A Simple and Underappreciated Way to Save Lives

We recently worked with a global health researcher, Vijay Kotecha, to explore the evidence supporting immediate skin-to-skin contact (SSC) and early initiation of breastfeeding (EIBF) after birth, two closely-related practices that we promote in the Newborn Care Foundations course. We found that immediate SSC and EIBF substantially reduce neonatal mortality, and the potential for highly cost-effective interventions to promote their practice may be underappreciated. 

Immediate SSC and breastfeeding within the first hour of birth significantly reduce neonatal mortality but remain underutilized. These practices are distinct from kangaroo care and exclusive breastfeeding, which are already widely recognized and promoted. Immediate SSC and EIBF are particularly promising due to their early timing, ease of implementation, and universal applicability. Extensive evidence supports their effectiveness: randomized controlled trials demonstrate that immediate SSC enhances early breastfeeding, stabilizes cardiac and respiratory functions, prevents hypothermia and hypoglycemia, and reduces risk of maternal postpartum hemorrhage. The potential for mortality reduction is substantial. We estimate that shifting from delayed to early initiation of breastfeeding reduces neonatal mortality by 7–24%.

A visual summary of pathways between SSC, EIBF, and clinical outcomes. The type of evidence is indicated with color-coded arrows.

Despite international guidelines recommending these practices universally, implementation remains inconsistent. Rates of immediate SSC and EIBF vary widely: some low- and middle-income countries have rates over 70%, while many others have rates below 30%. Targeted interventions, such as health worker training and quality improvement initiatives, have significantly increased rates, suggesting high adherence is achievable in almost any context.

We’re not aware of any major global health actors that currently focus on promoting universal immediate SSC and EIBF, despite their demonstrated benefits and low cost. It may be highly cost-effective and impactful to reduce neonatal deaths globally by targeting these practices. Immediate SSC and EIBF require minimal resources and can be adopted by existing health systems without major investments or additional commodities.

Key uncertainties remain regarding the scale-up potential, long-term effectiveness, and the relative merits of different interventions to improve rates of immediate SSC and EIBF. Further research into cost-effectiveness, optimal intervention intensity, and implementation strategies could enhance these practices' global impact.

HealthLearn actively promotes immediate SSC and EIBF in our Newborn Care Foundations course, and our preliminary research suggests this training effectively increases adoption rates at scale. We’re planning to make updates to the course and our platform to reinforce these practices further, while also continuing to evaluate how our training changes rates of EIBF and immediate SSC. More broadly, we’ll be advocating for major actors in global health to pay more attention to this promising area for intervention.

For more details, please refer to the extended report and a longer summary published on the Effective Altruism Forum.