Determinants of the utilization of postpartum family visits: Evidence from rural areas of Eastern China

Abstract

BackgroundPostpartum Family Visits (PFVs) have been advocated as a way to improve health outcomes for puerperal women and their newborns. This study aimed to identify individual factors associated with the utilization of PFVs in rural Jiangsu Province, China.MethodsWe employed responses of the household survey in Jiangsu province, part of the National Health Service Survey (NHSS), a nationally representative survey in China. The data analysis framework was designed based on Andersen’s behavioral model. The outcome variables included nonuse and deficient use of PFVs, and the explanatory variables were organized into three hierarchical levels: predisposing, enabling and need factors. Univariate analysis and multivariate logistic regression analysis were conducted to examine the impact of the three hierarchical levels on PFVs utilization.ResultsA total of 884 rural women who had a childbearing history in the prior five years answered PFVs questions. About 23.4% of them had never received any PFVs, and 40.4% received <3 visits. In the results of multivariate logistic regression, educational level (OR = 0.43, 95% CI: 0.24–0.77), income (OR = 0.62, 95% CI: 0.43–0.88), the distance from the nearest hospital (OR = 1.49, 95% CI: 1.07–2.07) and parity (OR = 2.17, 95% CI: 1.54–3.05) had significant relationship with nonuse. Factors significantly associated with deficient use of PFVs included employment (OR = 0.62, 95% CI: 0.39–0.98), the distance from the nearest hospital (OR = 1.73, 95% CI: 1.26–2.36), level of delivery institution (OR = 1.57, 95% CI: 1.14–2.17), and parity (OR = 1.45, 95% CI: 1.03–2.05).ConclusionThe study found lower Social Economic Status (SES), long distance with primary health institutions, and the increased need for services stemming from multi-parity reduced the likelihood of nonuse or deficient use of PFVs in rural areas. Multiparous, low SES women and those living far away from primary health institutions should be paid more attention to assure the coverage of postpartum care.

Risk factors for women’s non-utilization of decentralized primary health care facilities for postnatal care in rural western Ethiopia

“…This may be explained by the role of knowledge in increasing awareness of basic health services and health risks, leading to improved health-seeking behavior. This finding is in agreement with results from various developing countries 15,16,20,51,52 and from other studies in rural Ethiopia. 14,48,53…”

“…Our study found the odds of non-utilization of PNC services were higher among women who had never visited health facilities for ANC services than among those who had, corroborating the findings of other studies. 4,7,16,20,34 Similarly, recent demographic health surveys across African countries indicate that rural postnatal residents who were ANC non-users had higher odds of not receiving postnatal services. 5 Furthermore, our study revealed that women who had experienced postnatal complications after their last birth were much more likely to visit a reproductive health facility for PNC services than those who had not encountered any complications.…”

“…7,14,48 Studies carried out elsewhere found that absence of postnatal complications cannot protect against either actual or potential postnatal morbidity and maternal deaths. 14,20,34,48…”

“…Research suggests the following are risk factors for women's non-utilization of PNC: availability and accessibility of health facilities; availability of transport and rural road network; maternal literacy, age, and occupation; cultural beliefs; attitude of providers; place and mode of delivery; history of pregnancy; knowledge of pregnancy programs, complications, and PNC services; health promotion; and home visits. 5,7,[20][21][22] The extent to which any of these factors poses risks to women's nonutilization of PNC services varies according to local cultural practices, geographic setting, and various barriers within specific societies. 14,[23][24][25] The effectiveness of the health system in Ethiopia is undermined by non-utilization of existing decentralized health care facilities (DHFs) for PNC.…”

Relationship between patient ethnicity and prevalence of anemia during pregnancy and the puerperium period and compliance with healthcare recommendations - implications for targeted health policy

“…The postpartum care visit is an important opportunity to follow up women at increased risk for certain conditions such as anemia as well as impaired physical health and emotional problems. However, compliance with postpartum healthcare recommendation is not consistent and healthcare services utilization can be absent in 10-40% of puerperal women, depending on the specific area and population [10][11][12]. Thus, it is important to identify populations at increased risk for postpartum anemia and low compliance with medical surveillance in order to change policies that will assist in decreasing anemia prevalence in Israel and improve patients' medical care.…”