By Vijayetta Sharma
Postnatal care remains an unaddressed health priority, even as better delivery care has reduced Maternal Mortality Rate (MMR) across countries.
The life-threatening risks faced by pregnant women and newborns in Gaza with no access to postnatal care and nutrition is an urgent reminder for improving care in developing countries.
A recent study of 71 low- and middle-income countries showed that out of 76 percent of women who give birth in a health facility, only 41 percent received postnatal care interventions. Countries belonging to lower wealth quintiles reported wider care gaps.
In developing countries, including India, women’s self-care practices after childbirth—a barometer of their health awareness and cultural care norms—remain insignificant. This reduces visits to health centres for seeking health advice from medical professionals.
The main factors determining whether women utilise postnatal services are last pregnancy birth outcome, wantedness of pregnancy, place of delivery, educational status and monthly income.
A study from Ethiopia found that only 32.5 percent male partners participated in postnatal care service utilisation, which shows that decreased family influence or engagement impedes women from accessing postnatal services.
Globally, about 260,000 women died during and following pregnancy and childbirth in 2023. An estimated 48.9 percent of postpartum maternal deaths occurred within 24 hours of delivery, 24.5 percent between 2-7 days and 24.9 percent within 8-42 days.
Postnatal care not being effectively provided by health centres may stand in the way of achieving the Sustainable Development Goal target 3.1 of reduced MMR, while also perpetuating the non-caring attitude of women for future pregnancies.
The lag in postnatal care
The WHO recommends four postnatal care visits. The first checkup within 24 hours assesses maternal hemorrhage, infection and uterine involution (the shrinking back of the uterus to its nonpregnant size and weight), and checks neonatal breathing, feeding and temperature, with breastfeeding and Vitamin K initiation.
The second visit, 48–72 hours later, monitors maternal recovery, infection and anemia, and checks newborn weight gain for jaundice and feeding. Between 7–14 days, postpartum depression is screened, maternal health assessed, and newborn growth and immunisation evaluated.
At six weeks, the final maternal check includes a pelvic exam, contraception counseling and a full newborn exam with proper milestone tracking.
Although approximately one-quarter of maternal deaths occur during the later postnatal period, global statistical data repositories of WHO, UNICEF and NFHS predominantly focus on postnatal care within two days of delivery.
Most studies assessed postnatal care from the perspective of early facility-based visits (typically the first two), while neglecting follow-up visits later in the six-week period. This not only leaves postnatal care documentation and analysis underrepresented but also poorly understood.
While early postnatal care is improving in data reporting, follow-up visits —particularly beyond seven days — remain poorly documented across health systems, and in surveys such as Demographic and Health Surveys and Multiple Indicator Cluster Surveys .
The trends in Early Postnatal Care Coverage (percentage of women receiving postnatal care within two days) in India indicate a substantial increase in early coverage from 37 percent (NFHS-3) in 2005-06 to 78 percent (NFHS-5) in 2019-21.
As noted by this researcher in district Faridabad, Haryana in December 2024, among women with four antenatal care visits, 67.3 percent received no postnatal care, and only 11.2 percent completed all four postnatal care visits.
The researcher found that postnatal care services sharply decline among women belonging to the Scheduled Castes (60.1 percent), Other Backward Classes (72.7 percent), women earning below ₹5,000 per month (100 percent), those with less than Class 10 education (81.5 percent), and mothers aged 20–25 (70 percent)—despite high antenatal care coverage—due to poor follow-up systems, low health literacy, economic barriers and limited autonomy among younger and marginalised women.
A community health worker from district Faridabad stated that frequent shortages of essential medicines, including calcium tablets, reduced the motivation among new mothers to attend postnatal care check-ups.
Lack of infrastructure and basic services such as electricity, water and poor roads discourage women from seeking postnatal care, primarily due to diminished trust in the healthcare system.
Due to the absence of proper accommodation, adequate food, medicines and critical equipment like operating theatres, X-ray machines and labs, women often bypass nearby health centres for delivery in favor of better-equipped facilities.
An auxiliary nurse midlife from a primary health centre in Faridabad district stated, “Due to lack of essential equipment like X-rays and ultrasound machines, high-risk deliveries are often referred to better-equipped hospitals, which not only delays care but also discourages women from seeking postnatal care at local health centers.”
Some beneficiaries of Janani Suraksha Yojana, a nodal scheme under the National Health Mission to promote institutional deliveries, remarked that lack of clean drinking water, power outages and absence of heating facilities during winters made community health centres less conducive for deliveries and postnatal visits.
Bridging the care gap
Institutional delivery care not translating into postnatal care puts women’s lives at stake. Identifying the reasons for women missing postnatal care follow-ups, whether for institutional or personal reasons, can be the first step towards addressing this vital issue.
State governments can make visible improvements in postnatal care by providing high quality care in health facilities with superior infrastructure, timely treatment support and advice, and encouraging spousal involvement as part of postnatal checkups.
Better delivery care is a gateway to utilising postnatal care services at health centres, and can also improve overall attitudes of compassion, respect and care given to women during childbirth.
Devising an index for Maternal First Pregnancy Mortality (MFPM) and Maternal Second or Later Pregnancy Mortality (MSLPM) can help identify the incidents of death occurring due to missed postnatal care. The service gaps arising from systemic inadequacies can be seen in women’s declining use of postnatal care services from their first pregnancy to subsequent ones, which pose health challenges depending on other structural and personal conditions over that period.
Policy implications for strengthening health facility infrastructure, protocols for providing compassionate care, follow-up care reminders, medical staff readiness for strengthening maternal health in policy and practice, and designing local strategies prioritising comfort and ease of women from different communities can significantly improve postnatal health outcomes.
Making motherhood safer is both a human rights imperative and a vital indicator of effective policy and systemic accountability. Women’s experience of safe and dignified deliveries can build trust, promote continued postnatal care, and transform community attitudes toward institutional health services.
The article is an outcome of a Seed Money Project funded by Manav Rachna International Institute of Research and Studies, Faridabad, Haryana.
Dr. Vijayetta Sharma is Associate Professor of Public Policy at Manav Rachna International Institute of Research and Studies. She has been a Post-doctoral Research Fellow in Information Science at Indian School of Business (ISB). Her research areas are maternal and child health, health policy, and governance.
Originally published under Creative Commons by 360info™.
