Why Women Do Not Use Postpartum Care Services in Developing Countries

Postpartum care is care provided to a woman within 6 weeks or 42 days after birth. The World Health Organization recommends that postpartum care should be provided by a skilled health personnel, such as a doctor, midwife, or nurse in a health care facility. Postpartum care is very important because it helps in the timely identification and management of postpartum complications.

Lack of or inadequate postpartum care has become an issue of major concern, especially in developing countries. Most maternal deaths occur in the postpartum period from complications such as severe bleeding, infections, hypertensive disorders, and complications from delivery and unsafe abortion.

Many women do not receive any postpartum care after birth despite high maternal death rates in the postpartum period. Many researchers have conducted studies in several developing countries to determine the barriers to postpartum care after birth. I conducted a review of the literature to synthesize research findings on why women do not use postpartum care services in developing countries.

In this post, I highlight the most common reasons why women decide not to seek postpartum care after birth, summarized below.

• The view that postpartum care is not necessary/needed
• Lack of support or encouragement from husband or family
• Cost of services
• Lack of awareness of postpartum care
• Cultural barriers
• No complications and no awareness of complications
• Lower level of women’s education
• Women’s farming occupation or unemployment
• Lower level of husband’s education
• Husbands farming occupation or agricultural work

Participants in several studies reported that they did not seek postpartum care because they thought postpartum care was not necessary; they did not have support from husbands or family members; they could not afford the cost of postpartum services; they did not know about postpartum care; and they could not seek care due to cultural barriers. These barriers call for community-based health intervention programs. Some of the interventions could focus on educating women on the importance of postpartum care, the timing of postpartum care visits, and why they should attend visits even when they “feel fine” or do not observe any immediate signs of complications.  Community campaigns should also encourage support from husbands and family members to women to motivate them to seek postpartum care. In addition, clear guidelines on when women should return for postpartum visits after birth should be communicated to them prior to their discharge from health care facilities.

Findings from the review also indicated that women are less likely to use postpartum care services if they had no complications or no concern about complications, if they or their husbands are less educated, and if they or their husbands are farmers or involved in agricultural work. This points to the importance of educating not only women, but also their husbands, about warning signs of postpartum complications and when to seek care. It is equally important that women and their husbands are educated to return for their postpartum visits even if the woman did not have any complications during birth. This is because life-threatening complications are usually unpredictable and may require rapid action. Finally, interventions to encourage postpartum care use should target uneducated families and farming communities.

For the full article, see: Adams, Y. J., & Smith, B. A. (2018). Integrative Review of Factors That Affect the Use of Postpartum Care Services in Developing Countries. Journal of Obstetric, Gynecologic & Neonatal Nursing47(3), 371-384 (https://www.sciencedirect.com/science/article/pii/S0884217518300212).



Published by

Yenupini Joyce Adams

Yenupini Joyce Adams is an Assistant Professor of the Practice and the Global Maternal Research Lead at the Eck Institute for Global Health, University of Notre Dame. Her research passion is to improve maternal health, promote safe motherhood, and decrease maternal mortality and morbidity, especially in Sub-Saharan Africa and U.S, where the burden of maternal mortality is greatest.

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