Postnatal Care Experiences and Barriers to Care Utilization for Home- and Facility-Delivered Newborns in Uganda and Zambia

Abstract

Objectives The objective of this study was to examine experiences with, and barriers to, accessing postnatal care services, in the context of a maternal health initiative. Methods As part of a larger evaluation of an initiative to promote facility deliveries in 8 rural districts in Uganda and Zambia, 48 focus groups were held with recently-delivered women with previous home and facility deliveries (6 per district). Data on postnatal care experiences were translated, coded and analyzed using thematic content analysis techniques. Results were categorized into: positive postnatal care experiences, barriers to postnatal care utilization, and negative postnatal care experiences. Results Women who accessed care largely reported positive experiences, with Zambian women generally reporting more positive interactions than Ugandan women. The main reasons given for low postnatal care utilization were low awareness about the need, fear of mistreatment by clinic staff, cost and distance. In half of the focus groups, women described personal experience or knowledge of denial or threatened denial of postnatal care due to the birth location. Although outright denial of care was not common, women frequently described various types of actual or presumed discrimination because of having a home birth. Conclusions for Practice While many women reported positive experiences with postnatal care utilization, cases of delay or denial of postnatal care exist. As programs incentivize facility deliveries, the lack of focus on postnatal support may place home-delivered newborns in "double jeopardy" due to poor quality intra-partum care and reduced access to postnatal care.

Determinants of early postnatal care attendance: analysis of the 2016 Uganda demographic and health survey

“…The few studies that have been conducted on postnatal care utilization in Uganda have concentrated on postnatal care beyond 2 days of delivery [20,21], with no attention to factors influencing early postnatal care attendance-the period when maternal deaths are most common. Other studies on Uganda have focused on postnatal care checkups among newborns [20,22,23].…”

Care-seeking patterns for common pediatric illnesses: A mixed methods study in rural Guatemala

“…The recent evidence on mistreatment by health care personnel of women in labor and post-natal care has been highlighted as a key barrier for patient centered care. 34,35,36 An important finding to highlight is that despite low formal care seeking levels, 78% of the children were treated with ORT for diarrhea, and 48% with antibiotics for ARI. In contexts with poorly functioning health systems, alternative treatment delivery strategies that provide better access to communities can be strengthened for appropriate treatment for common childhood illnesses.…”

Evaluation of the quality of postnatal care and mothers satisfaction at the university college hospital Ibadan, Nigeria

“…Most of the participants in a Pakistan study verbalized low quality of maternity care, disrespect and impolite behavior of health professionals (Munawar et al, 2017). On the other hand, Sacks et al, (2017) submitted that a large proportion of their participants reported positive postnatal experiences with more satisfaction among the Zambian than the Ugandan women. The third hypothesis tested in this study found a relationship between maternal satisfaction on the wards and the age and parity of the mother out of all the other selected maternal sociodemographic characteristics tested.…”