Women’s Utilisation, Experiences and Satisfaction with Postnatal Follow-up Care Systematic literature review *Amal Al Hadi,1,2 Michelle Paliwoda,2 Jennifer Dawson,3 Karen Walker,4,5 Karen New2,6 Sultan Qaboos University Med J, November 2022, Vol. 22, Iss. 4, pp. 455–471, Epub. 7 Nov 22 Submitted 8 Dec 21 Revision Req. 19 Jan 22; Revision Recd. 28 Jan 22 Accepted 2 Mar 22 1Midwifery Program, Higher Institute of Health Specialities, Muscat, Oman; 2School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia; 3Newborn Research Centre, The Royal Women’s Hospital, Melbourne, Australia; 4Newborn Care, Royal Prince Alfred Hospital, Sydney, Australia; 5Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; 6School of Health and Behavioural Science, University of the Sunshine Coast, Queensland, Australia *Corresponding Author’s e-mail: a.alhadi@uq.net.au The maternity continuum includes postpartum care, which is delivered following childbirth, most commonly over a six-week period and comprises three stages: the immediate stage (0–24 hours after birth), the early stage (days 2–7) and the late stage (days 8–42).1 Care during the immediate stage is mostly administered in birth facilities, whereas early- and late-stage care is community-based. Care during the postnatal period is as important as antenatal and intrapartum care as complications can arise, resulting in adverse outcomes and leading to increased morbidity and mortality for the mother and/or newborn.1 Moreover, determining women’s satisfaction with postnatal care is essential as it has a direct influence on the utilisation of the postnatal follow-up care.2 Utilisation of healthcare services is crucial for not only women’s physical health but also their mental health. Early detection and management of postnatal mental health conditions such as anxiety and depression are vital, as such conditions have a significant impact not only on the woman but also upon the well-being of the newborn and the entire family.3 The World Health Organization (WHO) recom- mends that mothers and newborns receive postnatal care at the birthing facility for at least 24 hours.4 However, birthing facilities (e.g. hospitals) in many countries discharge women and their newborns before that time.5 A systematic review by Campbell et al. reported that the length of stay in birthing facilities has decreased, with women staying less than 24 hours following vaginal birth and less than 72 hours following a caesarean section.6 Kumar and Dhillon reported that early discharge underpins the lack of early detection and management of complications for both the mother and the newborn, which increases the risk of morbidity and mortality.7 Early discharge is also associated with increased neonatal readmission within 28 days of birth and increased risks of maternal postpartum depression.5,8 Immediate postnatal care is focused on the immediate general well-being of the mother and newborn following childbirth and involves treating complications, such as infections, perineal pain, vaginal discharge and excessive bleeding and supporting breastfeeding.7,9 Early and late postnatal care tends to focus on maximising maternal and newborn health and well-being through health monitoring and health promotion during postnatal follow-up care.10 This may include screening for maternal postpartum depression, checking and treating childbirth-related complications and having discussions on parenting and family planning.4,11 For the newborn, this covers breastfeeding support, monitoring of the newborn’s growth, development and overall health and referrals for specialised care, if required.1 Additionally, while becoming a new parent is exciting, it can also be a stressful time, particularly for first-time parents and those without strong social support and role models.12 Thus, early and late postnatal periods are REVIEW This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License. https://doi.org/10.18295/squmj.10.2022.059 abstract: Postnatal follow-up care is reported to be the ‘underutilised’ aspect of the maternity care continuum. This review explores women’s utilisation of early and late postnatal follow-up and their experiences and satisfaction with it. Five online databases were searched for English or Arabic articles published between 2011 and 2021. Methodological quality of included studies was assessed using the Mixed Methods Appraisal Tool; the Andersen healthcare utilisation model was the framework for data analysis. A total of 19 articles met all inclusion criteria. Utilisation facilitators included complications, travel distance, knowledge of the importance for attending and being offered a telephone call and home visit or clinic visit as options for follow-up. Impediments included lack of perceived need and not being provided with information about postnatal care. Comprehensive discussions with and examination by health providers were reported as positive experiences and influenced repeat utilisation. Dissatisfaction was associated with inconsistent information provided by health providers. Keywords: Postpartum Period; Postnatal Care; Women; Literature Review. https://creativecommons.org/licenses/by-nd/4.0/ Women’s Utilisation, Experiences and Satisfaction with Postnatal Follow-up Care Systematic literature review 456 | SQU Medical Journal, November 2022, Volume 22, Issue 4 important periods during which education from health professionals has the potential to influence positive parenting experiences and healthy child development.12 Forster et al. found that the majority of mothers (90%) viewed their experiences of a flexible model of care, which included early hospital discharge (within 12 hours) and four planned home visits, as positive; the majority (88%) of mothers indicated their willingness to participate in this model of care again.13 Additionally, Yonemoto et al.’s Cochrane systematic review found that home visits were associated with reduced newborn re-admissions in the weeks following birth, continued and exclusive breastfeeding and increased maternal satisfaction with postnatal care.14 The importance of postnatal contacts by healthcare professionals has been further emphasised by the WHO via the recommendation of three contacts following discharge from a health facility or home birth, in line with target three of the Sustainable Development Goals (SDGs).4,15 Thus, scheduled contacts and home visits during the postnatal period are essential to ensuring the ongoing monitoring of maternal and newborn health and well- being. National and international guidelines and recomm- endations for immediate, early and late postnatal care following birth at a health facility or at home have been developed by many countries, professional organisations and professional groups.4,11,16–19 Postnatal follow-up is provided in the early and late stages and it appears to vary from two postnatal visits around two and six weeks after birth to three visits starting at day three (47–72 hours), between days seven and 14 and at 42 days after birth.4,16 Additionally, there are reports in the literature that postnatal follow-up