Barriers to and enablers of kangaroo mother care

Kangaroo mother care (KMC) is defined as early, continuous, and prolonged skin-to-skin contact between the mother and preterm baby, exclusive breastfeeding, early discharge after hospital-initiated KMC with continuation at home, and adequate support and follow-up for mothers at home. 1) The World Health Organization issued recommendations for the care of preterm infants, including KMC, in 2015. 1) Globally, the Every Newborn Action Plan emphasizes KMC as an essential component of neonatal health initiatives.2) KMC has been identified as a useful and effective intervention for improving the outcomes of preterm infants.Compared with conventional care, KMC reduced mortality by 40%, sepsis by 65%, and hypothermia by 72%.3) It also reduced the incidence of severe illness and lower respiratory tract disease, hypoglycemia, and hospital readmissions.3) Moreover, KMC increased weight, length, head circumference, breastfeeding, maternal satisfaction, and maternal-infant attachment.3,4) It also led to beneficial neurodevelopmental, behavioral, social, cognitive, and emotional outcomes.5) However, limited national adoption and implementation of KMC was observed, and its global coverage remains low.6) In addition, there are significant variations in the onset and duration of skin-to-skin contact, holding position, essential equipment and supplies, discharge criteria, follow-up frequency, indicators and measurement, and medical personnel requirements.6) Various studies have emphasized the importance of understanding the barriers to and enablers of KMC at 3 levels, namely, with respect to healthcare providers, caregivers, and facilities, for its successful launch and implementation.[7][8][9] The International Network on KMC suggested proper training for clinicians, adherence to protocols, and the creation of a welcoming environment for families as key elements for effective implementation of KMC.7) In a multicountry study, including KMC in the preservice curriculum and service training and providing training to other healthcare administrators were facilitating factors for implementing KMC.8) In a qualitative study, the respondents highlighted the importance of ensuring availability of equipment, supplies, facilities, modified patient ward, and quality of services, as well as proper training as critical prerequisites.9) Bonding, social support, sufficient mother-infant bonding time, medical

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