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Effect of Postnatal Care Services on Postnatal Care Attendance among Mothers in Nigeria

Abstract

The postnatal period is a critical stage in maternal and newborn health because mothers and newborns may experience complications that require timely assessment, counselling, treatment, and follow-up. Postnatal care provides an important opportunity to identify and manage maternal and newborn health problems, promote breastfeeding, provide family planning counselling, assess maternal recovery, monitor newborn wellbeing, and educate mothers on appropriate home care and danger signs. Despite the importance of postnatal care, many mothers in Nigeria do not attend recommended postnatal services or may not receive adequate follow-up after childbirth. Factors such as inadequate availability of postnatal services, limited access to healthcare facilities, long distance to facilities, financial barriers, inadequate staffing, poor quality of care, limited health information, and inconvenient service arrangements may discourage postnatal care attendance. Postnatal care services refer to the availability and provision of appropriate maternal and newborn healthcare services after childbirth, including maternal assessment, newborn assessment, breastfeeding support, counselling, family planning services, immunization-related services, screening, treatment, referral, and follow-up care. Postnatal care attendance refers to a mother's utilization of postnatal healthcare services within the recommended period after delivery. Against this background, this study investigates the effect of postnatal care services on postnatal care attendance among mothers in Nigeria. The study will be anchored on Andersen's Behavioral Model of Health Services Use, the Health Belief Model, and the Health Systems Framework. Andersen's Behavioral Model explains healthcare utilization through predisposing, enabling, and need-related factors and provides a framework for understanding how the availability and characteristics of healthcare services influence utilization. The Health Belief Model explains health-seeking behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action. The Health Systems Framework recognizes service delivery, health workforce, health information, medical technologies, and access to essential health services as important components of an effective healthcare system. Collectively, these theoretical perspectives provide a suitable framework for explaining how postnatal care services may influence postnatal care attendance among mothers in Nigeria. The study will adopt a quantitative cross-sectional research design. Data will be collected from mothers who have delivered within the relevant study period and are attending selected healthcare facilities or residing in selected communities across Nigeria. A multistage sampling technique will be used to select states, local government areas, healthcare facilities, communities, and eligible mothers. Postnatal care services will be assessed using indicators such as availability of maternal and newborn assessment, availability of trained healthcare personnel, breastfeeding counselling, family planning services, maternal danger-sign assessment, newborn danger-sign assessment, immunization-related services, mental health support, health education, referral services, follow-up arrangements, accessibility, affordability, privacy, and service operating hours. Postnatal care attendance will be assessed using indicators such as attendance at postnatal visits, timing of the first postnatal visit, number of postnatal visits attended, attendance within the recommended postnatal period, and completion of recommended follow-up visits. Structured questionnaires will be used for data collection, while maternal and child health records may be reviewed where available to validate reported attendance. Descriptive statistics will be used to summarize participants' characteristics, availability of postnatal care services, and attendance patterns. Inferential statistical techniques, including chi-square tests, correlation analysis, and multiple regression analysis, will be used to determine the effect of postnatal care services on postnatal care attendance. Diagnostic tests will also be conducted to assess the reliability of research instruments and the robustness of the findings. The study is expected to find that adequate availability and quality of postnatal care services have a significant positive effect on postnatal care attendance among mothers in Nigeria. Mothers who have access to accessible, affordable, comprehensive, respectful, and well-staffed postnatal services are expected to be more likely to attend postnatal visits within the recommended period and complete appropriate follow-up care. Availability of maternal and newborn assessments, breastfeeding support, family planning counselling, health education, and referral services may increase the perceived value of postnatal care and encourage continued attendance. Convenient service locations and operating hours may also reduce practical barriers to attendance. Conversely, limited service availability, inadequate staffing, poor service organization, long waiting times, financial barriers, and lack of essential postnatal services may discourage mothers from attending postnatal visits. However, postnatal care service availability alone may not fully determine attendance because maternal knowledge, household support, socioeconomic circumstances, distance to healthcare facilities, cultural practices, previous healthcare experiences, and perceived need for postnatal care may also influence attendance. The study is expected to contribute to the literature on postnatal care, maternal health, newborn health, healthcare utilization, reproductive health, community health, epidemiology, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, state ministries of health, primary healthcare authorities, hospitals, maternity facilities, healthcare workers, maternal and newborn health programme managers, development partners, and policymakers regarding strategies for improving postnatal care utilization. The study will also provide evidence-based recommendations for strengthening postnatal care services, ensuring adequate staffing, improving service accessibility and affordability, strengthening maternal and newborn counselling, improving follow-up and referral systems, increasing community awareness of the importance of postnatal care, and integrating comprehensive postnatal services into routine maternal and child healthcare programmes across Nigeria.

Keywords: Postnatal care services, postnatal care attendance, mothers, Nigeria, maternal health, newborn health, healthcare utilization, reproductive health, primary healthcare, maternal and child health, public health.