care is the “neglected”, under offered and/or underutilised aspect of the maternity care continuum.3,4,20 This may result in lost opportunities for health promotion and monitoring of mothers and their newborns. Promoting postnatal follow-up care is important to the whole family unit as mothers often have the role and responsibility of overseeing the family’s health in both health promotion and illness prevention and of managing ill health.21 Although there are many studies reporting on satisfaction and experiences of immediate postnatal care, less is known about the factors that influence women’s decisions with regard to utilising early and late postnatal follow-up and their experiences and satisfaction with care received. Thus, this review aimed to explore women’s utilisation of early and late postnatal follow-up and their experiences and satisfaction with it. Methods This systematic review used the population, exposure and outcome framework to guide the search strategy instead of the population, intervention, comparison and outcome, as the purpose of this review was not to investigate or compare exclusive interventions. Several preliminary searches were performed to identify commonly used keywords and the final search strategy was developed in collaboration with a senior librarian. Wildcard symbols were used in line with database requirements and Medical Subject Headings (MeSH; US National Library of Medicine, Bethesda, Maryland, USA) for PubMed (US National Library of Medicine) and Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCO Information Services, Ipswich, Massachusetts, USA) databases, where appropriate. For example, the question mark symbol “?” was used when searching for words that can be spelt with both an ‘s’ or a ‘z’ (utilisation/utilization) or for words with singular and plural forms (woman/ women). Between March and April 2021, PubMed (US National Library of Medicine), CINAHL (EBSCO Information Services), Scopus (Elsevier, Amsterdam, the Netherlands), Web of Science (Clarivate Analytics, Philadelphia, Pennsylvania, USA) and Google Scholar (Google LLC, Mountain View, California, USA) electronic databases were systematically searched using the English search terms “wom?n”, “maternal”, “post-partum period”, “post-partum care”, “postnatal care”, “postnatal follow-up”, “home-based”, “utili?ation”, “experience” and “satisfaction”. The language filter was not applied. Primary studies of any study design that reported one or more of the outcomes of women’s utilisation of or experience or satisfaction with early (2–7 days) or late (8–42 days) postnatal care, irrespective of birth setting (e.g. hospital, health centre, home), were eligible for inclusion. Full text publications in English or Arabic were eligible for inclusion; however, no studies published in Arabic were retrieved. Publications in which data collection occurred within the last 10 years (between January 2011 and July 2021) and within one year of childbirth were eligible. The search parameter was limited to articles published with data collected within the last 10 years to capture recent perspectives from women on postnatal service utilisation, experiences and satisfaction and to limit potential variation in practice change that may have occurred along with changes that have occurred around antenatal and intrapartum care. Studies were excluded if the data included immediate postnatal care and if the data specifically for early and/or late Amal Al Hadi, Michelle Paliwoda, Jennifer Dawson, Karen Walker and Karen New Review | 457 follow-up could not be extracted. Likewise, studies in which the views and experiences of women and their support network (partners or other family members) were presented collaboratively and wherein women’s responses could not be extracted were excluded. Abstracts, thesis, conference proceedings and secondary studies were also excluded. Search results were uploaded into Zotero reference management software, Version 5.0.96.2. Following the removal of duplicates, title and abstract screening was undertaken independently by three reviewers (AH, JD and MP) and arbitrated by a fourth reviewer (KN), if needed. Review of full texts was undertaken independently by three reviewers (AH, JD and MP) and the opinion of a fourth reviewer (KN) was sought to reach a final decision regarding eligibility when needed. A data extraction spreadsheet was developed by the review team. Data were extracted by one reviewer (AH) and verified by two others (MP and KN). Any disagreements were discussed to reach consensus. The review team continuously discussed and validated decisions made during all stages of the review process. The Mixed Methods Appraisal Tool (MMAT) 2018 was used to appraise the included studies as this tool permits the appraisal of qualitative, quantitative descriptive, mixed methods and non-randomised studies and randomised controlled trials.22 Quality assessment is undertaken by answering ‘yes’, ‘no’ or ‘can’t tell’ for five methodological quality criteria specific to each study design. For this review, a quality rating was assigned using a star (*) rating system from one star (20% of quality criteria met = one criterion received yes) to five stars (100% of quality criteria met = five criteria received yes).23 Two reviewers (AH and MP) independently assessed the quality of the included studies and discrepancies were resolved via discussions or the involvement of a third reviewer.24 The data analysis framework was based on the Andersen healthcare utilisation model of predisposing factors, enabling (and impeding) factors and need factors.25 As the review contained quantitative and qualitative studies, numerical data on utilisation and factors reported qualitatively that facilitated or impeded utilisation, influenced experiences positively or negatively and resulted in satisfaction or dissatisfaction with care received were summarised. Results A total of 172 articles were identified as potentially eligible. Following the removal of duplicates and the screening and data extraction processes, a total of 19 studies met the eligibility criteria for inclusion in this review [Figure 1]. Figure 1: Flowchart showing the article selection process. CINAHL = Cumulative Index to Nursing and Allied Health Literature. Women’s Utilisation, Experiences and Satisfaction with Postnatal Follow-up Care Systematic literature review 458 | SQU Medical Journal, November 2022, Volume 22, Issue 4 T ab le 1 : C ha ra ct er is ti cs o f i nc lu de d st ud ie s an d th e M ix ed M et ho ds A pp ra is al T oo l 2 01 8 qu al it y ra ti ng A ut ho r an d ye ar o f pu bl ic at io n C ou nt ry Pa rt ic ip an ts M et ho do lo gi ca l c ha ra ct er ist ic s P os tn at al fo ll ow -u p fi n di n gs M M A T qu al ity ra tin g U til is at io n Ex pe ri en ce s Sa tis fa ct io n A bu ka A be bo a nd Je m be r Te sf ay e2 6 (2 01 8) Et hi op ia N = 4 01 w om en a ge d 15 – 49 y ea rs w ho h ad a li ve bi rt h w ith in on e ye ar p ri or to th e su rv ey St ud y de si gn : C om m un ity -b as ed c ro ss - se ct io na l s tu dy D at a co lle ct io n: S tr uc tu re d, c lo se d- en de d, in te rv ie w er -a dm in is te re d, p re -t es te d qu es tio nn ai re c on du ct ed in 2 01 6 Sa m pl in g: S tr at ifi ed r an do m PN C w as u til is ed b y 19 1 (4 7. 