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  • Original Article
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Introduction of community-based skin-to-skin care in rural Uttar Pradesh, India



Two-thirds of women globally give birth at home, yet little data are available on use of skin-to-skin care (STSC) in the community. We describe the acceptability of STSC in rural Uttar Pradesh, India, and measured maternal, newborn, and ambient temperature in the home in order to inform strategies for introduction of STSC in the community.

Study design:

Community-based workers in intervention clusters implemented a community mobilization and behavior change communication program that promoted birth preparedness and essential newborn care, including adoption of STSC, with pregnant mothers, their families, and key influential community members. Acceptance of STSC was assessed through in-depth interviews and focus groups, and temperature was measured during home visits on day of life 0 or 1.


Incidence of hypothermia (<36.5°C) was high in both low birth weight (LBW) and normal birth weight (NBW) infants (49.2%, (361/733) and 43% (418/971), respectively). Mean body temperature of newborns was lower (P<0.01) in ambient temperatures <20°C (35.9±1.4°C, n=225) compared to 20°C (36.5±0.9°C, n=1450). Among hypothermic newborns, 42% (331/787) of their mothers had a lower temperature (range −6.7 to 0.1°C, mean difference 0.4±1.2°C). Acceptance of STSC was nearly universal. No adverse events from STSC were reported. STSC was perceived to prevent newborn hypothermia, enhance mother's capability to protect her baby from evil spirits, and make the baby more content.


STSC was highly acceptable in rural India when introduced through appropriate cultural paradigms. STSC may be of benefit for all newborns and for many mothers as well. New approaches are needed for introduction of STSC in the community compared to the hospital.

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essential newborn care


Kangaroo Mother Care


community-based KMC


low birthweight


skin-to-skin care


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We are grateful to the families and community members in Shivgarh for their willing participation. Support for the study was provided by The Office of Health, Infectious Diseases and Nutrition, Global Health Bureau, United States Agency for International Development (USAID) under the terms of Award GHS-A-00-03-00019-00, Global Research Activity Cooperative Agreement; the USAID India (New Delhi) Mission; and the Saving Newborn Lives initiative of Save the Children-US, through a grant from the Bill & Melinda Gates Foundation. We extend special thanks to Massee Bateman, director of Maternal and Child Health at USAID, New Delhi, for many fruitful discussions regarding the intervention program, and to Anne Tinker, director of Saving Newborn Lives, Save the Children-US for her support.

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Correspondence to G L Darmstadt.

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Presented in part at the First International Congress on Kangaroo Mother Care, Rio de Janeiro, November 10, 2004; CORE Annual Meeting, West Point, New York, April 20, 2005; Global Health Council 32nd Annual Conference, Washington, DC, June 2, 2005; Global Forum for Health Research, Mumbai, India, September 13, 2005; and Countdown to 2015: Tracking Progress in Child Survival, London, UK, December 14, 2005.

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Darmstadt, G., Kumar, V., Yadav, R. et al. Introduction of community-based skin-to-skin care in rural Uttar Pradesh, India. J Perinatol 26, 597–604 (2006).

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