Postpartum care : levels and determinants in developing countries

Focused antenatal care (ANC) and childbirth with a skilled attendant have been highlighted as effective interventions to reduce this burden. However, better understanding of conditions such as postpartum hemorrhage -- the largest killer -- and its occurrence in the early postpartum period have shown the importance of early and universal postpartum care (PPC). This study was undertaken to analyze the variables (occurrence, timing, and background characteristics) associated with receipt of postpartum care in 30 developing countries representing the major regions of the world. Data from Demographic and Health Surveys carried out between 1999 and 2004 were used in the study. Results show that about half of all births in these countries continue to occur outside health institutions, and in seven out of ten births mothers do not receive any postpartum care. Of the noninstitutional births for which mothers receive postpartum care, the average timing of the first postpartum checkup is three days after birth. If all births are counted -- assuming institutional births receive postpartum care 12 hours after delivery -- the average timing of postpartum care is two days following delivery. The characteristics of women most often associated with receiving postpartum care are belonging to a household with higher wealth status and having received antenatal care. Education beyond the primary level, urban residence, and media exposure are strongly correlated with receiving postpartum care. However, some relationships are less clear, or are reversed, for postpartum care performed by traditional birth attendants or other nonskilled attendants. This paper highlights specific countries where, despite low numbers of institutional births, many women do receive postpartum care. It is suggested that countries should invest in ensuring that all births -- whether at a health institution or at home -- are attended by a skilled provider at the time of delivery or within a few hours, to help reduce maternal morbidity and mortality. (Author abstract)