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Effect of Postpartum Home Visits on Postpartum Care Utilization among Mothers in Nigeria

Abstract

The postpartum period is a critical stage of maternal healthcare during which women may experience physical, emotional, and psychological challenges following childbirth. Timely postpartum care is essential for identifying and managing complications, supporting breastfeeding, providing family planning services, assessing maternal recovery, and promoting healthy practices for mothers and newborns. However, postpartum care utilization remains inadequate among some mothers in Nigeria due to geographical barriers, transportation difficulties, financial constraints, limited awareness, cultural practices, inadequate follow-up systems, and restricted access to healthcare facilities, particularly in underserved communities. Postpartum home visits provide an opportunity for healthcare workers to deliver essential maternal health services directly to mothers within their homes, thereby reducing some barriers to facility-based postpartum care. Such visits may include maternal assessments, health education, breastfeeding support, family planning counselling, screening for postpartum complications, psychological support, and referral to healthcare facilities when necessary. Against this background, this study investigates the effect of postpartum home visits on postpartum care utilization among mothers in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and Andersen's Behavioral Model of Health Services Use. The Health Belief Model explains how mothers' perceptions of postpartum health risks, perceived severity of complications, perceived benefits of postpartum care, perceived barriers, and cues to action may influence their utilization of postpartum services. The Social Ecological Model emphasizes the influence of individual, family, community, healthcare-system, and environmental factors on postpartum healthcare utilization. Andersen's Behavioral Model explains how predisposing characteristics, enabling resources, and healthcare needs influence mothers' use of postpartum healthcare services. Collectively, these theoretical perspectives provide a suitable framework for explaining how postpartum home visits may influence postpartum care utilization among mothers in Nigeria. The study will adopt a quantitative analytical cross-sectional or quasi-experimental research design. The study population will comprise mothers who have recently given birth and are within the defined postpartum period in selected communities and healthcare facilities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, healthcare facilities, households, and eligible mothers. Postpartum home visits will be assessed using indicators such as availability of home-visit services, number and frequency of visits, timing of the first visit, duration of visits, healthcare worker involvement, maternal health assessment, breastfeeding support, family planning counselling, postpartum health education, screening for maternal complications, newborn assessment where applicable, referral services, follow-up arrangements, and continuity of care. Postpartum care utilization will be assessed using indicators such as attendance at postpartum clinic visits, completion of recommended postpartum contacts, maternal health assessments, postpartum complication screening, breastfeeding support, family planning service utilization, maternal counselling, newborn-related postpartum services, and timely use of healthcare services when complications occur. Data will be collected using structured questionnaires, postpartum home-visit records, maternal healthcare registers, referral records, community health worker records, and relevant maternal and child health programme documents. Descriptive statistics will be used to summarize participants' characteristics, exposure to postpartum home visits, and patterns of postpartum care utilization. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of postpartum home visits on postpartum care utilization. Where a quasi-experimental design is adopted, postpartum care utilization before and after implementation of a structured home-visit programme may be compared, while relevant demographic, socioeconomic, obstetric, geographical, and healthcare-access factors are appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that postpartum home visits have a significant positive effect on postpartum care utilization among mothers in Nigeria. Mothers who receive timely and regular postpartum home visits are expected to demonstrate higher utilization of recommended postpartum services than mothers without access to home-based follow-up. Home visits may improve access to maternal health assessments, breastfeeding support, family planning counselling, health education, early identification of postpartum complications, and referral services. Bringing postpartum care closer to mothers may reduce transportation and geographical barriers while allowing healthcare workers to identify challenges within the home environment and provide individualized support. However, inadequate staffing, irregular home visits, limited funding, poor transportation for community health workers, cultural practices, inaccurate household information, and weak referral systems may limit the effectiveness of home-based postpartum services. The study therefore expects accessible, regular, adequately resourced, and well-coordinated postpartum home-visit programmes to contribute significantly to improved postpartum care utilization among mothers in Nigeria. The study is expected to contribute to the literature on postpartum home visits, postpartum care utilization, maternal healthcare, community-based maternal services, maternal and newborn health, primary healthcare, continuity of care, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, local government health authorities, primary healthcare centres, hospitals, community health workers, maternal and child health programmes, development partners, and policymakers regarding strategies for strengthening postpartum care. The study will also provide evidence-based recommendations for expanding postpartum home-visit services, improving community health worker capacity, strengthening postpartum referral and follow-up systems, integrating home visits into routine primary healthcare, improving maternal health education and breastfeeding support, and ensuring continuity between home-based services and facility-based postpartum care across Nigeria.

Keywords: Postpartum home visits, postpartum care utilization, mothers, maternal healthcare, community-based maternal care, postpartum follow-up, maternal health, primary healthcare, home-based care, Nigeria, public health.