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Advice for Parents of Newborns in High- and Low-Income Countries

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March 27, 2013

To mark the critical first 28 days of a newborn’s life–the neonatal period (when a baby is most at risk)– in the lead up to the Global Newborn Health Conference, Gary Darmstadt and others will be sharing, via Twitter, 28 days of “Did You Know?” facts about newborn health. Follow @gdarmsta, share the facts widely using #Newborn2013 and we can work towards saving newborn lives together. 

In talking to new parents of healthy babies in the US, most pediatricians will provide anticipatory guidance. That means advice about feeding their newborn, expected sleeping patterns, number of stools and wet diapers to expect in a day, and how to recognize what may be danger signs in their baby. There is a plethora of materials parents can access:  books, pamphlets, websites, and adverts.  Add to this information volunteered by grandparents and parents, friends and co-workers, and the new, often sleep-deprived parents are surrounded, and often overwhelmed with advice from all corners.

We each take that advice with a grain of salt. And we each know that when our newborn is sick, regardless of what our well-meaning friends suggest, we can always take her to the doctor for professional advice and care.

 We must recognize the powerful influence of grandmothers, fathers and traditional healers on newborn care to combine both traditional and formal health care approaches.

That’s the scenario in many neighborhoods in high-income countries. Now let’s go to a rural community in South East Asia or West Africa where a newborn baby may be unwell.

There are significant differences.

A large number of newborns continue to be born outside of health facilities, often in the home. The delivery is managed by a non-skilled birth attendant such as an elderly woman from the village; there may have been variable attention given to clean delivery care; the new parents have probably received very little anticipatory guidance from a health professional; and the baby may not have been named or been in any contact with the health or registration system.

On all continents, though, moms, family members and community members probably recognize or sense when a baby is sick—those very subtle signs of fever or sleeping longer than normal or urinating less, or just “feeling that something isn’t quite right”.  And these rural community members also give  suggestions of what could be wrong with a newborn, why he is not eating, or why he has breathing troubles They also provide their suggestions of how to treat those illnesses. 

What sort of suggestions do we find?

Some work we have completed in rural Ghana suggests that while mothers and care-givers recognize these “danger signs” of illness, their understanding of the causes and thus the suggestions of how to treat those illnesses may be different and oftentimes based on tradition. For example, rubbing herbs on the mother’s chest will make her milk less “bitter” so the baby will eat more, or making a loud noise in the baby’s ear will help her breathe at birth.

Another difference between these two scenes is that mothers in rural northern Ghana don’t get to take the advice “with a grain of salt.”

Decisions about newborn health care often rest beyond the mothers and instead with the fathers, grandmothers, and mothers-in-law. Grandmothers are often the first to spot problems and then decide how to treat them, either with a traditional approach, a local healer, or, in the case of certain illnesses, a skilled health care worker at a health clinic, although, as another study found, less than half of newborns who were identified as being sick or possibly sick from rural Africa and South East Asia were taken to see any qualified health practitioner.

The findings indicate that even if a mother wants to take her dehydrated baby directly to a health center knowing that would be the best care, she cannot make that decision on her own. 

So what does this mean for those of us working in global health?

As we are preparing for the Global Newborn Health Conference coming up April 15-18, we have to consider the implications of these cultural practices when designing interventions for newborn health. Newborn care must reach beyond the usual boundaries of a health clinic or a focus only on the mother. We must recognize the powerful influence of grandmothers, fathers and traditional healers on newborn care to combine both traditional and formal health care approaches.

Getting advice is inevitable as a new parent. We want to make sure that advice is appropriate – both culturally and technically – and can help save a newborn’s life.

You can also get involved. Join Gary’s team at, a community of people crowdfunding projects related to women and girls, where Gary is featuring a maternity waiting home project in Sierra Leone. The project helps to educate women and their families to have safer births and give babies a better chance of survival. 

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