# Factors affecting postnatal care service utilization in Pyuthan district: A mixed method study

## TL;DR

This study explores why postnatal care services are underused in Nepal's Pyuthan district, finding that socioeconomic factors and access to knowledge and transportation are key.

## Contribution

The study combines quantitative and qualitative methods to identify novel predictors and barriers to postnatal care utilization in a specific Nepali district.

## Key findings

- 38.43% of mothers utilized postnatal care services as per protocol.
- Knowledge of postnatal care and socioeconomic status were strong predictors of service utilization.
- Transportation and road access significantly influenced postnatal care service use.

## Abstract

The first hours, days, and weeks following childbirth are critical for the well-being of both the mother and newborn. Despite this significance, the postnatal period often receives inadequate attention in terms of quality care provision. In Nepal, the utilization of postnatal care (PNC) services remains a challenging issue. Employing a facility-based concurrent triangulation mixed-method approach, this study aimed to identify factors associated with PNC service utilization, as well as its facilitators and barriers. A quantitative survey involved 243 mothers who had given birth in the six months preceding the survey, selected using a multistage sampling technique from six health facilities of two randomly selected local levels of the Pyuthan district. Weighted multivariate logistic regression was employed to identify predictors of PNC service utilization. Additionally, qualitative analysis using Braun and Clarke’s six-step thematic analysis elucidated facilitators and barriers. The study revealed a weighted prevalence of PNC service utilization as per protocol at 38.43% (95% CI: 32.48–44.74). Notably, Socioeconomic status (AOR-3.84, 95% CI: 2.40–6.15), place of delivery (AOR-1.86, 95% CI: 1.16–3.00), possessing knowledge of postnatal care (AOR = 6.75, 95% CI: 3.39–13.45) and access to a motorable road (AOR = 6.30, 95% CI: 3.94–10.08) were identified as predictors of PNC service utilization. Triangulation revealed knowledge on PNC, transportation facilities, PNC home visits, and postpartum weaknesses to visit health facility as areas of convergence. Conversely, divergent areas included the proximity of health facilities and the effect of COVID-19. The study identified a low prevalence of PNC service utilization in the district. To enhance utilization, targeted interventions to increase awareness about postnatal care, appropriate revision of existing policies, addressing wider determinants of service utilization, and ensuring effective implementation of PNC home-visit programs are of utmost importance.