6% ) w om en b et w ee n on e an d 42 d ay s af te r bi rt h. Fa ct or s t ha t f ac ili ta te d ut ili sa ti on : - M at er na l e du ca tio n, o cc up at io n, h ou se ho ld m on th ly in co m e an d jo in t d ec is io n- m ak in g (h us ba nd /w ife d ya d) - Th e gr ea te r nu m be r of A N C v is it s w as a ss oc ia te d w ith in cr ea se d po st na ta l u til is at io n. A w ar en es s of a t l ea st o ne p os tp ar tu m d an ge r si gn w as a ls o as so ci at ed w ith in cr ea se d ut ili sa tio n. Fa ct or s t ha t i m pe de d ut ili sa ti on : Bi rt hi ng a t h om e w as a ss oc ia te d w ith d ec re as ed ut ili sa tio n. N ot r ep or te d N ot r ep or te d ** ** * A lm al ik 44 (2 01 7) Jo rd an N = 1 50 w om en , a ge d 17 – 46 y ea rs , re cr ui te d on th e da y of h os pi ta l di sc ha rg e w ith a fo llo w -u p at 6 – 8 w ee ks po st na ta lly St ud y de si gn : P ro sp ec tiv e co ho rt s tu dy D at a co lle ct io n: S el f- ad m in is tr at ed po st pa rt um le ar ni ng n ee ds o n a 50 -i te m s ca le co m pl et ed o n th e da y of d is ch ar ge ; a t 6 – 8 w ee ks a ft er g iv in g bi rt h, w om en w er e as ke d to c om pl et e th e po st pa rt um p er ce iv ed m et le ar ni ng n ee ds s ca le fo llo w in g a po st pa rt um ch ec k- up a t a h ea lth c en tr e. D at a co lle ct io n oc cu rr ed in 2 01 5. Sa m pl in g: C on ve ni en ce s am pl in g 11 7 (7 8% ) w om en a tt en de d th e he al th c en tr e fo r a po st pa rt um c he ck -u p be tw ee n 6 an d 8 w ee ks . - W om en w ho w er e ol de r, w er e em pl oy ed , ha d a hi gh er le ve l o f ed uc at io n, h ad r eg ul ar at te nd an ce a t A N C vi si ts , h ad a c ae sa re an se ct io n an d w an te d m or e in fo rm at io n, “h ad hi gh er le ar ni ng n ee ds ”. - Pr im ar y un m et le ar ni ng n ee ds w er e da ng er s ig ns p os t- ca es ar ea n se ct io n, ph ys ic al c ha ng es , br ea st fe ed in g an d ne w bo rn c ar e. N ot r ep or te d ** ** B el ih u an d D er es sa 27 (2 02 0) Et hi op ia N = 3 32 w om en w ith a m ea n ag e of 2 7. 8 ye ar s w ho h ad g iv en bi rt h w ith in si x w ee ks a nd at te nd ed o ne of fo ur h ea lth ce nt re s fo r ea rl y po st na ta l fo llo w -u p ca re (w ith in o ne w ee k) St ud y de si gn : I ns tit ut io n- ba se d cr os s- se ct io na l s tu dy D at a co lle ct io n: S tr uc tu re d in te rv ie w er - ad m in is te re d qu es tio nn ai re d es ig ne d fo r th e st ud y ba se d on ‘d iff er en t l ite ra tu re s an d m od ifi ed fo r th e ob je ct iv e of th e st ud y’ to as se ss P N C u til is at io n at o ne w ee k af te r de liv er y. D at a co lle ct io n oc cu rr ed in 2 01 8. Sa m pl in g: S ys te m at ic s am pl in g PN C w as u til is ed b y on ly 8 4 (2 5. 3% ) w om en w ith in th e fir st w ee k. Fa ct or s th at fa ci lit at ed e ar ly u til is at io n: C om pl ic at io ns d ur in g la bo ur a nd d el iv er y, li vi ng w ith in 3 0 m in ut es o f a h ea lth c en tr e, b ei ng a w ar e th at th ey s ho ul d at te nd fo r PN C w ith in o ne w ee k. Fa ct or s th at im pe de d ea rl y ut ili sa tio n: B ei ng u ni nf or m ed a nd /o r no t g iv en a n ap po in tm en t f or a tt en di ng c ar e in o ne w ee k, b ut fo r si x w ee ks , l iv in g m or e th an a 3 0- m in ut e w al k aw ay fr om th e he al th c en tr e, p ar tn er s el f- em pl oy ed (e .g ., fa rm er ) a nd c ul tu ra l r ea so ns (n ot s pe ci fie d) -Th e m aj or ity o f w om en re po rt ed th e ne ed fo r ad vi ce o n m at er na l a nd ne on at al p os tp ar tu m co m pl ic at io ns . N ot r ep or te d * M M AT = M ix ed M et ho ds A pp ra is al T oo l; PN C = p os tn at al c ar e; A N C = a nt en at al c ar e; G P = ge ne ra l p ra ct iti on er ; E D H S = Et hi op ia n D em og ra ph ic a nd H ea lth S ur ve ys ; W H O = W or ld H ea lth O rg an iz at io n; IP H S = In di an P ub lic H ea lth St an da rd s. Amal Al Hadi, Michelle Paliwoda, Jennifer Dawson, Karen Walker and Karen New Review | 459 T ab le 1 (c on t’d .): C ha ra ct er is ti cs o f i nc lu de d st ud ie s an d th e M ix ed M et ho ds A pp ra is al T oo l 2 01 8 qu al it y ra ti ng A ut ho r an d ye ar o f pu bl ic at io n C ou nt ry Pa rt ic ip an ts M et ho do lo gi ca l c ha ra ct er ist ic s P os tn at al fo ll ow -u p fi n di n gs M M A T qu al ity ra tin g Br od ri bb e t al .40 (2 01 3) A us tr al ia N = 8 8 w om en , in cl ud in g 18 w om en a ge d 21 – 41 y ea rs , in vo lv ed in th e pi lo t s tu dy , re cr ui te d in ho sp ita l a ft er ch ild bi rt h an d fo llo w ed -u p ap pr ox im at el y 10 w ee ks af te r bi rt h; 70 w om en , ag ed 2 1– 39 ye ar s, w ho h ad gi ve n bi rt h le ss th an tw o ye ar s pr io r an d pa rt ic ip at ed in an e va lu at io n st ud y St ud y de si gn : Q ua lit at iv e st ud ie s. -Th e pi lo t s tu dy in ve st ig at ed p ri m ar y ca re se rv ic es w om en a cc es se d du ri ng th e ei gh t- w ee k po st pa rt um p er io d. -Th e se co nd s tu dy e va lu at ed a u ni ve rs al po st na ta l c on ta ct s er vi ce (i nc lu di ng p ho ne co nt ac t o r a ho m e vi si t w ith in 1 0 da ys o f di sc ha rg e po st -b ir th ). -D at a w er e an al ys ed to ge th er b ec au se b ot h st ud ie s as ke d si m ila r qu es tio ns r eg ar di ng po st pa rt um c ar e in th e co m m un ity . D at a co lle ct io n: D at a w er e co lle ct ed u si ng se m i- st ru ct ur ed , f ac e- to -f ac e in te rv ie w s co nd uc te d be tw ee n 20 10 a nd 2 01 2 (s tu dy 1 ) an d in 2 01 1 (s tu dy 2 ). Sa m pl in g: N ot r ep or te d -W om en d id n ot a pp ea r to b e gi ve n co ns is te nt in fo rm at io n ab ou t w he n th ey s ho ul d vi si t t he ir G P fo r m at er na l a nd n ew bo rn p os tp ar tu m c he ck -u ps . -F ir st p os tp ar tu m v is it ra ng ed fr om fi ve d ay s to 2. 5 m on th s, w ith m os t v is it s ar ou nd s ix w ee ks , co m m on ly fo r th e ne w bo rn im m un is at io ns . -S om e w om en fo llo w ed in st ru ct io ns g iv en in th e ne w bo rn p er so na l h ea lth r ec or d bo ok (r ec om m en da tio n: a tt en d G P w ith in th e fir st fo ur w ee ks ). Fa ct or s th at fa ci lit at ed u til is at io n: E xp lic it in fo rm at io n/ in st ru ct io ns (W om en w ho b ir th ed in th e pu bl ic s ec to r co m pa re d to th e pr iv at e se ct or re po rt ed h av in g re ce iv ed e xp lic it in st ru ct io ns fr om a m id w ife to a tt en d th ei r G P in th e fir st tw o w ee ks af te r ch ild bi rt h, e sp ec ia lly if th ey w er e di sc ha rg ed w ith in 4 8 ho ur s of b ir th .)F ac to rs th at im pe de d ut ili sa tio n: L ac k of k no w le dg e re ga rd in g th e re as on s fo r fo llo w -u p po st -b ir th , n o pr ob le m s w er e ev id en t, w er e m ul tip ar ou s, e xp er ie nc ed a s en se o f ab an do nm en t b y th e ho sp ita l a nd th ei r sp ec ia lis ts W om en r ep or te d th at G Ps w er e se en fo r an y m at er na l o r in fa nt h ea lth is su es , w he re as k no w le dg