Many low-resource regions of the world lack medical technology, including incubators. So why not turn parents into pseudo-incubators? When a baby is born prematurely, a good way to help them survive and thrive is to simply hold them close to a parent’s bare chest. No technology needed!
This is the essence of kangaroo care.
It is a method of holding the baby, wearing only a diaper, against a parent’s bare chest for skin-to-skin contact. In 1978, medical researchers Edgar Rey Sanabria and Héctor Martínez-Gómez introduced the technique to the maternity ward of San Juan de Dios Hospital in Bogota, Colombia. They hoped to find a way to reduce the country’s high death rate among premature infants – around 70% at the time.
The name evokes the way kangaroo mothers hold their offspring in their pouch.
Previously, these premature babies were placed in incubators – when available – to control the infants’ temperature, provide an optimal amount of oxygen and keep them away from loud noises and disturbing bright lights. But resource-poor countries have few incubators and babies were dying for lack of technology.
Colombian researchers found that parent-child hugs had similar benefits to incubators.
Kangaroo care works, researchers say, because infants pick up on the heartbeats and breathing rhythms of the parent’s body, helping to stabilize their own heartbeat and breathing. A parent’s body heat also helps to control the baby’s temperature.
The researchers published their findings in the 1983 Spanish-language journal Curso de Medicina Fetal. They presented their findings that year at a UNICEF conference: Babies placed in kangaroos sleep more and cry less than those in an incubator.
UNICEF, recognizing the potential of kangaroo care, began spreading information about the technique around the world.
Starting Kangaroo Parenting Care immediately after birth has the potential to save up to 150,000 infant lives each year, according to a World Health Organization study.
Since 1983, the practice has slowly spread around the world – for full-term, low-birth-weight babies as well as premature babies and in resource-rich and resource-poor countries alike. Fathers are also recruited – babies don’t care which parent the kangaroo is.
The latest country to encourage this practice is Côte d’Ivoire, where in 2019 the infant mortality rate for children under 12 months was 59 deaths per 1,000 births. In comparison, the average infant mortality rate in industrialized countries was 4 deaths per 1,000 births; the US rate was 6 deaths per 1,000 births.
In 2019, with the help of UNICEF, the Center Médical Hospitalier Universitaire de Treichville in Abidjan, the country’s largest city, opened its first kangaroo care service. In the ward, designated by the World Health Organization as a mother-child intensive care unit, the mother is available to the baby 24 hours a day. This intensive care unit is under the direction of pediatrician Dr Some Chantière . This is a pilot program to educate mothers and fathers in a technique little known in the country.
“There were a lot of deaths and a lack of knowledge about how to care for premature babies among the parents we let out, so we had to start that,” says Chantière. “We knew the program from its roots in Colombia. Prior to the program, 60-70% of all premature babies coming out of NICU boxes [or incubators] wants to die. Now we are saving over 90%.”
The new program is “of critical importance in reducing the mortality of premature babies and can influence hospitals from the public to the private sector in Côte d’Ivoire”, said Dr. Berthe Evelyne Lasme-Guillao, associate lecturer in pediatrics at Félix Houphouët University. -Boigny and head of the neonatology department at the University Hospital of Yopougon.
She thinks kangaroo care is a perfect fit for Ivory Coast due to the high infant mortality rate and lack of medical technology, including incubators. “Programs like this can be adapted anywhere with dedicated, trained people,” says Lasme-Guillao.
Dads are also trained in the technique, according to Mark Vincent, UNICEF representative in Côte d’Ivoire. “Fathers see the importance of babies being close to the mother’s body,” he says. “They realize they can do it too.”
In April, I was able to interview and photograph several couples who participated in the Ivorian pilot kangaroo care program at Treichville Hospital.
These are the stories of the moms and dads – and the babies – I’ve met.
“It was what we had to do and it saved my child’s life”
Not all kangaroo care starts in a hospital. Bru Adjen learned the program at home. His wife, Inzuwe Rose, gave birth to twins. The son weighed over 4 pounds, but the daughter weighed only 2.7 pounds, making her a good candidate for kangaroo care. Inzuwe Rose learned the technique in the hospital ward and took the knowledge home when her daughter had reached 4 pounds and could be released. She taught the technique to her husband.
He had never seen mothers, let alone fathers, use kangaroo care. “The start was strange for me, but over time I got used to it,” he says. “It was what we had to do and it saved my child’s life.”
