Neonatal care practices need to be further explored
Authors: Harsha Kumar H N
Journal: The Lancet Global Health (2021)

Emma Sacks and colleagues (January, 2021),1Sacks E Mehrtash H Bohren M et al.The first 2 h after birth: prevalence and factors associated with neonatal care practices from a multicountry, facility-based, observational study.Lancet Glob Health. 2021; 9: e72-e80Summary Full Text Full Text PDF PubMed Scopus (14) Google Scholar whose study explores the care practices (including labour) in the first 2 h after birth, have worked on an important issue. The authors have rightly focused on low-cost but life-saving practices, such as breastfeeding within 30 min after birth and breastfeeding on demand.2WHOGuideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services. World Health Organization, Geneva, Switzerland2017https://www.who.int/nutrition/publications/guidelines/breastfeeding-facilities-maternity-newborn/en/Date accessed: November 19, 2020Google Scholar Some of the recommended care practices are not dependent on high-tech equipment, which makes the findings of the study relevant even in resource-poor settings. The findings of the study are based on observations in public health-care facilities, but the authors do not specify whether the services provided in these facilities were free or not. Public health-care facilities that provide free services would presumably be sought by many pregnant women, multiplying the workload of the health-care personnel. This higher workload could in turn increase the chance of neglect or of mistreatment during care.3Reader TW Gillespie A Patient neglect in healthcare institutions: a systematic review and conceptual model.BMC Health Serv Res. 2013; 13: 156Crossref PubMed Scopus (89) Google Scholar Private health-care facilities that are dependent on patients who pay for their services cannot afford to allow mistreatment or neglect during care. The authors have attributed incorrect care practices to insufficient training of health-care providers on recent guidelines. Although this insufficient training could be a contributing factor, it does not completely explain the persistence of incorrect care practices; for instance, an association between incorrect care practices and free or private health-care facilities could have been explored. If the data were available, the authors could also have explored the association between training of health-care providers and mistreatment, incorrect care practices, and neglect, rather than simply ascribing it as a reason. Breastfeeding is important and affects neonatal survival.4Smith ER Hurt L Chowdhury R et al.Delayed breastfeeding initiation and infant survival: a systematic review and meta-analysis.PLoS One. 2017; 12e0180722PubMed Google Scholar Unlike other care practices, such as keeping mother and baby together, or placing the baby in direct, skin-to-skin contact with the mother, breastfeeding is not entirely dependent on the health-care provider. Breastfeeding is affected by other factors, such as maternal education, maternal awareness about breastfeeding, and any instruction received by the prospective mother during the antenatal period. A multiparous mother might be more comfortable with breastfeeding than a nulliparous mother. As such, the authors should not have treated breastfeeding like any other care practice. It is not fair to put the onus for wrong or incorrect breastfeeding practices entirely on the health-care providers. The findings of the study also suggest that low maternal age has the higher association with maternal and neonatal mistreatment, but the reasons for this association are not clear from the study. Table 4 of the original article1Sacks E Mehrtash H Bohren M et al.The first 2 h after birth: prevalence and factors associated with neonatal care practices from a multicountry, facility-based, observational study.Lancet Glob Health. 2021; 9: e72-e80Summary Full Text Full Text PDF PubMed Scopus (14) Google Scholar shows that the association between mothers with no formal education and maternal and neonatal mistreatment or neglect is stronger than for mothers with some education. The authors have not explored this association, and the reasons for it are not clear; neither have they explored the influence of financial independence of the pregnant mothers, which plays an important role in the empowerment of women, on the occurrence of non-recommended care practices. Financially independent pregnant mothers could afford care in a private health-care facility, and would be less vulnerable to maternal and neonatal mistreatment. Education improves opportunities to earn a livelihood;5Committee on Improving the Health, Safety, and Well-Being of Young Adults, Board on Children, Youth, and Families, Institute of Medicine, National Research CouncilInvesting in the health and well-being of young adults. National Academies Press, Washington DC2015Google Scholar therefore, maternal education could serve as a proxy indicator for financial independence. Multivariate analysis has been carried out on the data. The authors could have provided information about colinearity. As pointed out, a pregnant mother who is not educated is less likely to be employed or earning money, which makes her more likely to seek free services in public health-care facilities. Some variables might not be truly independent, suggesting that colinearity might be possible in such circumstances. I declare no competing interests. The first 2 h after birth: prevalence and factors associated with neonatal care practices from a multicountry, facility-based, observational studyA high proportion of neonates did not receive recommended care practices, and some received practices that might constitute mistreatment. Further research is needed on understanding and measuring mistreatment to improve care, including respectful care, for mothers and neonates. Full-Text PDF Open AccessNeonatal care practices need to be further explored – Authors' replyThe field of experience of care for (including mistreatment of) neonates is relatively new. Our Article1 exploring neonatal care practices in a multicountry observational study provides a preliminary examination of occurrences and sets the stage for additional research that is crucial to this agenda. We thank Harsha Kumar H N for his keen interest in this topic and for raising important questions, especially about the type of facilities providing immediate postnatal care to neonates globally. Full-Text PDF Open Access