Kangaroo Mother Care: natural, healing and cost-effective, so what’s next?

What could be more natural than a mother holding her newborn baby skin-to-skin close to her chest?

The practice, called Kangaroo Mother Care (KMC), is one of the most healing experiences that a mother can practice with her newborn baby. This simple act has the potential of saving hundreds of thousands of newborns every year at a very low cost. Yet, despite its proven effectiveness and instinctive nature, implementation of KMC has been limited to a few countries and is practiced only in facilities. In fact, so far, KMC is not widely adopted and practiced in communities where many births take place.

KMC is proven to be life-saving when it comes to babies who are born low birth weight or preterm. The effects of Kangaroo Mother Care on improving survival of low birth weight babies are well known and documented: KMC promotes breastfeeding and speeds up weight gain, controls the baby’s temperature and reduces the risk of infections and breathing difficulties – dramatically improving the odds of survival. 

This past week at the 9th International Kangaroo Mother Care Conference in Ahmedabad, India, over 400 participants from countries across the world gathered to discuss new research and share implementation experiences, with the hope that KMC will continue to be adopted and accepted at wide-scale worldwide, strengthening existing maternal and newborn health programs and saving more newborn lives.

The first day of the conference focused on reviewing evidence for the efficacy of this technique towards improving the survival and health of premature babies. The opening session by Dr. Vinod Paul, Professor and Head of the Department of Pediatrics at the All India Institute of Medical Sciences (AIIMS), set the stage for a 4-day discussion of Kangaroo Care as the ‘prime philosophy of care for preterm babies’. Dr. Paul’s overview of Born Too Soon: The Global Action Report on Preterm Birth followed recent worldwide attention to this issue, garnered as nations, parents and organizations around the world only days before marked the second annual World Prematurity Day

"Babies who are born premature are at greatest risk of dealth" said Dr. Paul. "Data from the recent Born Too Soon reports reminds us we have a major global challenges to address." More than one in 10 newborns are born preterm, and over 1 million babies die from complications of prematurity each year.

The conference gathered participants from over 30 countries across Africa, Asia, the Americas and Europe, including medical professionals, program managers, Ministry of Health officials as well as nursing and midwifery students. During the first day of the conference, speakers shared evidence of the lasting benefits of practicing KMC on the development and growth of preterm babies, looking at neurodevelopment milestones as key indicators of success.

"Early care profoundly influences brain development" concluded Dr. Nils Bergman, pediatrician at the University of Cape Town in South Africa. The sensory input experienced by babies in the KMC position, particularly through smell and skin-to-skin contact, have direct links to the emotional and social functions of the brain, improving neural networks and strengthening emotional and social intelligence in preterm babies.

There is a critical window of opportunity for neural connections, and for babies that are born too soon; KMC seems to provide the necessary experiential and sensory input to help strengthen these brain connections. A recent study by Cyril Schneider and colleagues from Quebec’s Universite Laval, provides evidence that these effects are indeed long lasting. Researchers looked at adolescents who had been born very preterm, and determined that those who benefited from KMC had better brain functioning in adolescence than premature babies placed in incubators, when compared to adolescents born at term. Coined as KMC’s Butterfly Effect, this evidence concludes that even the smallest changes brought on by KMC is preterm babies result in substantial improved brain function over time.

"This kind of information provides us with additional good ammunition to continue advocating for the implementation of KMC programs" said Dr. Hanifah Sengendo, program manager for Save the Children’s Saving Newborn Lives program in Uganda. As countries across the world continue to make progress in integrating and expanding KMC programs, and dozens of others prepare for implementation, such data complements the robust evidence available showing that KMC is extremely effective at saving the lives of small babies.

Save the Children’s Saving Newborn Lives program (SNL) and USAID’s flagship Maternal and Child Health Integrated Program (MCHIP) were a strong voice sharing implementation lessons from countries in Latin America and Africa at this biennial international conference. SNL joined MCHIP in hosting panel sessions demonstrating the effectiveness of a regional network in Latin America for improving KM adoption and shared results from an in-depth evaluation looking at tracking implementation in 4 African countries.

In Latin America and the Caribbean, a regional KMC network has spurred momentum in several countries, including the Dominican Republic, Paraguay, El Salvador, and Nicaragua. Supported by the Latin American and Caribbean Neonatal Alliance, of which both SNL and MCHIP are founding members, this regional KMC network has coordinated regional trainings, provided technical assistance, established an online community of practice to discuss linkages and learnings, as well as agreed to common indicators to measure progress across the region. 

Dr. Goldy Mazia from MCHIP and Bertha Pooley from Save the Children represent Latin America and the Caribbean Neonatal Alliance. 

African countries have also made progress in the implementation of KMC programs. Results from a multi-country evaluation of progress were presented at the height of the conference, in a dynamic panel including speakers from Uganda, Malawi and Rwanda. Although the 4 countries evaluated (Mali being the fourth, but unable to participate in the conference) have taken different appraoched to setting KMC policy and service guidelines, developing clinical training materials, and documenting implementation of KMC services, they all demonstrate that expansion of quality KMC in facilities is possible, and that progress is happening. Speakers commented on the strengths and barriers for sustainable implementation, and presented findings from an in-depth analysis coordinated by Anne-Marie Bergh from South Africa’s Medical Research Council (MRC) with strong support from all country Ministries of Health. 

Experts agree: we must do more to encourage mothers and caregivers, medical professionals, governments and program managers to adopt and expand Kangaroo Mother Care, to ensure many more babies have a healthy start to a full life. 

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