Separating Newborns from Mothers and Maternal Consent for Newborn Care and the Association with Health Care Satisfaction, Use and Breastfeeding: Findings from a longitudinal survey in Kenya
Authors: Nakphong Michelle K. , Sacks Emma , Opot James , Sudhinaraset May 
Published: October 2020

Objectives

Disrespectful and poor treatment of newborns such as unnecessary separation from parents or failure to obtain parental consent for medical procedures occurs at health facilities across contexts, but little research has investigated the prevalence, risk factors, or associated outcomes. This study aimed to examine these practices and associations with health care satisfaction, use, and breastfeeding.

Design

Prospective cohort study

Setting

Health facilities in Nairobi and Kiambu counties in Kenya

Participants

Data were collected from women who delivered in health facilities between September 2019 and January 2020. The sample included 1,014 women surveyed at baseline and at least one follow-up at 2-4 or 10 weeks postpartum.

Primary and secondary outcome measures

1) Outcomes related to satisfaction with care and care utilization, 2) Continuation of post-discharge newborn care practices such as breastfeeding.

Results

17.6% of women reported being separated from their newborns at the facility after delivery, of whom 71.9% were separated over 10 minutes. 44.9% felt separation was unnecessary and 8.4% reported not knowing the reason for separation. 59.9% reported consent was not obtained for procedures on their newborn. Women separated from their newborn (>10 minutes) were 44% less likely to be exclusively breastfeeding at 2-4 weeks (aOR=0.56, 95%CI: 0.40, 0.76). Obtaining consent for newborn procedures corresponded with 2.7 times greater likelihood of satisfaction with care (aOR=2.71, 95%CI: 1.67, 4.41), 27% greater likelihood of postpartum visit attendance for self or newborn (aOR=1.27, 95%CI: 1.05, 4.41), and 33% greater likelihood of exclusive breastfeeding at 10 weeks (aOR=1.33, 95%CI: 1.10, 1.62).

Conclusions

Newborns, mothers, and families have a right to high quality, respectful care, including the ability to stay together, be informed and have proper consent for care. The implications of these practices on health outcomes a month or more after discharge illustrate the importance of a positive experience of postnatal care.

Article Summary

Strengths and Limitations of the Study

This is one of the first studies to include survey questions surrounding details of separation of newborns from mothers and maternal consent for care, including risk factors and reasons for separation.

This study used longitudinal data collected over 10 weeks following delivery to assess associations with outcomes, including postpartum visit attendance and breastfeeding.

Differences in participants who responded to the 2-4week and 10 week follow-up interviews may have introduced bias due to differences in composition, thus comparisons of associations with outcomes between these two points should be interpreted conservatively.

Findings may have limited generalizability to other contexts, as the study sample included women who gave birth at facilities in Nairobi and Kiambu counties.