Postnatal period, from birth to the first six weeks, is the most crucial period for survival in which the majority of maternal and newborn deaths are the highest, particularly in the first week[1] According to the World Health Organization. later to an uncomplicated vaginal birth in a health facility, mothers should receive care in the facility for at least 24 hours after birth [1, 2]. and for home delivery, the first postnatal contact should be as early as possible within 24 hours. Besides, an additional three postnatal contacts (on 48 to 72 hours, between 7th and 14th days, and six weeks after birth) are recommended for all mothers and newborns[1–3].
Globally, there were an estimated 289,000 maternal deaths in 2013 and developing countries account for 99% of the global maternal deaths [4].The Sub-Saharan Africa region alone accounted for 62% of global deaths. Obstetric causes, notably, hemorrhage (27%), hypertensive diseases of pregnancy (14%), and sepsis (11%) account for a large proportion of maternal deaths An estimated 2.8 million neonates died worldwide in 2013, 1 million of these occurred on the first day [1, 3, 4] Complications from preterm birth (35%), intra partum related causes (24%) and severe infections (15%) are the leading direct causes of neonatal deaths. Inappropriate feeding and cultural practices following delivery may pose further risks to the life of the new born. Majority of the neonatal deaths also occur in developing countries, with the highest rate in sub-Saharan Africa (39% of global neonatal deaths) [2, 4]
According to the NDHS (2013), more than half (56 percent) of women did not receive any postnatal care [5] The survival and well-being of a woman and her new-born depends substantially on the care received during pregnancy, delivery and the postnatal period as a large number of maternal and neonatal deaths occur during the first 24 h after delivery [6] Neonatal mortality in the first week of life accounts for approximately 75 percent of all neonatal death and majority of these deaths occur in developing countries. Most of these new-born deaths are due to sepsis, asphyxia and problems associated with low birth weight [3, 6] Studies show that deaths within the first week of life account for almost 40% of all deaths among children under the age of five [1, 7] Also, about 700 babies die (around 30 every hour) on a daily basis in sub-Saharan Africa which has the highest number of new-born deaths in Africa, and the second highest in the world [8].
The health of mothers has been regarded as an indicator of the health of society The provision of services to the mother and their newborn has been set up for the prevention and reduction of maternal and neonatal deaths worldwide3.Postnatal care services help to safeguard women from complications and provide essential opportunities to assess the infant’s development[4, 9]. Evidence shows that the use of maternal and newborn health services during the postpartum period is influenced by many of socio-demographic, health service-related, and cultural factors [4, 10, 11].Multiple studies find parity, mother’s education, and a woman’s economic status are significant predictors for the utilization of maternity care [12, 13].Researchers also indicate that PNC utilization is affected by distance to facilities, area of residence, place and type of delivery [14–16].Studies indicated that the extent of PNC services utilization was associated with factors like maternal age, educational level, occupation, place and mode of delivery, number of pregnancies, awareness about obstetric-related danger sign, and awareness about PNC services. The determinants of utilization of PNC services are not also the same across different cultures and socioeconomic status within a society [4, 17–19].
Despite its importance, the postnatal period is generally the most neglected and underutilized services in developing countries, particularly Ethiopia, and most mothers do not receive care from a skilled health care provider during the first few days after delivery[3, 20]. A large proportion of maternal deaths occur during the first 48 hours after delivery that can be averted with crucial PNC services [4]. In developing countries, a fully functioning mother-baby package intervention has been estimated to have the postnatal cumulative effect of averting 75 to 85% of maternal death[21].Lack of PNC utilization may result in a number of complications. Of those, maternal and neonatal infections, incomplete immunization, frequent and mistimed pregnancies, severe postpartum hemorrhage which claims at least 22% of maternal deaths and which kills a woman within two hours in the absence of medical interventions were identified [22].