Use and Evaluation of Postpartum Care Services in Rural Central Malawi

Dr. Yenupini Joyce Adams with postpartum woman and newborn, Kandeu, Malawi

In this project, funded by the American Nurses Foundation (ANF) and the Center for Gender in Global Context (GENCEN) at Michigan State University, I interviewed subsistence farmers (husband-and-wife farmer dyads) in rural communities in Ntcheu district, Malawi. I explored reasons for their decision to seek postpartum care, evaluated postpartum care received after delivery in health facilities, and examined husband’s knowledge and attendance at their wives’ postpartum care. I used an interviewer-administered survey methodology, which was innovative in that I included husband-and-wife dyads and interviewed them simultaneously but separately. No other postpartum care utilization study in Sub-Saharan Africa had interviewed husband-and-wife dyads prior to my study, despite abundant evidence that husbands, as household heads, influence wives’ decisions to seek care.

Peer-reviewed manuscripts from this project:

1. Adams, Y.J. (2016). Use of postpartum care services in rural central Malawi.

This dissertation examines the use of postpartum care within the context of a developing country, and more specifically, among rural communities in central Malawi. It is a three-manuscript dissertation. Manuscript one, an integrative review, identifies factors affecting the use of postpartum care in developing countries, guided by the three delays model.

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 and Neonatal Nursing, 47(3), 371-384. doi: 10.1016/j.jogn.2018.02.006

Manuscripts two and three are described below.

2. Adams, Y.J., Stommel, M., Ayoola, A.B., Horodynski, M., Malata, A., & Smith, B.A. (2016). Use and evaluation of postpartum care services in rural Malawi. Journal of Nursing Scholarship, 49(1). doi: 10.1111/jnu.12257

This study examined women’s evaluation of postpartum care services (postpartum clinical assessments, health education, and midwife kindness) received from midwives prior to discharge in rural health facilities, and husband-and-wife-farmer dyads’ reasons for their decisions to return for one-week postpartum care visits in rural central Malawi.

Results Summary:

Most women reported receiving partial basic routine postpartum assessments such as fundal check, bleeding check, breast exam/soreness, blood pressure and temperature check. The results reveal the inadequacy of assessments offered to women in rural health facilities prior to discharge

Women’s Evaluation of Postpartum Assessments and Acts of Kindness received from Midwives

Despite inadequate care, 77% of women felt midwives paid close attention to them and 83% gave an overall positive evaluation (3.5-5 on a scale of 1-5). Participants stated prior negative experiences, or not perceiving a need for care (feels fine), may potentially prevent them from returning for postpartum care visits in a health facility.

Women returned for one-week postpartum care visits because they were advised by midwives to return for care, and also to make sure their babies were examined. The main reason why husbands permitted their wives to return for postpartum care was because they wanted their wives to be examined,  especially if they had a concern about their wives’ health.

3. Adams, Y.J., Stommel, M., Ayoola, A.B., Horodynski, M., Malata, A., & Smith, B.A. (2018). Husbands’ knowledge and attendance at wives’ postpartum care among rural farmers. Health Care for Women International, 39(9), 1020-1037. Doi: 10.1080/07399332.2018.1491976

This study examined husbands’ knowledge and attendance at their wives’ postpartum visit in a sample of rural husband-and-wife farmer dyads in central Malawi.

Results Summary:

Many husbands admitted they did not know about care their wives received in health facilities

 Percent agreement between dyad responses, restricted to dyads in which both husband and wife gave an answer of “yes” or “no”
% Agreement (n/N)*
N = 70
% Do not know (n)
Postpartum Assessments
Blood Pressure56.7 (17/30)57.1 (40)
Temperature40.7 (11/27)61.4 (43)
Abdominal Exam64.3 (18/28)60.0 (42)
Vaginal Exam/Checked Bleeding48.5 (16/33)52.9 (37)
Breast Exam/Soreness28.0 (7/25)64.3 (45)
Baby Exam74.5 (38/51)27.1 (19)
Table from publication: Doi: 10.1080/07399332.2018.1491976

The percent agreements between dyads were low. The odds of reporting that the woman received postpartum assessments were greater among husbands than among wives, meaning that husbands tended to say yes that their wives were assessed even when the wives were not.

Close to 60% of husbands did not go with their wives for their one-week postpartum care visits, with top three reasons being at work/busy doing other work, out of town, and did not see the need

We recommend that nurses/midwives should be encouraged to welcome husbands as partners in their wives’ care, by either allowing them into private examination rooms or providing them with information on the status of their wives’ health. Women should also be encouraged to have open discussions with their husbands about the care they received in health facilities, and any health issues or concerns from visits.

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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