Table 2 Matrix of enablers and barriers to KMC from the mother, father, and family perspective

Barriers

KMC felt forced

· Were unaware of the benefits of KMC

· Were expected to perform KMC with little or no instruction

· Could not see newborn during KMC

· Did not feel a bond with the infant

· Perceived newborn did not enjoy KMC

Support from Society

· Fear, guilt doing KMC publically

· Felt KMC was role of mother

· Mothers did not want father to perform KMC

· Caregivers unable to devote time

· Other responsibilities at home or work interfered

· Mothers lonely and depressed in KMC ward

· Time needed to commute from home to hospital was too much

Mothers

· Fatigue

· Postpartum depression

· Pain hindered KMC, particularly after a C-section

· Discomfort sleeping upright

Financing

· Cost associated with travel, food, lodging, parking, clinical fees

· Lack of transport and distance to facility

Traditional Newborn Care

· Infants traditionally carried on back, thus carrying on the front seemed odd

· Bathing practices interfered

· If breast feeding not pursued KMC less likely to continue

· Considered unclean where diapers not used

Gender Roles

Stigma

Support from HCWs

· Did not respect family privacy

· Unsupportive, loud, uncaring

Service Delivery

· Lack of privacy

· Lack of necessary resources

Stigma

· Mothers reported shame of having a preterm infant

· Caregivers lied about carrying a newborn on their chest

· Others presumed the newborn was ill or deformed

Support from Family

· Mothers-in-law and grandmothers did not approve

· Bad attitudes and peer pressure negatively influenced desire to perform KMC

Enablers

Benefits For Newborns

· Slept longer, less anxious, happier, more willing to feed

Support from Society

· Societal acceptance of paternal involvement

· Parents preferred to practice KMC at home than at the facility to at tend to other responsibilities

· Unlimited visitation hours at health facility

Mothers

· KMC helped mother’s recover from post-partum depression

· KMC helped to relieve stress and promote emotional well-being

Financing

· Belief that KMC cut down hospital bills due to early discharge

· Assumed to be a cheaper than incubator care

· Parents more likely to stay if services were free

Service Delivery

· Private, quiet spaces for KMC

Gender Roles

· Normalization of paternal involved in child care

Benefits For Caregivers

· KMC was calming, relaxing, comforting, natural, instinctive, secure, logical, healing

· Created a family bond, inspired caregiver confidence

· Sped emotional and physical recovery of mother

· Made caregivers feel useful

Support from HCWs

· Mothers less apprehensive to practice KMC. Best results with continuous training and support

Support from Family

· Grandmothers, sisters, others helping with chores increased uptake and duration of KMC

· Paternal support crucial to success of KMC, they alleviate workload, support, encourage, increase mother’s confidence

· More likely to understand and respond well if mother explained KMC