Multifactorial determinants of postpartum care uptake in low- and middle-income countries: A systematic review and meta-analysis.

Abstract

Background: Postpartum care (PPC) uptake within six weeks after delivery is essential to prevent maternal morbidity and mortality. Aim: to understand the determinants contributing to PPC uptake in low-and-middle income countries (LMIC). Method: PubMed, Embase, CINAHL, Cochrane, Web of Science databases were searched on PPC uptake for childbearing women in LMIC. Studies published in English in peer-reviewed journals since 2013 were eligible. A meta-analysis using a random-effect model was undertaken to measure the pooled effect of five key determinants of PPC uptake. Findings: Among 1602 generated records, 24 cross-sectional studies were selected for the review. Nine of them were included in the meta-analysis (n=198 402 women). Overall, 55.4% of women used PPC. The pooled findings of PPC uptake were associated with urban locations (OR=1.88, 95% confidence interval (CI):0.76-1.91), and women’s primary (OR=1.45,95%CI:1.31-1.61) and secondary (OR=1.67,95%CI:1.45-1.92) education levels. Moreover, women from poor (OR=1.38,95%CI:1.23-1.56), middle (OR=1.56,95%CI:1.35-1.80), richer (OR=2.01,95%CI:1.71-2.35) and the richest (OR=3.31,95%CI:2.82-3.88) households were more likely to use PPC. Other facilitators included: PPC awareness, knowledge of postpartum morbidities, antenatal care, skilled birth attendant, health facility-based delivery, caesarean, women’s autonomy in decision-making, wanted pregnancy, primiparity, mass media exposure, women’s partner education and employment. Barriers to PPC uptake included: distance from health facilities, single marital status, unwanted pregnancy, cultural belief. Conclusion: The differences in PPC uptake in LMIC reflect social inequities. These findings can inform equitable maternal health policies and programs in LMICs. Strengthening community outreach and addressing structural barriers by improving PPC quality and access may enhance uptake and reduce preventable complications