e on in fa nt b eh av io ur pr ob le m s an d pa re nt in g ad vi ce w as so ug ht fr om c hi ld a nd fa m ily h ea lth c en tr es , te le ph on e ad vi ce li ne s or m ot he rs ’ g ro up s. Po si tiv e ex pe ri en ce fa ct or s: C om pr eh en si ve di sc us si on o f t he ir so ci al s itu at io n, ho w th e fa m ily w as m an ag in g, s pe ci fic qu es tio ns a bo ut pr ob le m a re as e ith er ph ys ic al o r m en ta l an d a co m pr eh en si ve ex am in at io n of th em se lv es a nd th ei r ne w bo rn N eg at iv e ex pe ri en ce fa ct or s: C ur so ry e xa m in at io n w ith li tt le d is cu ss io n D is sa tis fa ct io n w as as so ci at ed w ith th e di ve rg en ce o f in fo rm at io n gi ve n ar ou nd c he ck - up s: s ix w ee ks fo r m ot he r/ ne w bo rn ; fo ur w ee ks fo r ba by an d si x w ee ks fo r m ot he r; a ro un d fiv e w ee ks fo r ne w bo rn , m ot he r di d no t ne ed a ny c he ck -u ps ; fir st 5 – 10 d ay s fo r m ot he r/ ne w bo rn an d ag ai n at s ix w ee ks fo r m ot he r an d ei gh t w ee ks fo r ne w bo rn o r ad vi se d at o ne , t w o an d th en fo ur m on th s. ** ** * C re an ga e t al .34 (2 01 7) M al aw i N = 1 ,3 01 w om en a ge d 15 – 49 y ea rs w ho h ad a li ve bi rt h w ith in th e la st 1 2 m on th s St ud y de si gn : B as el in e, tw o- st ag e cl us te r sa m pl in g ho us eh ol d su rv ey D at a co lle ct io n: -s el f- re po rt ed s ur ve y w ith d at a co lle ct ed in 2 01 2, p ri or to im pl em en ta tio n of a n in te rv en tio n to im pr ov e ut ili sa tio n an d qu al ity o f p er in at al h ea lth s er vi ce s. Th e qu es tio ns to a ss es s qu al ity o f c ar e w er e de ve lo pe d se pa ra te ly fo r ea ch ty pe o f P N C us in g th e H ul to n fr am ew or k on q ua lit y of m at er ni ty c ar e as g ui de . S am pl in g: T w o- st ag e cl us te r sa m pl in g 1, 00 9 (7 7. 5% ) p os tp ar tu m w om en h ad a t l ea st o ne po st na ta l c he ck . T im in g of th e fir st p os tn at al v is it fo r m at er na l a nd /o r ne w bo rn w as o n av er ag e 3. 1 w ee ks a nd a ve ra ge n um be r of p os tn at al c he ck s w ith in e ig ht -w ee k po st pa rt um p er io d w as 3 .1 . Fa ct or s th at fa ci lit at ed u til is at io n: L iv ed c lo se to a he al th fa ci lit y (< 30 m in ut es ) a nd h is to ry o f f am ily pl an ni ng Fa ct or s th at im pe de d ut ili sa tio n: L iv ed > 1 ho ur fr om a h ea lth fa ci lit y O f t he w om en w ho an sw er ed q ua lit y of PN C q ue st io ns , 9 0. 4% re po rt ed th ey w er e ad vi se d on d an ge r si gn s to w at ch fo r in bo th th em se lv es a nd th ei r ne w bo rn , 9 5. 4% re ce iv ed b re as tf ee di ng su pp or t a nd c ou ns el lin g an d 97 .9 % r ec ei ve d co un se lli ng o n m et ho ds to a vo id o r de la y an ot he r pr eg na nc y. N ot r ep or te d ** ** D ar eg a et al .28 (2 01 6) Et hi op ia N = 7 03 w om en , a ge d ≥1 8 ye ar s, w ho g av e bi rt h w ith in p as t 1 2 m on th s St ud y de si gn : C om m un ity -b as ed c ro ss - se ct io na l s tu dy D at a co lle ct io n: In te rv ie w er - ad m in is te re d, s tr uc tu re d qu es tio nn ai re s de si gn ed fo r th e st ud y, a da pt ed fr om pe rt in en t l ite ra tu re a nd p re -t es te d on 5 % o f ta rg et p op ul at io n no t i nc lu de d in th e st ud y. D at a w er e co lle ct ed in 2 01 3. S am pl in g: R an do m O f t he to ta l r es po nd en ts , 5 56 (7 9. 1% ) h ad h ea rd ab ou t P N C s er vi ce s bu t o nl y 22 3 (3 1. 7 % ) u til is ed PN C s er vi ce s ov er a p er io d of u p to s ix w ee ks . Th e m aj or ity u se d he al th e xt en si on w or ke rs a t h ea lth ai d po st s (9 1. 5% ) a nd h ad h om e bi rt he d (n = 2 12 , 30 .2 % ). Fa ct or s th at fa ci lit at ed u til is at io n: U til is ed A N C s er vi ce s, a bl e to d ec id e fo r th em se lv es , l iv ed le ss th an 5 k m fr om a h ea lth fa ci lit y N ot r ep or te d N ot r ep or te d ** ** * M M AT = M ix ed M et ho ds A pp ra is al T oo l; PN C = p os tn at al c ar e; A N C = a nt en at al c ar e; G P = ge ne ra l p ra ct iti on er ; E D H S = Et hi op ia n D em og ra ph ic a nd H ea lth S ur ve ys ; W H O = W or ld H ea lth O rg an iz at io n; IP H S = In di an P ub lic H ea lth St an da rd s. Women’s Utilisation, Experiences and Satisfaction with Postnatal Follow-up Care Systematic literature review 460 | SQU Medical Journal, November 2022, Volume 22, Issue 4 T ab le 1 (c on t’d .): C ha ra ct er is ti cs o f i nc lu de d st ud ie s an d th e M ix ed M et ho ds A pp ra is al T oo l 2 01 8 qu al it y ra ti ng A ut ho r an d ye ar o f pu bl ic at io n C ou nt ry Pa rt ic ip an ts M et ho do lo gi ca l c ha ra ct er ist ic s P os tn at al fo ll ow -u p fi n di n gs M M A T qu al ity ra tin g G eb re hi w ot et a l.2 9 (2 01 8) Et hi op ia N = 3 67 w om en , a ge d >1 5 ye ar s, w ho ha d a ch ild ag ed 4 5 da ys u p to s ix m on th s St ud y de si gn : F ac ili ty -b as ed , c ro ss - se ct io na l s tu dy D at a co lle ct io n: S tr uc tu re d qu es tio nn ai re a da pt ed b y re vi ew in g re le va nt lit er at ur e an d qu es tio nn ai re s uc h as E D H S 20 11 a nd W H O G ui de lin e fo r Po st na ta l C ar e; p re -t es te d am on g 5% o f t ot al s am pl e po pu la tio n no t s el ec te d fo r th e st ud y. D at a co lle ct io n pe ri od o cc ur re d in 2 01 4. S am pl in g: R an do m 17 0 (4 6. 3% ) k ne w a bo ut th e av ai la bi lit y of P N C at h ea lth fa ci lit ie s; o f t he se , 7 3 (4 2. 9% ) k ne w th e fr eq ue nc y of v is it s. O nl y 11 8 (3 2. 2% ) h ad u til is ed po st na ta l f ol lo w -u p at le as t o nc e w ith in 4 2 da ys of d el iv er y. Th e m aj or ity (5 1. 7% ) h ad fi rs t v is it be tw ee n da ys 1 5 an d 42 , 2 8. 8% b et w ee n da ys s ev en an d 14 a nd 1 9. 4% w ith in th re e da ys . O f t ho se w ho ut ili se d fo llo w -u p, 3 8. 1% a tt en de d fo r PN C v is it , 28 % fo r ca re o f s ic k m ot he r, 20 .3 % c ar e of s ic k ba by an d 13 .6 % fo r ba by im m un is at io n. F ac to rs th at fa ci lit at ed u til is at io n: H ad a tt en de d A N C a t l ea st on ce , k ne w a bo ut P N C a nd ti m in g of v is it s, h ad at te nd ed P N C a ft er p re vi ou s pr eg na nc y an d ha d co m pl ic at io ns d ur in g de liv er y, li ve d w ith in w al ki ng di st an ce to th e he al th c en tr e. W om en ’s oc cu pa tio n (p ri va te e m pl oy ee s an d bu si ne ss w om en ) a nd ed uc at io n le ve l, hu sb an d’ s oc cu pa tio n an d ed uc at io n le ve l i nfl ue nc ed a tt en da nc e. Fa ct or s th at im pe de d ut ili sa tio n: N o kn ow le dg e ab ou t th e av ai la bi lit y of P N C s er vi ce s (n = 1 84 , 7 3. 9% ), fo ur o r m or e pr ev io us c hi ld re n, h ea lth y an d hi gh w or kl oa d in th ei r ho us e O f t he w om en w ho h ad vi si te d a PN C c lin ic (n = 11 8) , m os t ( n = 10 3, 87 .3 % ) h ad e xp er ie nc ed re ce iv in g le ss th an s ix el em en ts o f p os tn at al fo llo w -u p ca re , t he lo w es t e le m en ts w er e on p er so na l h yg ie ne , m ea su ri ng b od y te m pe ra tu re o f t he ba by , c ou ns el lin g on H IV tr an sm is si on , ba by c ar e an d ex cl us iv e br ea st fe ed in g. N ot r ep or te d ** ** Iz ud i e t a l.3 2 (2 01 7) Su da n N = 3 85 w om en w ith a m ea n ag e of 2 7. 