Postpartum care in developing countries is beginning to gain a lot of attention as statistics show that the majority of maternal deaths occur during the postpartum period. Researchers, including myself, are busy trying to understand the fundamental reasons behind poor access to and delivery of postpartum care in Sub-Saharan Africa, a region where many women do not receive postpartum care after childbirth.
Current empirical evidence shows that socio-economic, demographic, and geographic factors can explain access to postpartum care. In particular, low level of education or illiteracy is associated with less use of postpartum care, as are residence in a rural area and farming as major occupation.
One of the questions of growing interest is: why do women decide not to return to health facilities for recommended postpartum care? Aside socio-economic factors, scholars are discovering that lack of women’s autonomy to make decisions, lack of husband support, and limited access to postpartum information or lack of awareness, tend to prevent women from seeking timely postpartum care.
Paying attention to barriers to postpartum care use is commendable, and has enhanced our understanding of areas to target for interventions. However, much less attention has been paid to the extent to which nurse/midwife advice influences women to seek postpartum care. My work in Malawi has showed that nurses/midwives serve as an important medium for postpartum information flow to women and their families, and may be one avenue to improve the use of postpartum care.
My research on the use of postpartum care, conducted in central Malawi has targeted rural subsistence farmers, a vulnerable population with even lesser use of postpartum care as the research evidence suggests. To my surprise, I found that almost all the participants in my study returned for the recommended one-week postpartum care visits. I asked a follow-up question: “why did you decide to seek postpartum care in the health facility?” The top reason women gave for deciding to return for their recommended postpartum visit, was that they were advised by the midwife to return!
This highlights the importance of midwife advice in improving postpartum care use. Nurse/Midwife advice to patients and their family to return to a health facility for postpartum care per country or WHO guidelines, is a simple, inexpensive intervention that could potentially improve postpartum care use among rural women in Sub-Saharan Africa!