Continuation of Kangaroo Mother Care when transitioning from facility to community: maternal and familial perspectives from South India

BACKGROUND: Kangaroo Mother Care (KMC) is an effective intervention shown to significantly lower neonatal morbidity and mortality, especially among low-birth-weight (LBW) infants. Despite its success, many families struggle to implement KMC effectively post-discharge. METHOD: This qualitative study employed a hermeneutical-phenomenological approach to explore the experiences of mothers and families practicing KMC after discharge from the hospital in South India. In-depth, semi-structured interviews were conducted with eight mothers, fathers, and grandmothers, focusing on their experiences with community KMC (cKMC) and their challenges in maintaining cKMC at home. All the data were transcribed verbatim and reflexive thematic analysis was done to identify the enablers and barriers to practice cKMC. RESULTS: Three main themes emerged from the analysis: Breast Feeding - Persevering Despite Initial Difficulties, Kangaroo Mother Care - Seeing benefits but struggling to practice, and Family Boon or Bane - Family as a crucial context for cKMC practice. While encountering challenges, participants expressed a strong commitment to breastfeeding, persevering to breastfeed by expressing breast milk, getting donor milk and using skin-to-skin contact to increase the milk flow. KMC was adopted positively and benefitted from support by the healthcare team and infrastructure during hospital stay, but continuation at home was difficult due to inadequate counselling, lack of community follow-up and challenging home environment. Family emerged both as a support system and a source of a tension to KMC practice. While fathers and grandmothers actively supported KMC in hospital settings, post-discharge traditional gender norms and domestic responsibilities hindered continuity at home. CONCLUSION: To promote sustained family-inclusive cKMC practices, there is a need for structured education to empower all caregivers, including grandmothers and fathers. Adoption of gender inclusive terminology such as "Kangaroo Family Care" can help to dismantle gender-oriented perceptions and encourage participation of all family members. Engaging grandparents as champions of KMC can promote intergenerational support for families and improve the outcome of LBW newborns. Community health teams should strengthen through tailored training on antenatal counselling and post-discharge support.