9 ye ar s w ho a tt en de d a po st na ta l fo llo w -u p vi si t w ith in 2 – 7 da ys a ft er b ir th St ud y de si gn : A na ly tic al c ro ss -s ec tio na l s tu dy D at a co lle ct io n: D at a w er e co lle ct ed in 2 01 6 vi a in te rv ie w s us in g st ru ct ur ed q ue st io nn ai re s at 1 3 lo ca tio ns (o ne r eg io na l r ef er ra l h os pi ta l, tw o co un ty h os pi ta ls a nd 1 0 pr im ar y he al th ca re c en tr es ). Sa m pl in g: S ys te m at ic ra nd om a nd c on ve ni en ce O nl y 44 (1 1. 4% ) w om en u til is ed e ar ly P N C (w ith in 2 – 7 da ys )F ac to rs th at fa ci lit at ed e ar ly ut ili sa tio n: S ec on da ry le ve l o f e du ca tio n or b ey on d, at te nd ed A N C v is it s, b ir th ed in h ea lth fa ci lit y, h ad he al th e du ca tio n on P N C v is it s, in fo rm ed a bo ut PN C c he ck -u ps a ft er b ir th , k ne w p os tp ar tu m co m pl ic at io ns , h ad fr ie nd ly h ea lth w or ke rs a nd w itn es se d pr es en ce o f h ea lth w or ke rs a t h ea lth fa ci lit ie sF ac to rs th at im pe de d ea rl y ut ili sa tio n: H ad ho m e bi rt h, a cc es se d he al th s er vi ce s at g ov er nm en t he al th fa ci lit ie s, r ep or te d m or e th an 1 h ou r to re ac h th e ne ar es t h ea lth fa ci lit y, li ve d m or e th an 5 km fr om th e ne ar es t h ea lth fa ci lit y N ot r ep or te d N ot r ep or te d ** ** Iz ud i a nd A m on gi n3 1 (2 01 5) U ga nd a N = 3 57 w om en a ge d 15 – 49 y ea rs w ho h ad g iv en bi rt h be tw ee n on e w ee k an d on e ye ar St ud y de si gn : C ro ss -s ec tio na l s tu dy D at a co lle ct io n: S tr uc tu re d qu es tio nn ai re co ns is tin g of b ot h op en - an d cl os ed -e nd ed qu es tio ns , p re te st ed to a ss es s it s ac ce pt ab ili ty , va lid ity , r el ia bi lit y an d ap pr op ri at en es s. D at a w er e co lle ct ed in 2 01 4. S am pl in g: S ys te m at ic ra nd om a nd c on ve ni en ce . A to ta l o f 2 88 (8 0. 7% ) w om en h ad fu ll kn ow le dg e of th e av ai la bl e PN C s er vi ce s at th e ne ar es t h ea lth fa ci lit y. E ar ly P N C (b et w ee n 2– 7 da ys p os t- bi rt h) w as o nl y ut ili se d by 5 5 (1 5. 4% ) w om en ; 1 91 w om en (5 3. 5% ) u til is ed P N C w ith in 4 2 da ys p os t- de liv er y. Fa ct or s th at fa ci lit at ed e ar ly u til is at io n: F or m al em pl oy m en t, ed uc at io n ab ou t P N C s ch ed ul es an d co m pl ic at io ns , a tt en da nc e at p ri va te h ea lth fa ci lit y. Fa ct or s th at im pe de d ea rl y ut ili sa tio n: P N C at p ub lic h ea lth fa ci lit y, n ot g iv en e du ca tio n on po st pa rt um c om pl ic at io ns b ef or e di sc ha rg e, s el f- em pl oy ed m ot he rs , a lo ng o r ve ry lo ng q ue ui ng tim e at th e he al th fa ci lit y, e nc ou nt er ed r ud e he al th w or ke rs . N ot r ep or te d N ot r ep or te d ** ** M M AT = M ix ed M et ho ds A pp ra is al T oo l; PN C = p os tn at al c ar e; A N C = a nt en at al c ar e; G P = ge ne ra l p ra ct iti on er ; E D H S = Et hi op ia n D em og ra ph ic a nd H ea lth S ur ve ys ; W H O = W or ld H ea lth O rg an iz at io n; IP H S = In di an P ub lic H ea lth St an da rd s. Amal Al Hadi, Michelle Paliwoda, Jennifer Dawson, Karen Walker and Karen New Review | 461 T ab le 1 (c on t’d .): C ha ra ct er is ti cs o f i nc lu de d st ud ie s an d th e M ix ed M et ho ds A pp ra is al T oo l 2 01 8 qu al it y ra ti ng A ut ho r an d ye ar o f pu bl ic at io n C ou nt ry Pa rt ic ip an ts M et ho do lo gi ca l c ha ra ct er ist ic s P os tn at al fo ll ow -u p fi n di n gs M M A T qu al ity ra tin g Jo ha ns so n et a l.4 2 (2 01 9) Sw ed en N = 1 80 he al th y w om en , m os tly ag ed 2 5 ye ar s, of S w ed is h or ig in , w ho ha d a hi gh le ve l of e du ca tio n, liv ed w ith th ei r pa rt ne r, ha d an un co m pl ic at ed pr eg na nc y an d bi rt h an d w er e on e w ee k po st pa rt um St ud y de si gn : C ro ss -s ec tio na l s tu dy u si ng qu an tit at iv e an d qu al ita tiv e da ta w ith a co nc ur re nt m ix ed m et ho ds d es ig n D at a co lle ct io n: V ia a n on lin e qu es tio nn ai re ad m in is te re d on e w ee k po st -b ir th . Th e qu es tio nn ai re c on si st ed o f 2 2 cl os ed - en de d an d fo ur o pe n- en de d qu es tio ns . Th e qu es tio nn ai re w as p ilo t t es te d by fo ur p ar en ts (b ot h m ot he rs a nd th ei r pa rt ne rs ) w ho h ad re ce iv ed s im ila r PN C ju st b ef or e th e st ar t o f da ta c ol le ct io n, w hi ch to ok p la ce b et w ee n 20 17 a nd 2 01 8. S am pl in g: P ur po si ve (a ll w om en w ho p ar tic ip at ed in a h om e- ba se d m od el o f m id w ife ry c ar e ov er 1 2 m on th s w er e in vi te d to p ar tic ip at e [n = 2 47 ].) -E ar ly d is ch ar ge a nd u til is at io n of o pt io na l po st na ta l f ol lo w -u ps b y te le ph on e, h om e vi si ts a nd ho sp ita l v is it s. -1 00 % u til is ed te le ph on e co nt ac t ( m ea n: 2 .0 6 ± 1. 08 7) , 9 3. 9% (n = 1 69 ) h om e vi si t( s) a nd 9 8. 3% (n = 17 7) h os pi ta l v is it( s) 15 2 (8 4. 4% ) r ep or te d po si tiv e PN C ex pe ri en ce s. H av in g th e op po rt un ity to r ec ei ve br ea st fe ed in g su pp or t an d to a sk m id w iv es qu es tio ns c on tr ib ut ed to th is e xp er ie nc e. Po si tiv e ex pe ri en ce fa ct or s: E ar ly d is ch ar ge fo llo w ed b y ho m e vi si ts (w as e xp er ie nc ed as p er so na l, ca lm in g, co m fo rt ab le a nd ha rm on io us ), te le ph on e co nt ac ts , o rg an is ed an d eff ec tiv e ho sp ita l vi si ts a s w el l a s ha vi ng en ou gh ti m e fo r ch ec k- up .N eg at iv e ex pe ri en ce fa ct or s: -S om e m ot he rs w an te d a lo ng er h os pi ta l s ta y w he n ne ed in g m or e br ea st fe ed in g or in fo rm at io na l s up po rt be fo re d is ch ar ge , la ck o f c o- or di na tio n of c ar e w he n ex tr a ch ec k- u ps w er e ne ed ed fo r th e in fa nt , b ei ng un ab le to c ho os e th e da y fo r th e ho sp ita l vi si t o r ch os e ei th er ho sp ita l o r ho m e vi si ts , st re ss ed p ro fe ss io na ls , pr of es si on al s w ho ga ve c on tr ad ic tin g ad vi ce a nd th e fa th er or th e fa m ily n ot b ei ng in vo lv ed in th e vi si t. -A ls o, fe w m ot he rs ha d a le ss p os iti ve ex pe ri en ce o f t he h om e vi si t, as th ey p er ce iv ed th at th e m id w ife w as un sk ill ed . Te le ph on e co nt ac t fo llo w -u p: 1 72 (9 7. 2% ) w om en re po rt ed b ei ng ve ry s at is fie d or sa tis fie dH om e vi si t fo llo w -u p: 1 63 (9 6. 5% ) w om en re po rt ed b ei ng ve ry s at is fie d or sa tis fie dH os pi ta l vi si t f ol lo w -u p: 1 57 (9 1. 