In Nepal, the smallest of babies struggle to live. Born too soon and weighing less than 2500 gm, they are among the 80 percent of newborns who die within a week. Some die sooner.
Prematurity accounts for a third of newborn deaths in Nepal. In Nepal, newborn mortality, over the past 15 years, has declined at a slower pace than infant and child mortality overall, resulting in an increase in the proportion of neonatal mortality of all infant deaths. (read more here and here).
In many developing countries where I work, health facilities don’t have specialized neonatal units or even a reliable source of electricity to power a baby warmer. However, Kangaroo Mother Care (KMC) is a feasible innovation that can make all the difference for low birth weight babies even in settings without these specialized units. KMC is a globally recommended method to nurture premature newborns through skin-to-skin contact from mother, father, or other family members to the baby. Low-cost, high-impact, and evidence-based, KMC is a preferred intervention for decreasing newborn morbidity and mortality applicable in all countries, including high and low resource settings.
And yet, despite strong evidence of improved health outcomes among newborns receiving KMC, it is rarely completely integrated within health systems. This also holds true in Nepal. Though KMC is in the national policy for care of low birth weight babies and is taught to midwives and other health providers, it is not widely practiced or promoted. Nepal is trying to change that. Through increased attention and investment, Nepal’s Every Newborn Action Plan aims to ensure 35% of all premature newborns receive KMC by 2035, in an effort to reduce neonatal deaths to less than 11 per 1,000 live births in every province.
Studies show that for KMC to succeed, health providers and parents must be engaged and committed to its use. Challenges to KMC include need for time, social support, and health provider acceptance. In my many years as an OBGYN, I saw very few women practicing KMC. Women found the traditional swaddling cloth to be cumbersome, especially if she was left to fend for herself while her husband was out of the home working. While fathers were eager to care for their newborns, they would hesitate if asked to try KMC because they saw the traditional cloth used to wrap the baby as something only a woman would wear.
Our study by Jhpiego, supported by the Nepal Ministry of Health and Laerdal Global Health with Jhpiego, was designed to determine if a neutral-looking, easy-to-use wrap would change behavior and increase the use of KMC. We put the client at the center of the study and used a Laerdal designed an ergonomic wrap, which provided support and proved to be comfortable and easy to wear. Findings showed that mothers preferred the ergonomic wrap over the traditional cloth. What has been most gratifying about the study was that the ergonomic wrap appealed to a large number of dads who also tried it out. That was an unexpected surprise and a bonus!
As health providers, we have a moral and ethical responsibility to be able to save each and every newborn in the most feasible, pragmatic, and readily-available way. And yet, we are not really doing this as much as we should. Training health care providers to place the health benefits of KMC at the center of their counselling with mothers of low birth weight babies has been a key initiative in achieving the amazing results of continuing KMC in home.
However, just building the capacity of health care providers is not enough. We need to teach mothers to provide KMC and respectfully and meaningfully engage the whole family in this lifesaving care. Family members who believe KMC is good for the newborn are more motivated to practice KMC.
Looking ahead, I am hopeful for the day when the potential survival of every low birth weight baby born in a health facility is ensured and that they receive continuous KMC, even after discharged from the facility. Health care providers, researchers, and policy makers should place the realities of people’s everyday lives at the center of innovative services for them to work. Saving newborn lives should be our reality in health facilities and communities and not just a development agenda to be fulfilled.
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