title: 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.
authors.affiliation: Department of Epidemiology, Columbia University Medical Center, 722 W 168 Street, New York, NY, 10032, USA. ers2113@columbia.edu.|USAID Maternal and Child Survival Program (MCSP)/ICF International, Washington, DC, USA. ers2113@columbia.edu.
authors.forename: Emma
authors.initials: E
authors.lastname: Sacks
authors.affiliation: Department of Epidemiology, Columbia University Medical Center, 722 W 168 Street, New York, NY, 10032, USA.|Department of Sociology and Anthropology, College of the Holy Cross, Worcester, MA, USA.
authors.forename: Tsitsi B
authors.initials: TB
authors.lastname: Masvawure
authors.affiliation: Makerere School of Public Health, Kampala, Uganda.
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Atuyambe
authors.affiliation: Makerere School of Public Health, Kampala, Uganda.
authors.forename: Stella
authors.initials: S
authors.lastname: Neema
authors.affiliation: Institute for Social and Economic Research, University of Zambia, Lusaka, Zambia.
authors.forename: Mubiana
authors.initials: M
authors.lastname: Macwan'gi
authors.affiliation: Institute for Social and Economic Research, University of Zambia, Lusaka, Zambia.
authors.forename: Joseph
authors.initials: J
authors.lastname: Simbaya
authors.affiliation: Department of Global and Population Health, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Kruk
mesh_terms: D002755:Choice Behavior; D036861:Delivery, Obstetric / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D017144:Focus Groups; D006801:Humans; D009321:Natural Childbirth / Q000523:psychology* / Q000706:statistics & numerical data; D011181:Postnatal Care / Q000523:psychology* / Q000706:statistics & numerical data*; D011247:Pregnancy; D036301:Qualitative Research; D011787:Quality of Health Care; D012424:Rural Population / Q000706:statistics & numerical data; D014454:Uganda; D015024:Zambia
keywords: Disrespectful care; Health services; Maternal health; Neonatal care; Newborn care; Postnatal care; Qualitative methods; Uganda; Unintended consequences; Zambia