Factors that influence uptake of routine postnatal care: Findings on women’s perspectives from a qualitative evidence synthesis

Abstract

Background Effective postnatal care is important for optimal care of women and newborns–to promote health and wellbeing, identify and treat clinical and psychosocial concerns, and to provide support for families. Yet uptake of formal postnatal care services is low and inequitable in many countries. As part of a larger study examining the views of women, partners, and families requiring both routine and specialised care, we analysed a subset of data on the views and experiences of women related to routine postnatal care. Methods We undertook a qualitative evidence synthesis, using a framework analysis approach. We included studies published up to December 2019 with extractable qualitative data, with no language restriction. We focused on women in the general population and their accounts of routine postnatal care utilization. We searched MEDLINE, PUBMED, CINAHL, EMBASE, EBM-Reviews, and grey literature. Two reviewers screened each study independently; inclusion was agreed by consensus. Data abstraction and scientific quality assessment were carried out using a study-specific extraction form and established quality assessment tools. The analysis framework was developed a priori based on previous knowledge and research on the topic and adapted. Due to the number of included texts, the final synthesis was developed inductively from the initial framework by iterative sampling of the included studies, until data saturation was achieved. Findings are presented by high versus low/middle income country, and by confidence in the finding, applying the GRADE-CERQual approach. Findings Of 12,678 papers, 512 met the inclusion criteria; 59 articles were sampled for analysis. Five themes were identified: access and availability; physical and human resources; external influences; social norms; and experience of care. High confidence study findings included the perceived low value of postnatal care for healthy women and infants; concerns around access and quality of care; and women’s desire for more emotional and psychosocial support during the postnatal period. These findings highlight multiple missed opportunities for postnatal care promotion and ensuring continuity of care. Conclusions Factors that influence women’s utilization of postnatal care are interlinked, and include access, quality, and social norms. Many women recognised the specific challenges of the postnatal period and emphasised the need for emotional and psychosocial support in this time, in addition to clinical care. While this is likely a universal need, studies on mental health needs have predominantly been conducted in high-income settings. Postnatal care programmes and related research should consider these multiple drivers and multi-faceted needs, and the holistic postpartum needs of women and their families should be studied in a wider range of settings. Registration This protocol is registered in the PROSPERO database for systematic reviews: CRD42019139183.

Pregnancy complications and later life women's health

“…Access to postnatal care is not equal across the globe. Rates of receipt of a routine postnatal check‐up for mothers may be as low as 10% and as high as 90%, with a median of just over 60% across 48 countries 63,64 . Both socioeconomic and geographical factors contribute to this inequity 64 .…”

“…Rates of receipt of a routine postnatal check‐up for mothers may be as low as 10% and as high as 90%, with a median of just over 60% across 48 countries. 63 , 64 Both socioeconomic and geographical factors contribute to this inequity. 64 If a positive impact is to be made on women's future morbidity and mortality from noncommunicable disease, access to postnatal follow up and primary care must be made convenient and available to as many women as possible.…”

“… 63 , 64 Both socioeconomic and geographical factors contribute to this inequity. 64 If a positive impact is to be made on women's future morbidity and mortality from noncommunicable disease, access to postnatal follow up and primary care must be made convenient and available to as many women as possible. For women who live in less advantaged circumstances and communities, or in remote areas, other solutions including use of mobile device based telemedicine (M‐health) and community based peer education have shown potential for risk reduction, although long‐term studies with hard outcomes are needed to confirm their effectiveness.…”

IMAgiNE EURO: Data for action on quality of maternal and newborn care in 20 European countries during the COVID‐19 pandemic

“…[8][9][10] In addition, key dimensions of experience of care such as patient participation, provision of emotional support, and attempts to reduce certain interventionist procedures of limited clinical value, were among the first aspects of care to be sidelined during the pandemic. 11 Although emotional support is widely recognized as being important to patient experiences and recovery, 12 many health authorities or facilities did not allow companions of choice or visits from family members, and some facilities routinely separated infants from parents in a, likely ineffective, effort to reduce transmission risk. 13 While there have been previous studies from individual countries examining women's and families' experiences utilizing healthcare 1).…”

Improving policy, financing and delivery of postnatal care services

“…Unfortunately, postnatal care is largely undervalued by communities and often perceived as a low priority for health professionals; these perceptions negatively influence the uptake and coverage of care. 3 , 10 Among various solutions, antenatal care contacts provide a strategic opportunity to promote the value and importance of care following childbirth.…”