title: Inequities in postnatal care in low- and middle-income countries: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To assess the socioeconomic, geographical and demographic inequities in the use of postnatal health-care services in low- and middle-income countries.
  
  
  METHODS
  We searched Medline, Embase and Cochrane Central databases and grey literature for experimental, quasi-experimental and observational studies that had been conducted in low- and middle-income countries. We summarized the relevant studies qualitatively and performed meta-analyses of the use of postnatal care services according to selected indicators of socioeconomic status and residence in an urban or rural setting.
  
  
  RESULTS
  A total of 36 studies were included in the narrative synthesis and 10 of them were used for the meta-analyses. Compared with women in the lowest quintile of socioeconomic status, the pooled odds ratios for use of postnatal care by women in the second, third, fourth and fifth quintiles were: 1.14 (95% confidence interval, CI : 0.96-1.34), 1.32 (95% CI: 1.12-1.55), 1.60 (95% CI: 1.30-1.98) and 2.27 (95% CI: 1.75-2.93) respectively. Compared to women living in rural settings, the pooled odds ratio for the use of postnatal care by women living in urban settings was 1.36 (95% CI: 1.01-1.81). A qualitative assessment of the relevant published data also indicated that use of postnatal care services increased with increasing level of education.
  
  
  CONCLUSIONS
  In low- and middle-income countries, use of postnatal care services remains highly inequitable and varies markedly with socioeconomic status and between urban and rural residents.
authors.affiliation: Alliance for Health Policy and Systems Research, World Health Organization, avenue Appia 20, 1211 Geneva, Switzerland .
authors.forename: Étienne V
authors.initials: ÉV
authors.lastname: Langlois
authors.affiliation: Research Centre of the University of Montreal Hospital Centre, Quebec, Canada .
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Miszkurka
authors.affiliation: Research Centre of the University of Montreal Hospital Centre, Quebec, Canada .
authors.forename: Maria Victoria
authors.initials: MV
authors.lastname: Zunzunegui
authors.affiliation: Alliance for Health Policy and Systems Research, World Health Organization, avenue Appia 20, 1211 Geneva, Switzerland .
authors.forename: Abdul
authors.initials: A
authors.lastname: Ghaffar
authors.affiliation: Library of the University of Montreal Hospital Centre, Quebec, Canada .
authors.forename: Daniela
authors.initials: D
authors.lastname: Ziegler
authors.affiliation: Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada .
authors.forename: Igor
authors.initials: I
authors.lastname: Karp
mesh_terms: D003906:Developing Countries; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D011181:Postnatal Care / Q000379:methods / Q000706:statistics & numerical data*; D011203:Poverty; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000517:prevention & control*; D012959:Socioeconomic Factors