Kangaroo mother care: a transformative innovation in health care  

Elizabeth Franklin Midwife advisor has represented ICM as a member of the WHO Strategic and Technical Advisory Group of Experts (STAGE) on Kangaroo Mother Care (KMC).  

In May 2023 the World Health Organization (WHO) released the updated Global Position Paper and Implementation Strategy for Kangaroo Mother Care (KMC). ICM has collaborated in this process and continues to collaborate on the update of the KMC practice guidelines. 

KMC is a transformative innovation in the care of preterm or low birthweight (LBW) infants and has been shown to reduce the risk of neonatal mortality by 40%.  KMC involves continuous and prolonged skin-to-skin contact (as many hours per day as possible), with support for exclusive breastfeeding and feeding with expressed breastmilk, timely discharge from the neonatal intensive care unit to a lower level of care or home with instructions for skin-to-skin contact, close follow-up and monitoring.   

KMC was first introduced in Colombia in 1978 to address the scarcity of incubators, high rates of newborn infections and a high incidence of newborns being abandoned at the hospital by their parents. In the ensuing years, continued research has shown that KMC is a critical life-saving intervention for preterm infants and United Nations organisations and other stakeholders have spearheaded many efforts to accelerate the uptake of KMC.  

Despite the long-standing evidence on the positive impact of KMC on maternal and newborn health outcomes, the implementation of KMC has shown itself to be a persistent challenge with many barriers to mothers and newborns being care for together from birth.  

Upscaling and the translation of evidence into practice is an imperative, and even more so given that recent research shows that KMC can be started immediately after birth in any setting, unless the newborn is unable to breathe spontaneously after resuscitation, is in shock, or needs mechanical ventilation. The mounting evidence showing the incredible benefits of immediate KMC (iKMC) for small and preterm newborns has revealed lower infection rates, reduced hypothermia, better feeding and increased rates of survival. 

The updated Global Position Paper and Implementation Strategy (2023) focus on the togetherness of the mother and newborn, ensuring that the power to participate actively in their own and their newborn´s healthcare remains with the mother. Of equal importance is respect for the mothers’ autonomy, and support and inclusion of other family members.  

The updated KMC practice guidelines are designed to help health workers support mothers and families in practising Kangaroo Mother Care (KMC) in all health system levels and in the community after discharge. Included is guidance on antenatal education for families with risk of preterm birth, how to initiate skin-to-skin contact immediately after birth, early initiation of expression of breastmilk and breastfeeding and caring and monitoring of the mother and newborn practicing KMC. For health facility administrators and program managers there is guidance on system change for the implementation of KMC.  

Midwives are the first and closest contact women have when giving birth. Their role is crucial in applying KMC immediately after birth for newborns who can breathe spontaneously after resuscitation, whether the birth occurs within a hospital setting or in the case of unexpected premature birth in the home or primary care setting. Midwives are uniquely positioned to advocate for keeping mothers and newborns together and to challenge hospital routines that lead to periods of separation for the purpose of the midwife/ health care worker to perform their duties.  

The philosophy of non-separation inherent to KMC has the potential to have a significant impact on how midwives and allied healthcare workers care for all mothers and their newborns, regardless of type of birth, the newborns gestational age or birth weight. Fundamental change in the way neonatal and postnatal care is provided is needed at all levels of health care, requiring healthcare workers and administrators to reflect about existing routines and how they may result in separation of mothers and their newborns. If our focus is the health, well-being, and optimal emotional and physical outcomes for both the mother and newborn, with the support of their family, caring for mothers and their newborns together, without any periods of separation, is a priority which requires collaboration between administrators, midwives and allied healthcare workers such as neonatal nurses, obstetricians and pediatricians. 

The research makes it clear that KMC is relevant and important and should be implemented globally, bridging economic and north/ south differences- across low-/middle- and high-income countries. The vision is healthcare provision where mothers, infants and families form an inseparable centre around which maternal–newborn service delivery is organised.