3% ) w om en re po rt ed b ei ng v er y sa tis fie d or s at is fie d ** ** M M AT = M ix ed M et ho ds A pp ra is al T oo l; PN C = p os tn at al c ar e; A N C = a nt en at al c ar e; G P = ge ne ra l p ra ct iti on er ; E D H S = Et hi op ia n D em og ra ph ic a nd H ea lth S ur ve ys ; W H O = W or ld H ea lth O rg an iz at io n; IP H S = In di an P ub lic H ea lth St an da rd s. Women’s Utilisation, Experiences and Satisfaction with Postnatal Follow-up Care Systematic literature review 462 | SQU Medical Journal, November 2022, Volume 22, Issue 4 T ab le 1 (c on t’d .): C ha ra ct er is ti cs o f i nc lu de d st ud ie s an d th e M ix ed M et ho ds A pp ra is al T oo l 2 01 8 qu al it y ra ti ng A ut ho r an d ye ar o f pu bl ic at io n C ou nt ry Pa rt ic ip an ts M et ho do lo gi ca l c ha ra ct er ist ic s P os tn at al fo ll ow -u p fi n di n gs M M A T qu al ity ra tin g La lib er té e t al .43 (2 01 6) C an ad a N = 4 72 w om en a ge d 18 y ea rs a nd ol de r w ho h ad de liv er ed a he al th y te rm si ng le to n in fa nt St ud y de si gn : R an do m is ed c on tr ol le d tr ia l us in g a 1: 2 ra tio to r an do m is e m ot he rs to ei th er s ta nd ar d ca re (c on tr ol g ro up , n = 1 57 ) or m an da to ry a tt en da nc e of o ne v is it to a ne w ly e st ab lis he d in te gr at iv e po st pa rt um co m m un ity -b as ed c lin ic (i nt er ve nt io n gr ou p, n = 31 5) D at a co lle ct io n: U nd er ta ke n in 2 01 4; fo llo w -u p da ta w er e co lle ct ed fr om m ot he rs at tw o, fo ur , 1 2 an d 24 w ee ks p os tn at al ly v ia a se lf- re po rt w eb -b as ed s ur ve y (R ED C ap ) or a te le ph on e in te rv ie w Sa m pl in g: s tr at ifi ed ra nd om In te rv en tio n gr ou p: C ou ld a tt en d th e cl in ic a s m an y tim es a s th ey d es ir ed u p to s ix w ee ks a ft er bi rt h. A to ta l o f 3 4 (1 0. 8% ) d id n ot a tt en d th e cl in ic at a ll, 5 6 (1 7. 8% ) v is ite d on ce , 6 2 (1 9. 7% ) v is ite d tw ic e, 6 4 (2 0. 3% ) h ad th re e vi si ts a nd 9 9 (3 1. 4% ) vi si te d fo ur o r m or e tim es .C on tr ol g ro up : F ou r w om en w ith dr ew fr om th e st ud y. D at a on c lin ic at te nd an ce w er e no t r ep or te d. Th e ex pe ri en ce s of w om en a tt en di ng a n in te gr at ed c om m un ity - ba se d cl in ic d id n ot re su lt in s ig ni fic an t di ffe re nc es in br ea st fe ed in g ou tc om es (e xc lu si ve ly , p ar tia lly o r an y) a t t w o, fo ur o r 12 w ee ks . S im ila rl y, th er e w er e no s ig ni fic an t di ffe re nc es b et w ee n th e gr ou ps fo r de pr es si on sc or es a t t hr ee w ee ks , m ea n se lf- effi ca cy sc or es a t t w o, fo ur a nd 12 w ee ks . Th e in te rv en tio n gr ou p w as si gn ifi ca nt ly m or e sa tis fie d w ith th e br ea st fe ed in g su pp or t t he y re ce iv ed c om pa re d to th e co nt ro l gr ou p. Th ey w er e al so s at is fie d w ith th e br ea st fe ed in g cl in ic in te rm s of lo ca tio n, p hy si ca l en vi ro nm en t, op en in g ho ur s an d ea si ne ss to g et a n ap po in tm en t a t a co nv en ie nt ti m e. ** ** O ng e t a l.3 5 (2 01 4) Si ng ap or e N = 1 3 fir st - tim e m ot he rs ag ed 2 1– 39 ye ar s w er e in te rv ie w ed be tw ee n 7– 11 d ay s po st h os pi ta l di sc ha rg e St ud y de si gn : D es cr ip tiv e qu al ita tiv e st ud y D at a co lle ct io n: O ne s em i- st ru ct ur ed in te rv ie w w as c on du ct ed w ith e ac h m ot he r at he r ho m e/ or a t t he h os pi ta l a ft er e ar ly (fi rs t) po st na ta l c on su lta tio n. A n in te rv ie w g ui de w as d ev el op ed w ith th e co ns ul ta tio n of tw o ex pe rt s in q ua lit at iv e re se ar ch . D at a w er e co lle ct ed in 2 01 1– 20 12 . S am pl in g: P ur po si ve N ot r ep or te d -I nf or m at io n gi ve n pr io r to d is ch ar ge d id no t p re pa re m ot he rs fo r th e po st na ta l p er io d at h om e re su lti ng in a pe rc ei ve d la ck o f kn ow le dg e in v ar io us as pe ct s of in fa nt an d m at er na l c ar e, in cl ud in g ba th in g an d sw ad dl in g, a s w el l a s fa ct ua l i nf or m at io n on co m m on n or m al a nd ab no rm al s ym pt om s. -P ar tic ip an t’s ex pe ri en ce w as th at m or e gu id an ce a nd su pp or t i s ne ed ed in th e ea rl y po st na ta l pe ri od a nd th at h om e vi si ts w er e ne ed ed . -N ot a ll of th e w om en re ce iv ed in fo rm at io n of c on ta ct d et ai ls fo r a ‘h ot lin e’ p ho ne nu m be r to c on ta ct a he al th p ro fe ss io na l w he n ad vi ce is n ee de d po st d is ch ar ge (a st an da rd p ra ct ic e w he re in a ll w om en sh ou ld b e pr ov id ed th is in fo rm at io n) . D is sa tis fa ct io n w as e xp re ss ed ar ou nd a dv ic e gi ve n by la ct at io n co ns ul ta nt s ov er th e ph on e re ga rd in g br ea st fe ed in g (‘i m pr ac tic al a dv ic e’ ) ** ** * M M AT = M ix ed M et ho ds A pp ra is al T oo l; PN C = p os tn at al c ar e; A N C = a nt en at al c ar e; G P = ge ne ra l p ra ct iti on er ; E D H S = Et hi op ia n D em og ra ph ic a nd H ea lth S ur ve ys ; W H O = W or ld H ea lth O rg an iz at io n; IP H S = In di an P ub lic H ea lth St an da rd s. Amal Al Hadi, Michelle Paliwoda, Jennifer Dawson, Karen Walker and Karen New Review | 463 T ab le 1 (c on t’d .): C ha ra ct er is ti cs o f i nc lu de d st ud ie s an d th e M ix ed M et ho ds A pp ra is al T oo l 2 01 8 qu al it y ra ti ng A ut ho r an d ye ar o f pu bl ic at io n C ou nt ry Pa rt ic ip an ts M et ho do lo gi ca l c ha ra ct er ist ic s P os tn at al fo ll ow -u p fi n di n gs M M A T qu al ity ra tin g Sa ck s et a l.3 3 (2 01 7) U ga nd a an d Z am bi a N = 3 93 w om en w ith a m ea n ag e of 2 6. 3 ye ar s w ho h ad g iv en bi rt h w ith in o ne ye ar o f t he d at a co lle ct io n pe ri od St ud y de si gn : D es cr ip tiv e qu al ita tiv e ne st ed st ud y (w ith in a la rg er e va lu at io n st ud y) D at a co lle ct io n: Fo cu s gr ou ps (n = 4 8) w er e he ld a cr os s fo ur ru ra l c on tig uo us d is tr ic ts in U ga nd a an d fo ur ru ra l n on -c on tig uo us d is tr ic ts in Z am bi a. -S em i- st ru ct ur ed in te rv ie w g ui de s w er e tr an sl at ed a nd b ac k tr an sl at ed fo r ac cu ra cy . D at a co lle ct io n to ok p la ce in 2 01 2– 20 13 . Sa m pl in g: N ot r ep or te d- Th e m aj or ity o f p ar tic ip an ts r ep or te d no t s ee ki ng PN C . F ac to rs th at fa ci lit at ed u til is at io n: B ot h co un tr ie s’ co m m un ity h ea lth w or ke rs a nd n ur se s ta ug ht w om en th e im po rt an ce o f P N C F ac to rs th at im pe de d ut ili sa tio n: L ac k of im po rt an ce in b ot h co un tr ie s, a h ea lth y m ot he r an d ba by m ea ns n o ne ed to s ee k PN C , c os t ( fo r tr an sp or t a nd u nd er fiv e ca rd ) a nd d is ta nc e (r ep or te d m or e in Z am bi a) , fe ar o f m is tr ea tm en t a t h ea lth fa ci lit ie s an d pr ev io us ne ga tiv e ex pe ri en ce (b ei ng m ad e to w ai t, ye lle d at , c ri tic is ed , p hy si ca lly a bu se d; r ep or te d m or e in U ga nd a) In a pp ro xi m at el y ha lf of th e fo cu s gr ou ps in bo th c ou nt ri es , w om en ex pe ri en ce d di re ct d en ia l of c ar e, d is co ur ag em en t fr om s ee ki ng c ar e or fe ar of b ei ng tu rn ed a w ay (p re do m in an tly r el at ed to h av in g gi ve n bi rt h at ho m e) . Z am bi a: M os t fo cu s gr ou ps r ep or te d po si tiv e ex pe ri en ce s w ith PN C . M ot he rs s ta te d th at th ey w er e ‘re ce iv ed w el l’ an d ex am in ed fo r po ss ib le c om pl ic at io ns an d th at th e nu rs es ’ at tit ud es w er e ge ne ra lly po si tiv