Global policy guidance on care of vulnerable infants under six months and their mothers

Millions of infants worldwide are born vulnerable or become so in their first six months of life. These infants face risks such as poor growth, illness, and even death. Their health is closely tied to their mothers' wellbeing, yet global policies often fail to integrate care for both. This scoping review examined how existing global policies guide the care of vulnerable infants under six months and their mothers, using the MAMI Care Pathway to assess whether these policies support continuous, respectful, and high-quality care for both mother and child.

The review analysed 83 global policy documents, with 62 selected for in-depth review (20 guidelines and 42 guidance and manuals). Many policies focused only on infants, with just one document addressing only mothers (perinatal mental health), while 11 targeted both. Infant vulnerability was described in many ways, such as ‘small’, ‘sick’, or ‘developmentally delayed’. Similarly, maternal vulnerability included descriptions like ‘malnourished’, ‘absent’, or ‘suffering from mental health issues’.

The review found that some important conditions, like being small for gestational age, low birth weight, and nutritional oedema, were not well covered. The most common vulnerability identified was congenital illness, followed by low birth weight, preterm birth, breastfeeding problems, maternal health issues, and maternal absence or death. However, policy guidance was scattered across multiple documents, making it difficult to find clear, aligned recommendations for implementation. This fragmented approach prevents holistic care for mother-infant pairs. For example, when an infant is identified with low birthweight, one set of guidance dictates the care, if this same infant remains small beyond six weeks of life, we now classify them as being underweight, and care is guided by other guidelines or policies highlighting a lack of continuum of care.

Another major gap was the lack of connection between maternal and infant care. Policies often identified at-risk infants but did not include support for their mothers, even though maternal wellbeing is crucial for infant survival. Ideally, recognising an at-risk infant should immediately trigger care for both mother and child. Most policies focused only on the early postnatal period, addressing issues like small newborns and breastfeeding difficulties, but failing to guide long-term care for these high-risk infants.

Poor growth or low anthropometry identified during growth monitoring was also not fully considered as a general vulnerability factor, often being seen as a concern only for nutrition specialists rather than all health workers. Although weight-for-age is an important indicator of risk in infants under six months, it is often missed. All relevant policy guidance should include consistent anthropometric assessment and responsive growth monitoring.

To improve care, policies need to be better integrated and consolidated at the country level. Clearer, more practical guidance will help frontline health workers provide continuous, person-centred care, ensuring vulnerable infants and their mothers receive the support they need.