Postnatal Care Experiences and Barriers to Care Utilization for Home- and Facility-Delivered Newborns in Uganda and Zamb
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Postnatal Care Experiences and Barriers to Care Utilization for Home- and Facility-Delivered Newborns in Uganda and Zambia Emma Sacks1,2 • Tsitsi B. Masvawure1,3 • Lynn M. Atuyambe4 • Stella Neema4 Mubiana Macwan’gi5 • Joseph Simbaya5 • Margaret Kruk6
•
Springer Science+Business Media New York 2016
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, & Emma Sacks [email protected] 1
Department of Epidemiology, Columbia University Medical Center, 722 W 168 Street, New York, NY 10032, USA
2
USAID Maternal and Child Survival Program (MCSP)/ICF International, Washington, DC, USA
3
Department of Sociology and Anthropology, College of the Holy Cross, Worcester, MA, USA
4
Makerere School of Public Health, Kampala, Uganda
5
Institute for Social and Economic Research, University of Zambia, Lusaka, Zambia
6
Department of Global and Population Health, Harvard School of Public Health, Boston, MA, USA
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. Keywords Newborn care Neonatal care Postnatal care Maternal health Disrespectful care Health services Qualitative methods Unintended consequences Uganda Zambia
Significance There are limited data on barriers to postnatal care utilization. Analyses of 48 focus groups of a maternal mortality initiative in Uganda and Zambia indicate that barriers to postnatal care utilization may include actual or threatened denial of care and fear of mistreatment for homedelivered newborns and their mothers. Cos
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