In the late nineteen seventies, in Colombia, too many underweight newborn babies were dying in the hospitals. One doctor wondered what would happen if the newborn babies were constantly kept close to the mother as is the case with marsupials such as kangaroos.
The results of trying this skin-to-skin contact with the mother were so life-saving that today it is recommended worldwide by the WHO. The practice is low cost, suiting resource-poor settings.
Kangaroo mother care has been used in India since the late nineteen nineties. Training was conducted and the government provided support via guidelines. However, in practice, there is a lack of comprehensive and uniform guidelines regarding the full spectrum of kangaroo mother care.
Is this because obstetricians lack knowledge about the practice? Or does the practice come into conflict with their beliefs?
To investigate these questions, researchers from St. John’s Medical College, Bengaluru conducted a country-wide survey of Indian obstetricians.
They created a Google form questionnaire. The questionnaire was reviewed by six subject-matter experts to make it clearer and more relevant. The questionnaire inquired about how kangaroo mother care is used in the workplace, including hospital policies, infrastructure, and delivery practices.
The questions also covered age and gender as well as personal and professional background such as years of experience of the respondents, practice location, and clinical setting. Questions on beliefs and attitudes covered personal opinions, such as whether antenatal counselling should be routine and whether kangaroo mother care should be formally taught in medical curricula. There were questions to test awareness about scientific evidence, the latest WHO guidelines, and the health benefits of kangaroo mother care for premature or low-birth-weight infants.
The survey was shared via WhatsApp, Telegram, and email. The researchers used snowball sampling where participants forward the survey to networks. Thus, the survey reached over 40,000 obstetricians across India over a six-month period. The survey was completed by more than two hundred practicing obstetricians and trainees most of whom were female and under forty years old. About two-fifths of the respondents had less than five years of practice. About one fifth were senior doctors with twenty or more years of experience. Nearly three-fifths of the respondents were working in academic medical centres and two-fifths in private institutions. The participants came from a variety of healthcare settings across rural and urban areas in Tier-I, Tier-II, and Tier-III cities. Almost all respondents worked in facilities that delivered low-birth-weight babies.
To evaluate the responses, the researchers used both quantitative and qualitative methods. They assigned each response to one of four color-coded categories based on scientific accuracy and alignment with best practices.
To handle different question types fairly, the researchers used a statistical model. With the help of an algorithm, they divided the final scores for each domain – observations, beliefs, and science – into low, moderate, and high. They also ran tests to check whether age, years of experience, or practice location – academic or non-academic – influenced knowledge, beliefs, or clinical practices.
Text responses to open-ended questions were categorized to group common challenges, including gaps in knowledge, workplace barriers, and issues related to specific delivery scenarios such as Caesarean sections.
The researchers found that there was high general awareness. They also identified key misconceptions. While more than eighty percent of the obstetricians knew that kangaroo mother care reduces newborn mortality, specific scientific details were less well understood.
Nearly seventy percent of the respondents conflated the proper practice which involves prolonged skin-to-skin care and exclusive breastfeeding with brief, routine skin-to-skin contact given immediately at birth.
Obstetricians overwhelmingly supported the practice. Most of them strongly advocated introducing kangaroo mother care counselling during routine prenatal visits and felt that training should be explicitly integrated into undergraduate and postgraduate medical curricula for obstetrics, gynaecology, and paediatrics.
Moderate-to-high scores came from more than forty percent of the respondents in the Science section. The scores were slightly lower for the Observations section, and the Beliefs section.
Age and experience showed a statistically significant positive relationship with scientific knowledge and practical observations, with less than a two percent probability that these results occurred by chance. Older, more experienced doctors demonstrated a better grasp of kangaroo mother care.
Doctors practicing in academic institutions held significantly stronger evidence-based beliefs than those in non-academic settings, with a similar two percent likelihood of the finding being due to random variation.
About 35% of the respondents worked in facilities that lacked a dedicated ward for the practice, showing that operational and infrastructural constraints remain a major barrier even when doctor attitudes are positive.
The research reveals that, while Indian obstetricians hold very positive attitudes toward kangaroo mother care, training for early-career doctors alongside infrastructure improvements and clearer clinical guidelines are essential to fully integrate the practice into routine maternal and newborn care.
Maternal-Fetal Medicine 8 (3): 243-248 (2026)
DOI: 10.1097/FM9.0000000000000310
Reported by Gita Madhu
Freelance writer, Goa
The reports in this website are free to use for Indian media houses.
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Notes for young mothers:
The baby should be naked except for a diaper. However, if the weather is cold, the baby could have a warm headcover and warm booties. The baby is placed upright between the mother’s breasts. The baby’s head is turned to one side so the cheek rests against the mother’s upper chest.
To keep the airway open, the baby’s chin is tilted up, not tucked into the chest. The baby’s arms and legs are flexed into a frog-like posture, with knees bent and sitting on the mother’s chest.
To hold the baby firmly against the mother’s chest, the baby is secured in place with a hands-free support such as a sturdy binder or elastic wrap, tight enough to support the baby
so it doesn’t slide down, but loose enough to allow the baby to breathe freely.
The mother then closes her dress over the wrap or places a warm blanket over the baby and herself.
It is important to build a routine and track duration, sitting comfortably in a recline of about a 30 to 45-degree angle or walking around safely once secured.
Each session should be for about an hour as taking the baby in and out too frequently can tire them. The process can be done for many hours a day.
Besides the mother, others can also undertake to give the baby skin-to-skin care.
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