"Kangaroo Mother Care" programme in India helps premature triplets thrive
When Renuka Hadapad gave birth to triplets on 25 October 2016 in Koppal, India she saw little reason to celebrate. The babies were all girls. With two daughters already and a culture favouring male children, Renuka and her husband, Somappa, had hoped for a son.
Moreover, despite a seamless birth in the district hospital, the triplets were born each weighing less than 1500 grams – making it difficult for them to nurse, stay warm or gain weight. Though Somappa and Renuka were heartbroken, the triplets needed their support to survive.
WHO recommends “Kangaroo Mother Care” or continuous skin-to-skin contact between mothers and low-birth weight or premature babies, and exclusive breastfeeding, as soon as they are born.
Wrapped in mother’s warmth for long periods of time
At first, Renuka lacked motivation to bond with the tiny triplets; but hospital staff, who are part of a WHO research programme working to scale-up Kangaroo Mother Care in India, persuaded her to work at it.
"The care and support given by the staff of the district hospital made me feel like this is my second home," said Renuka, who took to caring for the triplets nonstop while her husband worked. After 28 days in the hospital, the babies – called Mahadevi, Shrushti and Lakshmi – were discharged.
Returning home however posed new challenges. Kangaroo Mother Care is only effective when done for long periods of time until a baby weighs over 2500 grams or no longer wants to stay confined in skin-to-skin contact. Finding the time for three babies is no simple feat.
A team of community health workers kept Renuka’s spirits up. And then, with her husband away, she turned to her sister, and moved into her home. Between them, the women gave each of the babies at least 9 hours of skin-to-skin care every day for more than four months.
On 7 March 2017, the triplets crossed the 2500 gram mark.
"Kangaroo Mother Care successfully helped in saving these very low birth weight triplets,” said Dr Dhan Reddy, Koppal district surgeon.
Initiating Kangaroo Mother Care promptly at birth
With funding from the Bill & Melinda Gates Foundation, WHO is working in three districts in India and 14 woredas in Ethiopia to scale-up Kangaroo Mother Care. Through health worker trainings, conducive policies and improved infrastructure, WHO aims to ensure Kangaroo Mother Care is provided to at least 80% of low-birth weight babies in the district health facilities. After the first year of the programme, coverage has increased from nearly 0% to more than 40%.
"Success in scaling up Kangaroo Mother Care in Ethiopia and India means that we can apply the lessons worldwide," said Dr Rajiv Bahl, coordinator for research and development, WHO Department of Maternal, Newborn, Child and Adolescent Health.
In much of the world, Kangaroo Mother Care is only initiated 3–10 days after birth – meaning many deaths among preterm and low-birth weight babies have already occurred. WHO is also coordinating a multi-country research initiative in Ghana, India, Malawi, Nigeria and Tanzania to test the survival benefit of initiating Kangaroo Mother Care immediately after birth.
"I am pleased with this ongoing work of scaling up Kangaroo Mother Care," said Dr Henk Bekedam WHO Country Representative for India. "If immediate Kangaroo Mother Care is found to be effective in reducing deaths, it will benefit more families like Renuka and her triplets."
A first birthday celebration
For Renuka and family, 30 October 2017 was a day to remember. The Kopoal district hospital where the triplets were born hosted a birthday party with local partners — the Government of Karnataka, St John's National Academy of Health Sciences and Karnataka Health Promotion Trust — to celebrate their successful first year.
"Don’t discriminate against girl children. They are a gift," says Renuka, as she retold her journey of change throughout the year. Somappa, also joined his wife in acknowledging the support given by everyone to save and care for his daughters.
Today, Renuka is the district’s kangaroo mother care champion, and inspires other parents to not only adopt the technique but also to care for girl children.