Percent of newborns with delayed bath (for home and facility deliveries)

The percentage of most recent births during a specified time period delivered at home or in facilities, where the newborns had their first bath delayed at least six hours after birth. Ideally the bath should be delayed until 24 hours after birth (Save the Children, 2010). Delaying baths is a component of newborn thermal care and further details on summary indicators for thermal care can be found in Gage et al. (2005) and USAID/CORE Group (2004).

This indicator is calculated as:

(Number of newborns with first bath delayed at least six hours after birth / Total

number of most recent live births during a specified time period) x 100


Data on thermal care practices for most recent births from population based surveys such as Demographic Health Survey (DHS) and the UNICEF Multiple Indicators Cluster Survey (MICS) or from newborn care program surveys and reviews of facility delivery records. Generally DHS uses a recall period of five years and MICS uses a two year period. Data for calculating this indicator can also be collected through surveys of facilities and direct observation of providers in facilities. Data can be disaggregated by home versus facility deliveries, type of facility (e.g., public, private, non-governmental organization) and other factors such as district or urban/rural location. 


Population based surveys such as DHS and UNICEF/MICS; program surveys; direct observation in facilities, reviews of facility delivery records.


This indicator assesses delayed bathing, which is a core component of recommended newborn thermal care at delivery and can be used as a proxy for the quality of and adherence to protocols, performance of birth attendants, and adoption of newborn care messages at the community level (Gage et al., 2005). Where a national policy on thermal protection of newborns exists, this should be used as a standard against which to assess the practices of health care providers. Thermal care is one of five ‘Best Practices’ for all newborns: (1) Keeping the newborn warm to prevent hypothermia; (2) cord care; (3) eye care; (4) promotion of exclusive breastfeeding within one hour; and (5) routine immunizations (WHO, 2003).The newborn’s body temperature can drop rapidly after birth causing potentially life-threatening neonatal hypothermia. Hypothermia can lead to low blood sugar levels, respiratory distress, abnormal clotting, and increased risk of developing infections, jaundice and pulmonary hemorrhage (Save the Children, 2004).  Drying the newborn immediately after birth, skin-to-skin contact with the mother, wrapping the infant with a dry cloth or towel, keeping the newborn’s head covered, and delayed bathing, ideally for 24 hours, are essential care practices for keeping the newborn warm. Early skin-to-skin contact with the mother also promotes bonding and facilitates the initiation of breastfeeding. These strategies can be used effectively at home deliveries, as well as at facilities, and can improve newborn health and survival. Since the highest period of risk for neonatal deaths is within the first 24 hours, this indicator measures one of several thermal care practices that can improve infant health outcomes and is directly related to achieving Millennium Development Goal #4 to reduce infant and child mortality.


Surveys rely on recall of events and this indicator is subject to recall bias, which is likely to increase with the length of the recall period. Recall bias can be minimized by keeping the reference period short. A mother may not know when her most recent baby was bathed after birth and there is also the possibility that a mother would report the recommended behavior rather than actual practice. In a community where the practice of bathing the newborn is prevalent and there are programs aimed at raising awareness regarding newborn care, mothers may be aware of the correct practice, but traditional norms may prevent them from adopting the behavior (Gage et al., 2005). Direct observation is a way to avoid this bias.


newborn (NB), quality

Gage A, Ali D, Suzuki C, 2005, A Guide for Measuring and Evaluating Child Health Programs, Chapel Hill, NC: MEASURE Evaluation. https://www.cpc.unc.edu/measure/publications/ms-05-15  

Save the Children, 2010, Report of a Technical Working Group Meeting on Newborn Health Indicators, Washington, DC: Save the Children.

Save the Children, 2004, Every Newborn’s Health: Recommendations for care for All Newborns, Washington, DC: Save the Children. http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/EVERY-NEWBORNS-HEALTH.PDF  

USAID/CORE Group, 2004, Maternal and Newborn Standards and Indicators Compendium, Washington, DC: USAID.  http://www.coregroup.org/storage/documents/Workingpapers/safe_motherhood_checklists-1.pdf

WHO, 2003, Integrated Management of Pregnancy, Childbirth, Post Partum, and Newborn Care: A Guide for Essential Care Practice, Geneva: WHO. http://www.scribd.com/doc/7524352/Pregnancy-Childbirth-and-Postpartum-and-Newborn-Care-WHO-2003
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