Kangaroo Mother Care (KMC) is one of the most promising ways to save preterm and low birth weight babies in high- and low-income settings alike. This form of care, initiated in hospital, involves teaching mothers and other caregivers how to keep newborns warm through continuous, 24 hours per day, skin-to-skin contact on the mother’s chest. KMC has been shown to prevent infections, promote breastfeeding, regulate the baby’s temperature, breathing, and brain activity, and encourages mother and baby bonding.
KMC - Helping Babies Survive and Thrive
There are several forms of skin-to-skin care and KMC. Evidence of programmatic feasibility and effectiveness of these approaches varies, and not all are suitable for each context. There is a large body of evidence showing that continuous KMC is an effective intervention for small and/or preterm babies initiated on an in-patient basis. In most cases KMC can be used in place of incubators, which are prohibitively expensive in developing countries. A recent comparison of studies in 15 developing countries found that KMC was more effective than incubator care, cutting newborn deaths by 51% for preterm babies who were stable.
An analysis based on these findings suggests that up to half a million newborns could be saved each year if properly conducted KMC was practiced everywhere.
KMC is endorsed by the World Health Organization and leading experts in newborn health, but country-level adoption and implementation has been limited to date. Countries have had different experiences and approaches to setting KMC policy; developing training materials, supervision schedules, and tools; implementing routine monitoring and evaluation systems; identifying key service indicators; and documenting KMC activities.
For more than a decade, a core group of KMC experts and advocates, particularly the Fundación Canguro in Bogota, Colombia, Save the Children’s Saving Newborn Lives program (SNL) and USAID’s Maternal and Child Health Integrated Program (MCHIP) have been working together with governments, development partners and health professionals to systematically introduce, adopt, and promote the scale up and expansion of effective facility-initiated KMC. SNL and MCHIP have engaged government and development partners to initiate KMC services in at least 134 facilities, with over 1300 health workers trained across 20 countries.
In 2012, MCHIP and Saving Newborn Lives conducted a review of the introduction and expansion of KMC services in four African countries: Malawi, Mali, Rwanda, and Uganda. The multi-country review offers a snapshot of facility-based KMC activities and offers the opportunity for other countries and institutions to learn from the strengths and challenges of institutionalizing KMC. Results were shared at the International KMC Conference in India in November 2012. A similar review is currently underway in four Asian countries: India, Indonesia, Pakistan, and Bangladesh.
Countries in Latin America and the Caribbean region have also made progress in strengthening KMC activities. With support from the Latin American and Caribbean Neonatal Alliance, MCHIP and the USAID Health Care Improvement Project (HCI), teams have developed and implemented KMC programs in hospitals in the Dominican Republic, El Salvador, Guatemala, Honduras, and Nicaragua. While some countries have had programs for almost twenty years, other programs are just beginning. An active KMC community of practice across the region now includes an online component in Spanish, hosted on HCI’s maternal and child health knowledge portal.
The Last Mile - Getting Effective KMC to Scale
Despite its potential to save thousands of babies every year KMC has not had widespread scale up since it was first recognized as an effective practice 35 years ago. Certain countries have yet to endorse KMC as national policy; in other countries where KMC policies exist, KMC has been implemented and sustained only in a modest number of facilities, despite funding and technical support from donors and partners; and in some countries where KMC is being scaled up, there is considerable evidence and observation that there remains a large proportion of low birth weight babies not yet receiving quality KMC.
However, increased attention to preterm birth since 2012 has provided an opportunity to promote the use of effective KMC in developing countries. A group of major global health partners, led by the Bill & Melinda Gates Foundation, are leading an initiative to develop a KMC acceleration plan. This plan aims to define a path forward to accelerate the effective uptake of effective KMC. Specifically, this plan will:
- Identify barriers to the introduction and scale up of KMC in different contexts
- Develop a plan for accelerating KMC research, implementation, and policy/advocacy
- Define models for sustained KMC leadership and stakeholder engagement
As part of the KMC acceleration plan, a convening of key stakeholders took place in October 2013, bringing together experts from numerous disciplines including research, KMC implementation, policy/advocacy, and fields outside of global health. It gave stakeholders an opportunity to share best practices, challenge each other's thinking, and drive the KMC agenda forward.
The KMC acceleration convening in Istanbul was a key opportunity to build consensus for accelerated implementation of KMC. Read the KMC Consensus statement, published in the Lancet in November 2013.
A decade of KMC in Malawi
In Malawi, complications from preterm birth claim more than 6,500 lives each year. For more than a decade, the country has worked to establish KMC units in facilities, trained service providers, and revised protocols and policies to include KMC. Watch how one mother and her preterm baby benefited from this life-saving practice:
The KMC Toolkit
Key definitions and distinctions
Skin-to-Skin Care is recommended for all babies immediately after delivery to ensure warmth. It is also a recommended method when transferring sick newborns to a health facility.
Kangaroo Mother Care is the early, prolonged, and continuous skin-to-skin contact between the mother (or substitute) and her baby. KMC is initiated on an in-patient basis and continued after discharge, with support for positioning, feeding (ideally exclusive breastfeeding), and prevention and management of infections and breathing difficulties.
“Intermittent KMC” refers to recurrent but not continuous skin-to-skin contact between mother and baby, with the same support from health workers as continuous KMC. It is practiced when the caregiver is unable or unwilling to practice continuous KMC in a health facility, or if the baby is unstable. Although there may be other benefits, we do not have evidence indicating that this practice reduces mortality risk.
Post-Discharge KMC, also called ambulatory KMC, refers to KMC that continues after discharge from a health facility where KMC was initiated. Transition from in-patient to ambulatory KMC happens when the baby is feeding well, growing, and stable, and the mother demonstrates competency in caring for the baby on her own. The pair practices continuous KMC at home with an agreed-upon schedule for follow-up visits to monitor the health of the baby and the mother.
Community-initiated skin-to-skin care is the practice of continuous skin-to-skin care initiated and continued at home. This practice is also called “community KMC”, but it does not necessarily link to the full package of supportive care. It has been practiced where referral to a health facility is either challenging or not possible. To date, we do not have evidence that this practice reduces mortality risk.