barrier to access follow-up care. Further, crowding or restricting visitation rules due to shortage of space and staff can slow down the process of initiating KMC.
Clear and consistent communication
Transparent two-way communication channels are a critical enabler for successful implementation of KMC, especially between HCWs and facilities. Coordination on guidelines amidst all health care workers in the value chain of newborn care and between different facilities can assist in strengthening continuity of care for mothers, when transferring hospitals.
According to Chan and colleagues, it is critical to establish KMC protocols at the facility-level. This would call for checklists to ensure compliance and continuity for the mother and her child. At the regional level, training for HCWs by the government can act as catalysts to scale-up the adoption of KMC. Mali serves as a best-practice example where two tiers of involvement were facilitated. Firstly, there were “refresher sessions” on KMC in facilities and development of strong referral links between district hospitals and community health centers. Secondly, success stories were shared for advocacy at different levels. At country level, commitments from the Ministry of Health or other relevant bodies will help create a national momentum towards KMC. Increased communication among policymakers, HCWs and other stakeholders is needed to improve the implementation process.
Understanding how best to support KMC for women and newborns at different levels within the health system will help countries to address critical gaps, so as to facilitate the adoption and scale-up of KMC.