Understanding Inequities in Postnatal Care Services Utilization in Low- and Middle-income Countries

Session: Postnatal Care: Reaching Newborn Infants and Mothers with Preventative and Curative Care

Presenter: Etienne Langlois, World Health Organization
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Background:  Each year an estimated 289,000 women die worldwide from complications related to pregnancy, childbirth or the postnatal period and up to two thirds of such maternal deaths occur after delivery. There are also 2.9 million neonatal deaths per year. Of the maternal and neonatal deaths that occur globally, 99% occur in low- and middle-income countries (LMICs).   Compared with other maternal and infant health services, coverage for postnatal care (PNC) tends to be relatively poor. In Kenya, for instance, fewer than 20% of women use PNC services, while this proportion is 35% in the Democratic Republic of the Congo.

Methodology:  We conducted a systematic review of peer-reviewed and grey literature to assess the socioeconomic, geographic and demographic inequities in the use of postnatal care services in 31 low- and middle-income countries. We summarized the relevant studies qualitatively and performed meta-analyses of the use of PNC services according to selected indicators of socioeconomic status and residence.

Results:  Our results showed a gradient in the use of PNC services according to quintiles of socioeconomic status (SES); for instance, compared with women in the lowest SES quintile, the pooled odds ratio for use of PNC by women in the fifth quintile was: 2.27 (95% CI: 1.75–2.93). In addition, meta-analysis showed that compared to women living in rural settings, those living in urban settings were more likely to use PNC services (pooled OR 1.36).  A qualitative assessment of the relevant data also indicated that use of PNC services increased with the level of education.

Conclusions:  PNC services utilization remains highly inequitable and varies markedly with SES and between urban and rural residents in LMICs. These findings speak to the need for both community-level interventions to promote the use of PNC services, and health systems interventions to improve the supply of affordable and quality PNC services.