Barriers and Facilitators to Effective Kangaroo Mother Care in Ethiopia: A Qualitative Study

Abstract Background Globally, neonatal deaths account for nearly half of under-five mortality, with over 1 million deaths occurring within the first 24 hours of life—largely due to preterm birth. In Ethiopia, low birth weight newborns contribute to 60–80% of neonatal deaths, with a neonatal mortality rate of 33 per 1,000 live births. Kangaroo Mother Care (KMC) is a proven, cost-effective intervention for preterm and low birth weight babies, now recommended by World Health Organization (WHO) for immediate initiation after birth. Despite national policy support, KMC coverage in Ethiopia remains low, with fewer than 10% of eligible newborns receiving it. Understanding the barriers and enablers to effective KMC implementation is critical to improving coverage and outcomes. Methods The study conducted in August 2023 at Asella Referral and Teaching Hospital and Batu General Hospital in Oromia, utilized thematic analysis to explore barriers and facilitators of effective KMC. Data were collected through observations and in-depth interviews with 14 participants—six mothers and eight neonatal care providers. Semi-structured interviews were conducted in Amharic and Afan Oromo, recorded, and transcribed. Data were manually coded and analyzed thematically. A pre-tested, standardized questionnaire ensured data quality, and collection continued until saturation was achieved, with findings presented in detailed descriptions. Result Our analysis identified health system related barriers to effective KMC including inadequate healthcare infrastructure, skill gaps, low healthcare provider motivation, maternal emotional status, post-operative pain, lack of knowledge about KMC, and cultural norms that hasten mothers to go home after birth. Facilitators comprise quality improvement initiatives, visual aids, effective counseling, maternal willingness and regular pregnancy follow-up. Conclusion Addressing both systemic and individual-level barriers while reinforcing identified facilitators is essential to improve effective KMC uptake. Targeted, system-wide and mother-centered interventions are needed to improve uptake of effective KMC in Ethiopia. Clinical trial number: Not applicable