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Countdown to Childx: Global health expert Gary Darmstadt on improving newborn survival

newborn-IndiaEach year, around the world, almost 3 million babies die in the first month of life. But it doesn’t have to be that way: For many newborns, simple changes in their care could make the difference between life and death.

I spoke about this conundrum recently with global health expert Gary Darmstadt, MD, who will be among the panelists at this week’s Childx conference at Stanford. Darmstadt, who recently arrived at Stanford from the Bill & Melinda Gates Foundation, has focused much of his career on improving newborn health in developing countries. The key, he says, is engaging community members as full partners in creating the solutions for how to care for newborns. Excerpts of our conversation appear below.

Registration for the Childx conference is still open, and those who can’t attend in person can watch the conference’s live stream at the Childx website.

Preterm birth has just passed pneumonia as the No.1 cause of death, worldwide, for children under age 5, and yet many deaths from prematurity could be prevented with simple, low-tech interventions. What needs to change?

We’ve known since the late 1970s that kangaroo mother care, in which the mother keeps the infant on her chest next to her skin, is very effective. But the rate of adoption has been very poor, about 5 percent globally in 35 years.

It was originally conceived as a substitute for an incubator: By holding babies skin-to-skin you provide a constant source of warmth. What I think happened was that, by making kangaroo mother care a medical intervention rather than a natural behavior, we’ve stigmatized it. Mothers may think, “If I was a rich person, my baby would be in an incubator. Being a provider of kangaroo mother care tells me something about me and my baby: We’re second class.”

We need to communicate that kangaroo mother care is for every baby, everywhere. It’s not just something that poor people get if there aren’t enough incubators. Yes, there are situations where an incubator is helpful, but in many ways kangaroo mother care is superior. An incubator can’t provide a mother’s heartbeat or the feel of her breathing, her voice and her touch. It can’t provide breast milk. It’s not something you form a bond with that lasts for a lifetime. People have picked up the message that the medical device is superior, and they may feel like “I’m an inferior version of a medical device” rather than understanding that the medical device is, for many babies, an inferior attempt to produce what the mother or other family members can provide.

What are some key examples from your research of how social and environmental approaches can help improve infants’ health and survival?

I'm part of a team that worked closely with communities in India to understand how they perceive newborns’ needs and their issues in dealing with them. From there, we developed a simple package of preventive care. It consisted of things like holding babies skin-to-skin, breastfeeding, keeping infants warm, and basic hygiene. Once it was implemented, we saw a 50 percent reduction in neonatal mortality over a 16 month period.

We found, for example, that these communities had no real concept that hypothermia was bad for babies. They had a term for fever and understood that fever was a danger signal, but didn’t have a word that brought the connotation of harm or danger together with cold for babies. When we realized that, the community ended up coming up with a term – they called hypothermia “cold fever.” It created a whole new dialogue around hypothermia, and new openness to trying things that might be helpful to your baby, particularly skin-to-skin care.

What we really sought to do was to bring the science into language that was simple and related to their everyday experience. So the messaging became, “In the same way that when you bathe in the river, when you come out, you feel cold and wrap yourself in a sari, when a baby is born, it’s wet and feels cold, and we need to wrap up the baby for the baby’s protection.” Without understanding the social construct, the environment, we couldn’t come up with those simple messages that would become part of the social fabric.

What do you think scientists need to know about the strategies that change health practices around the world?

There is no substitute for truly engaging with communities as partners in creating the solutions. We can bring some science that the community members may not know, but they bring all the understanding of how things really work where they live. Even if you are a scientist way back on the basic end, recognize that you’re a part of a process that leads up to a person who lives in a particular environment, ecosystem and culture, and that, to change health practices, that person has to agree to take a risk or do something different. No matter where we focus our work, we’re part of that chain, and being aware of that is very important. We need to work together, because that is how real advances will be made.

Previously: Countdown to Childx: Q&A with pediatric health expert Alan Guttmacher, Countdown to Childx: Stanford expert highlights future of stem cell and gene therapies and Stanford hosts inaugural Childx conference this spring
Photo by DFID - UK Department for International Development

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