e an d ‘w el co m in g’ . U ga nd a: M os t f oc us gr ou ps r ep or te d ne ga tiv e ex pe ri en ce s w ith P N C (m os tly r el at ed to g iv in g bi rt h at h om e) . In b ot h co un tr ie s: W om en r ep or te d be in g sa tis fie d w ith PN C g iv en to th ei r ne w bo rn w he n ex am in ed , t re at ed fo r co m pl ic at io ns , im m un is ed a nd g iv en an u nd er fi ve c ar d. Z am bi a: M an y w om en w er e pl ea se d w ith th e m an ne r in w hi ch th e nu rs es a tt en de d to th em a nd th ei r ne w bo rn s. Th ey w er e al so s at is fie d w ith th e ca re th ey r ec ei ve d w he n th ey d ev el op ed co m pl ic at io ns , s uc h as ex ce ss iv e bl ee di ng . ** * Se lv ar aj e t al .36 (2 02 1) In di a N = 2 27 po st na ta l m ot he rs a ge d 19 – 42 y ea rs , be tw ee n 6– 10 w ee ks p os t- bi rt h St ud y de si gn : C om m un ity -b as ed c ro ss - se ct io na l s tu dy D at a co lle ct io n: D at a w er e co lle ct ed u si ng p re te st ed s em i- st ru ct ur ed pr of or m a w as d ev el op ed b as ed o n th e PN C as se ss m en t a s pe r IP H S gu id el in es . D at a w er e co lle ct ed u p to fo ur w ee ks a ft er th e co m pl et io n of th e po st pa rt um p er io d (s ix w ee ks ) i n 20 15 – 20 16 .S am pl in g: S im pl e ra nd om H om e vi si ts : O nl y 47 (2 0. 7% ) h ad r ec ei ve d at le as t on e ho m e vi si t b y an y he al th w or ke r, w ith 3 6 (7 6. 6% ) oc cu rr in g be tw ee n da ys 2 9– 42 . S ev en (1 4. 9% ) oc cu rr ed w ith in fi rs t s ev en d ay s an d th e re m ai ni ng fo ur (8 .5 % ) b et w ee n da ys 1 4– 28 . D ur in g th es e vi si ts , ne ith er th e m ot he r no r ne w bo rn w er e as se ss ed fo r an y he al th p ro bl em s. N on e of th e m ot he rs h ad re ce iv ed ‘a de qu at e’ v is it s (a t l ea st th re e pe r th e IP H S gu id el in es ). H ea lth fa ci lit y vi si ts : 9 8 (4 3. 2% ) w om en vi si te d th e ho sp ita l f or th em se lv es (n = 2 0, 9 % ) o r th ei r ne w bo rn (n = 7 8, 3 4. 4% ) d ur in g th e po st na ta l pe ri od (m os t f re qu en tly fo r m ot he r: lo w er b ac k ac he , p ro lo ng ed b le ed in g, in ad eq ua te m ilk s ec re tio n; fo r ne w bo rn : u pp er r es pi ra to ry in fe ct io n, ja un di ce , ph ys io lo gi ca l i ss ue s) . N ot r ep or te d N ot r ep or te d ** * Sh ah ja ha n et al .38 (2 01 7) B an gl ad es h N = 3 60 po st na ta l m ot he rs , a ge d >1 6 ye ar s w ho at te nd ed fo r PN C w ith in 4 2 da ys o f d el iv er y. St ud y de si gn : C om m un ity -b as ed c ro ss - se ct io na l s tu dy D at a co lle ct io n: F ac e- to -f ac e in te rv ie w u si ng a s tr uc tu re d qu es tio nn ai re , w hi ch w as d ev el op ed in a s im pl e, a cc es si bl e la ng ua ge a nd c om pi le d by a da pt in g qu es tio ns fr om p ub lis he d st ud ie s w ith a pp ro pr ia te m od ifi ca tio ns a nd /o r im pr ov em en t. Th e qu es tio nn ai re w as p ilo te d w ith 2 0 w om en pr io r to u se in th is s tu dy . D at a w er e co lle ct ed in 2 01 2. S am pl in g: R ec ru itm en t u ni ts (F am ily W el fa re A ss is ta nt H ea lth W or ke rs ) w er e ra nd om ly s el ec te d (n = 1 2) a nd th en 3 0 w om en fr om e ac h he al th w or ke r ca tc hm en t a re a w er e ‘sy st em at ic al ly id en tifi ed ’ f or in cl us io n as th e sa m pl e. 64 (1 7. 8% ) w om en u til is ed P N C s er vi ce s w ith in th e fir st 4 2 da ys p os tn at al ly (8 0% o f b ir th s w er e ho m e bi rt hs ). 13 5 (3 7. 5% ) w om en r ep or te d th ey kn ew th at r eg ul ar P N C w as n ec es sa ry . F ac to rs th at fa ci lit at ed u til is at io n: H ig h in co m e, h ig he r m at er na l ed uc at io n (m or e th an n in e ye ar s sc ho ol in g) , r ea di ng ne w sp ap er /m ag az in es , w at ch in g T V , h av in g m ob ile p ho ne a nd th os e w ho c ou ld w al k to th e he al th fa ci lit y Fa ct or s th at im pe de d ut ili sa tio n: n o Ed uc at io n or h av in g 1– 5 ye ar s of s ch oo lin g, h ig h tr an sp or ta tio n co st to th e ne ar es t h ea lth fa ci lit y an d m at er na l a ge N ot r ep or te d N ot r ep or te d ** ** M M AT = M ix ed M et ho ds A pp ra is al T oo l; PN C = p os tn at al c ar e; A N C = a nt en at al c ar e; G P = ge ne ra l p ra ct iti on er ; E D H S = Et hi op ia n D em og ra ph ic a nd H ea lth S ur ve ys ; W H O = W or ld H ea lth O rg an iz at io n; IP H S = In di an P ub lic H ea lth St an da rd s. Women’s Utilisation, Experiences and Satisfaction with Postnatal Follow-up Care Systematic literature review 464 | SQU Medical Journal, November 2022, Volume 22, Issue 4 T ab le 1 (c on t’d .): C ha ra ct er is ti cs o f i nc lu de d st ud ie s an d th e M ix ed M et ho ds A pp ra is al T oo l 2 01 8 qu al it y ra ti ng A ut ho r an d ye ar o f pu bl ic at io n C ou nt ry Pa rt ic ip an ts M et ho do lo gi ca l c ha ra ct er ist ic s P os tn at al fo ll ow -u p fi n di n gs M M A T qu al ity ra tin g Te sf ah un e t al .30 (2 01 4) Et hi op ia N = 8 20 m ot he rs a ge d >1 5 ye ar s w ho ha d gi ve n bi rt h w ith in th e pa st ye ar c om pl et ed th e su rv ey . N = 16 m ot he rs pa rt ic ip at ed in o ne o f t hr ee fo cu s gr ou ps St ud y de si gn : M ix ed m et ho ds s tu dy D at a co lle ct io n: Q ua nt ita tiv e da ta w er e co lle ct ed b y in te rv ie w u si ng a s tr uc tu re d pr e- te st ed q ue st io nn ai re . I t w as d ev el op ed th ro ug h re vi ew o f r el at ed E th io pi an a nd in te rn at io na l l ite ra tu re . F or th e qu al ita tiv e da ta , g ui di ng q ue st io ns fo r th e fo cu s gr ou ps w er e de ve lo pe d in E ng lis h an d tr an sl at ed to A m ha ri c an d th en c he ck ed fo r va lid ity . D at a w er e co lle ct ed in 2 01 1. Sa m pl in g: M ul tis ta ge sa m pl in g te ch ni qu e w as u nd er ta ke n fo r th e qu es tio nn ai re , f ol lo w ed b y st ra tifi ed r an do m sa m pl in g of w ar ds p ro po rt io ne d fo r ru ra l a nd ur ba n, th en r an do m s am pl in g of h ou se ho ld s. If o ne h ou se ho ld h ol d ha d m or e th an o ne el ig ib le m ot he r, th en r an do m lo tt er y m et ho d un de rt ak en to s el ec t t he m ot he r. F oc us gr ou ps : p ur po si ve Q ue st io nn ai re : -6 92 (8 4. 4% ) w om en w er e aw ar e th ey s ho ul d at te nd , a nd 6 09 (7 4. 3% ) s ta te d it w as n ec es sa ry fo r w om en a nd n ew bo rn s, b ut o nl y 54 8 (6 6. 8 % ) ut ili se d PN C s er vi ce s. 3 71 (6 7. 7% ) w om en a tt en de d on ce , 1 53 (2 7. 9% ) t w ic e an d ju st 2 4 (4 .4 % ) v is ite d th re e or m or e tim es w ith in s ix w ee ks a ft er d el iv er y. H al f ( 52 .2 % ) u til is e se rv ic es fr om h ea lth e xt en si on w or ke rs a nd c om m un ity h ea lth o ut re ac h se rv ic es , 49 .9 % a tt en de d a he al th in st itu tio n an d 0. 9% u se d tr ai ne d bi rt h at te nd an ts . -R ea so ns fo r ut ili si ng in cl ud ed : n ew bo rn im m un is at io n (n = 4 96 , 6 0. 5% ), fa m ily p la nn in g (n = 1 75 , 2 1. 3% ), co un se lli ng o n PN C (n = 1 29 , 15 .7 % ), co un se lli ng o n br ea st fe ed in g (n = 2 9, 3 .5 % ) an d ph ys ic al e xa m in at io n (n = 1 5, 1 .8 % ) F ac to rs th at fa ci lit at ed u til is at io n: K no w in g ab ou t t he PN C s er vi ce (9 0. 