Table 1 China’s premature birth intervention program and kangaroo mother care

Previously KMC was not practiced as part of routine neonatal care in China. Since 2014, the National Health Commission of China and China’s Premature Birth Intervention Program have been working to raise awareness and promote the implementation of KMC across a network of 50 hospitals. Ten of these hospitals volunteered to participate in a pilot of KMC implementation. Representatives from each hospital took part in a short theoretical and practical training in 2015. Prior to this, hospitals had either not implemented KMC or provided it only occasionally to individual newborns. Other activities to promote the implementation of KMC included international and national expert meetings, study/exposure visits for senior practitioners and policymakers to high income countries implementing KMC (UK, US, Netherlands and Sweden), KMC stakeholder workshops in China involving nurses, doctors and other cadres of medical staff and trainings provided to different cadres of health workers by Chinese neonatal care experts. Draft guidelines for KMC implementation were produced by a multi-stakeholder group. From 2017 to 2019, eight of the original ten pilot hospitals volunteered to use these standardized KMC guidelines to inform their further development and finalization. By the end of the pilot’s first year, nearly 20% of all preterm newborns born in the eight hospitals received intermittent KMC. Our analysis focuses on KMC role out at individual hospital level, not at national level.