Left Behind After Birth: A Cross-Sectional Analysis of Factors Associated With Postnatal Care Use in Sub-Saharan Africa

Background
Global commitment towards improving maternal and newborn health outcomes is pronounced, yet this is yielding little results as gaps in postnatal care (PNC) coverage persist across sub-Saharan Africa (SSA). Low uptake of PNC partly contributes to preventable maternal and neonatal morbidity and mortality within the early days after birth. A better understanding of the individual, systemic and contextual factors influencing PNC uptake is vital for shaping effective policies and targeted interventions. This study explores the prevalence and factors associated with PNC utilisation among women and newborns across 27 SSA countries, aiming to identify key factors influencing service uptake to inform targeted interventions.

Methods
We used data from the Demographic and Health Surveys (2015–2024), including 136,721 women aged 15–49 who had a live birth within 2 years of the survey. Andersen′s behavioural model guided the selection of predisposing, enabling and need factors. Multivariable logistic regression was employed to identify determinants of PNC utilisation for both mothers and newborns, adjusting for sampling design.

Results
The overall prevalence of PNC utilisation was 75.24% for mothers and 79.37% for children. PNC coverage varied significantly across countries, with the highest maternal utilisation in Ghana (94.9%) and the lowest in Malawi (47.5%). For newborns, coverage ranged from 96.7% in South Africa to 43.1% in Ethiopia. Significant factors associated with PNC uptake included caesarean delivery (AOR = 3.64; 95% CI: 3.33–3.98), four or more antenatal visits (AOR = 1.24; 95% CI: 1.20–1.29), higher maternal education (AOR = 1.32; 95% CI: 1.17–1.49), health insurance, employment status and frequent media exposure. Conversely, women with unintended pregnancies and limited access to health information were less likely to utilise PNC services.

Conclusion
PNC utilisation in SSA remains suboptimal and uneven. Addressing barriers related to education, healthcare access, media exposure and financial protection is essential to improving postnatal outcomes. Targeted, context-specific strategies are needed to accelerate progress towards achieving Sustainable Development Goal 3 in the region.