“It creates a bond with my child and brings me closer to my wife”
Pastor Kubyes Abuwaka lives in the northern district of Yopogoon. His wife, Abuwa Kristien, gave birth to twins. The boy, born weighing 2.6 pounds, died in the incubator. He and his wife feared losing their daughter, who also weighed 2.7 pounds at birth.
But when mother and daughter were admitted to the hospital’s mother-and-child ward, their daughter quickly gained weight. By the time she reached 4 pounds, she was discharged to continue the program at home.
“I’ve seen the benefit, and I’ve been doing kangaroo care with my wife for a month and a half,” says Abuwaka. “We both do it. It creates a bond with my child and brings me closer to my wife.”
The hugging technique, he says, made him a better dad. “I want other fathers to participate in this. I know dads have time issues with work, but it’s important to get more involved in helping moms.”
“I started to participate… to give the love of a father to my children”
Ablodie Kouwasi, 35, gave birth to triplets five weeks prematurely. Each baby weighed less than 4 pounds. Shortly after birth, a child died.
The surviving babies entered two of the hospital’s few incubators long enough to stabilize their breathing and heart rates before being released to make room for other infants in need. But Kouwasi and her husband, Yappe Pako, could only bring their daughter, Ambo Mari Este, home. Their son, Ambo Crisostome, had contracted malaria and had to stay in hospital.
But without the support of the incubator, no child has thrived. Their baby girl lost weight at home, and although their son recovered from malaria, he did not gain weight.
Hospital staff suggested kangaroo care, and the mother and her two babies were admitted to the kangaroo care ward. The couple learned skin-to-skin care techniques and mum was available 24 hours a day.
It worked quickly. “My wife has been doing it for three weeks, and now my son is healthy and gaining weight. My daughter regained all the weight she had lost, and more,” says Pako. “I started to participate myself to give the love of a father to my children.”
“I love it because I can walk with them and have them with me”
I met Day Adeline, 40, when her babies were two weeks old. “My twins were born at 32 weeks, both weighing less than 1.3 kg (3 pounds),” she says. “Doctors say I can’t walk outside [and risk contracting an illness] to make sure they don’t get sick. I have to stay inside this room. But she loves walking with them. Holding one at a time, bare skin to bare skin, she circles the small room to pass the time and do her own exercise. the kangaroo experience was good. I love it because I can walk with them and have them with me, and it encourages growth. “When the babies reached 4 pounds, she was able to go home with them. Doctors say it usually takes 2 to 3 weeks of kangaroo care before a newborn can leave the ward.
“I see my children growing up”
Youal Emmnual, 15, is in 9th grade. Her twins, born at 32 weeks, both weighed less than 3 pounds. The mother and babies were all admitted to the kangaroo care ward, where Emmnual was happy to be taken under the wings of some older mothers. In addition to the education provided by hospital staff, some of the older mothers on the ward form a sort of impromptu village, passing on their knowledge and experiences to younger mothers. “There is a community in this neighborhood,” says Emmnual. “The other mothers are always there for me. I can watch my children grow. I’ll be here another week or two. I want to go home to continue school. I will continue to do kangaroo at home.”
“I want to be an advocate for the program in my community”
While Aluneumua Kalmel, 40, cares for her premature son in the kangaroo ward, her grandmother watches over her three other children at home. “In this community that we’ve formed, we do everything together,” she says of the service. “When one person wakes up, we all wake up to help each other. We eat together and make sure to look out for each other. We formed a village. We love it so much, even though we didn’t. If we didn’t need to be here, we would want to stay. It is safer and healthier for the child. If we were home alone, we wouldn’t have this knowledge. When I get out of here, I want to be an advocate for the program in my community. I saw how it saved children.
“I need to learn about it [kangaroo care] so that I can take care of my child”
Weighing just 2.7 pounds, the little girl had no name when I met her in April 2022 in Ivory Coast. His mother, Diara Subs Aisha, followed a common local practice among parents of postponing the appointment of premature babies until they were sure the infants would survive. On her first day in the hospital’s mother-infant kangaroo ward, Aisha waits for a lesson with her baby on her chest as the baby sticks out a tiny hand from under a blanket.
Andrew Caballero-Reynolds is a freelance photographer based in Abidjan, Ivory Coast. He was a photographer and editor at AFP. He worked as chief photographer for Reuters in Sri Lanka and as staff photographer for Gulf News in Dubai. He has also worked as an emergency logistics coordinator for Doctors Without Borders and as a National Forest Service firefighter in Oregon on a shock team.
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