Neonatal care practices need to be further explored – Authors' reply
Authors: Emma Sacks, Hedieh Mehrtash, Mamadou Dioulde Balde, Theresa Azonima Irinyenikan, Kwame Adu-Bonsaffoh, Thae Maung Maung, Özge Tunçalp
Journal: The Lancet Global Health (2021)

The field of experience of care for (including mistreatment of) neonates is relatively new. Our 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 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. The facilities included in this study were public and provided care that was either free of charge or covered by national health insurance. Although the type of mistreatment can vary by type of facility, there is evidence that mistreatment can occur at both public and private facilities.2Sharma G Penn-Kekana L Halder K Filippi V An investigation into mistreatment of women during labour and childbirth in maternity care facilities in Uttar Pradesh, India: a mixed methods study.Reprod Health. 2019; 16: 7Crossref PubMed Scopus (38) Google Scholar Even in facilities that provide free health-care, families might be required to make informal payments.3Landrian A Philips BS Singhal S Mishra S Kajal F Sudhinaraset M Do you need to pay for quality care? Associations between bribes and out-of-pocket expenditures on quality of care during childbirth in India.Health Policy Plan. 2020; 35: 600-608Crossref PubMed Scopus (5) Google Scholar In some instances, families who demand accountability receive better care, but cases in which families are retaliated against or have feared retribution have also been documented.4Kabia E Mbau R Oyando R et al."We are called the et cetera": experiences of the poor with health financing reforms that target them in Kenya.Int J Equity Health. 2019; 18: 98Crossref PubMed Scopus (15) Google Scholar Therefore, it is important to apply standards for quality of care5WHOStandards of care for quality maternal and newborn care.https://www.who.int/docs/default-source/mca-documents/advisory-groups/quality-of-care/standards-for-improving-quality-of-maternal-and-newborn-care-in-health-facilities.pdfDate: 2016Date accessed: February 5, 2021Google Scholar at every facility providing maternal and neonate care, and to have patients and providers work together to achieve this goal. Mistreatment is probably due to a multitude of drivers, including the conditions and constraints of health-care systems.6Sen G Reddy B Iyer A Beyond measurement: the drivers of disrespect and abuse in obstetric care.Reprod Health Matters. 2018; 26: 6-18Crossref PubMed Scopus (56) Google Scholar Health-care systems should be accountable to patients and providers; they should provide enabling and empowering environments to support health-care workers, including proper equipment, training, supervision, and supportive policies. For example, to support breastfeeding, facility structures and policies should allow the participation of partners or of other family members, restrict the promotion of breast-milk substitutes, and encourage rooming-in of neonates with their families.7WHOTen steps to successful breastfeeding.https://www.who.int/activities/promoting-baby-friendly-hospitals/ten-steps-to-successful-breastfeedingDate accessed: February 5, 2021Google Scholar Investing in the physical and human resources of health-care systems is essential for both public and private facilities, and across levels of care. Building on the WHO study on mistreatment of women,8Bohren M Mehrtash H Fawole B et al.How women are treated during facility-based childbirth in four countries: a cross-sectional study with labour observations and community-based surveys.Lancet. 2019; 394: 1750-1763Summary Full Text Full Text PDF PubMed Scopus (151) Google Scholar we were able to use the available multicountry data to explore factors associated with neonatal care practices with a robust modelling approach.9 Kumar highlights additional factors that will need to be explored in future studies, such as the influence of the cost of services, types of facilities, training of providers, women's employment status, counselling on breastfeeding, and other family health-care preferences. We are hopeful that our paper promotes future research on defining and measuring neonatal care practices and on identifying strategies and policies to improve care. We 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 exploredEmma Sacks and colleagues (January, 2021),1 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.2 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. 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