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Summary Immediate skin-to-skin contact (SSC) between mothers and newborns and early initiation of breastfeeding (EIBF) may play a significant and underappreciated role in reducing neonatal mortality. These practices are distinct in important ways from more broadly recognized (and clearly impactful) interventions like kangaroo care and exclusive breastfeeding, and they are recommended for both preterm and full-term infants. A large evidence base indicates that immediate SSC and EIBF substantially reduce neonatal mortality. Many randomized trials show that immediate SSC promotes EIBF, reduces episodes of low blood sugar, improves temperature regulation, and promotes cardiac and respiratory stability. All of these effects are linked to lower mortality, and the biological pathways between immediate SSC, EIBF, and reduced mortality are compelling. A meta-analysis of large observational studies found a 25% lower risk of mortality in infants who began breastfeeding within one hour of birth compared to initiation after one hour. These practices are attractive targets for intervention, and promoting them is effective. Immediate SSC and EIBF require no commodities, are under the direct influence of birth attendants, are time-bound to the first hour after birth, are consistent with international guidelines, and are appropriate for universal promotion. Their adoption is often low, but ceilings are demonstrably high: many low-and middle-income countries (LMICs) have rates of EIBF less than 30%, yet several have rates over 70%. Multiple studies find that health worker training and quality improvement activities dramatically increase rates of immediate SSC and EIBF. There do not appear to be any major actors focused specifically on promotion of universal immediate SSC and EIBF. By contrast, general breastfeeding promotion and essential newborn care training programs are relatively common. More research on cost-effectiveness is needed, but it appears promising. Limited existing
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