7% w ho a tt en de d kn ew a bo ut th e se rv ic e) , b ei ng p ro vi de d w ith in fo rm at io n po st -b ir th a bo ut P N C b y he al th e xt en si on w or ke rs (8 5. 5% ), nu rs es (1 7. 8% ), fa m ily (8 .2 % ) a nd d oc to rs (1 .1 % ), m at er na l a ge (o ve r 25 y ea rs ), m ar ri ed , l iv ed in u rb an a re a, li ve d le ss th an tw o ho ur s fr om a he al th fa ci lit y, h ad a tt en de d A N C , s up po rt o f a he al th e xt en si on w or ke r F ac to rs th at im pe de d ut ili sa tio n: L ac k of ti m e (3 0. 5% ), lo ng d is ta nc e to pr ov id er (1 9. 3% ), la ck o f g ua rd ia ns fo r ch ild re n ca re (1 6. 1% ), la ck o f a w ar en es s (1 2. 7% ), cu ltu ra l ba rr ie rs (8 .6 % ), la ck o f s er vi ce (8 .6 % ) a nd c os tly tr an sp or ta tio n (3 .4 % ). A to ta l o f 3 52 (6 4. 2% ) w om en w ho d id n ot u til is e PN C r ep or te d no t ha vi ng th e ab ili ty to m ak e de ci si on s fo r ut ili sa tio n. Q ue st io nn ai re : 4 20 (7 6. 6% ) w om en w ho ut ili se d PN C h ad a po si tiv e pe rc ep tio n to w ar ds P N C . Fo cu s G ro up s: M os t m ot he rs as su m ed th at P N C se rv ic es w er e on ly av ai la bl e 45 d ay s af te r bi rt h (o nl y fo r ne w bo rn va cc in at io ns ). M os t m ot he rs e xp er ie nc ed a po si tiv e pe rc ep tio n to w ar ds P N C , a nd th ey en co ur ag e ot he rs to u se PN C . N ot r ep or te d ** * U pa dh ya i an d G up ta 39 (2 01 9) In di a N = 4 88 w om en , < 20 to > 35 y ea rs , w ho d el iv er ed w ith in th e pa st th re e m on th s St ud y de si gn : C ro ss -s ec tio na l c om m un ity - ba se d st ud y D at a co lle ct io n: In te rv ie w s of m ot he rs w er e co nd uc te d in th ei r ho us e us in g a pr et es te d an d pr ed es ig ne d qu es tio nn ai re . D at a w er e co lle ct ed fo r a pe ri od fr om 2 01 4 to 2 01 5. S am pl in g: U nc le ar (t w o- st ag e sy st em at ic r an do m s am pl in g. F ir st s ta ge : sl um s w er e id en tifi ed r an do m ly , a nd 3 0 sl um s w er e id en tifi ed . S ec on d st ag e: p ro po rt io na te to s iz e, s am pl in g w as d on e in th e se le ct ed sl um s to c ov er th e de si re d sa m pl e si ze o f 4 88 by h ou se -t o- ho us e vi si ts . 15 9 (3 2. 6% ) w om en r ec ei ve d no P N C p os t- bi rt h an d 25 6 (5 2. 5% ) h ad a p os tn at al v is it w ith in 4 8 ho ur s of d el iv er y an d on ly 7 6 (1 5. 6% ) r ec ei ve d al l re co m m en de d th re e or m or e vi si ts F ac to rs th at fa ci lit at ed u til is at io n: A ge (2 0– 35 y ea rs ), hi gh er so ci o- ec on om ic c la ss , e du ca tio n le ve l ( w om en a nd hu sb an d) , r ec ei ve d fo ur o r m or e an te na ta l c he ck - up s, b el on gs to jo in t f am ily , h ad c ae sa re an d el iv er y, ha d in st itu tio na l b ir th a nd h ad c om pl ic at io ns o r pe rc ei ve d he al th p ro bl em s af te r de liv er y Fa ct or s th at im pe de d ut ili sa tio n: A ge (< 20 o r >3 5 ye ar s) , lit er ac y, n uc le ar fa m ily a nd h ad a h om e bi rt h N ot r ep or te d N ot r ep or te d * M M AT = M ix ed M et ho ds A pp ra is al T oo l; PN C = p os tn at al c ar e; A N C = a nt en at al c ar e; G P = ge ne ra l p ra ct iti on er ; E D H S = Et hi op ia n D em og ra ph ic a nd H ea lth S ur ve ys ; W H O = W or ld H ea lth O rg an iz at io n; IP H S = In di an P ub lic H ea lth St an da rd s. Amal Al Hadi, Michelle Paliwoda, Jennifer Dawson, Karen Walker and Karen New Review | 465 T ab le 1 (c on t’d .): C ha ra ct er is ti cs o f i nc lu de d st ud ie s an d th e M ix ed M et ho ds A pp ra is al T oo l 2 01 8 qu al it y ra ti ng A ut ho r an d ye ar o f pu bl ic at io n C ou nt ry Pa rt ic ip an ts M et ho do lo gi ca l c ha ra ct er ist ic s P os tn at al fo ll ow -u p fi n di n gs M M A T qu al ity ra tin g *W oo dw ar d et a l.4 1 (2 01 6) A us tr al ia N = 1 5 m ot he rs , a ge d 25 – 43 y ea rs w ho h ad a n in fa nt a ge d un de r 12 m on th s St ud y de si gn : Q ua lit at iv e de sc ri pt iv e D at a co lle ct io n: S em i- st ru ct ur ed , f ac e- to -f ac e in te rv ie w . D at a w er e co lle ct ed in 2 01 2. Sa m pl in g: P ur po si ve -Th e m aj or ity o f w om en w ho r ec ei ve d pr iv at e ob st et ri ci an c ar e (n = 8 ) w er e di sc ha rg ed w ith a si x- w ee k ch ec k- up a pp oi nt m en t. -W om en w ho b ir th ed in p ub lic in st itu tio ns (n = 4 ) al l r ec ei ve d a ho m e vi si t o r a ph on e ca ll w ith in 1 0 da ys o f g oi ng h om e. -C om m un ity p os t- bi rt h ca re u til is ed in cl ud ed ph ar m ac y nu rs e (n = 1 0) , c hi ld a nd fa m ily h ea lth cl in ic (n = 1 0) a nd G P (n = 9 ). A p ri va te m id w ife w as u til is ed b y th re e w om en fo r al l p os tp ar tu m ca re . -Th e w om en w ho re ce iv ed a h om e vi si t o r ph on e ca ll ex pe ri en ce d re as su ra nc e an d su pp or t t hr ou gh th e co m m un ic at io n as th ey co ul d se ek a nd o bt ai n re lia bl e in fo rm at io n; th is e as ed th ei r tr an si tio n to p ar en tin g an d ga ve th em co nfi de nc e. -Th e w om en w ho re ce iv ed p ri va te ob st et ri ci an c ar e ex pe ri en ce d re ce iv in g a la ck o f i nf or m at io n ab ou t w he re o r ho w to ac ce ss P N C . -W om en e xp er ie nc ed ps yc ho so ci al s up po rt by th e ph ar m ac y nu rs es w ith a fo cu s of p os iti ve pa re nt in g va lid at io n. -W om en d id n ot re po rt e xp er ie nc in g ps yc ho so ci al s up po rt an d re as su ra nc e fr om G Ps o r th e ch ild a nd fa m ily h ea lth c lin ic s. Th ei r ex pe ri en ce w ith G Ps w as li m ite d to m ed ia l i ss ue s, h ea lth pr ob le m s or r ou tin e va cc in at io ns . Sa tis fa ct io n: Th e hi gh es t l ev el s of sa tis fa ct io n w er e re po rt ed b y w om en w ho h ad a h om e bi rt h (n = 3 ) a s th ey re ce iv ed c on tin uo us ho m e ca re b y a pr iv at el y pa id fo r m id w ife . W om en w er e ge ne ra lly sa tis fie d w ith P N C pr ov id ed b y th e ph ar m ac y nu rs es as it w as a cc es si bl e an d pr ov id ed co nt in ui ty o f c ar e. D is sa tis fa ct io n: -W om en e xp re ss ed di ss at is fa ct io n at ch ild a nd fa m ily he al th c lin ic s ar ou nd a la ck o f a ‘w om en - ce nt re d’ a pp ro ac h, co nt in ui ty o f c ar er an d to fo cu se d on su rv ei lla nc e ra th er th an s up po rt , w ith th e in fo rm at io n ab ou t w he re a nd ho w to a cc es s po st - bi rt h ca re in th e co m m un ity , w ith PN C a t l ar ge a s th ey d es cr ib ed it a s ‘re gi m en te d ca re ’ a s it fo cu se d on in fa nt su rv ei lla nc e ra th er th an s up po rt fo r m ot he rs . -A t p ha rm ac ie s, w om en w er e di ss at is fie d w ith th e ph ys ic al en vi ro nm en t ( PN C w as p ro vi de d in a n op en a re a of th e ph ar m ac y, a nd it w as av ai la bl e fo r lim ite d ho ur s) . ** ** M M AT = M ix ed M et ho ds A pp ra is al T oo l; PN C = p os tn at al c ar e; A N C = a nt en at al c ar e; G P = ge ne ra l p ra ct iti on er ; E D H S = Et hi op ia n D em og ra ph ic a nd H ea lth S ur ve ys ; W H O = W or ld H ea lth O rg an iz at io n; IP H S = In di an P ub lic H ea lth St an da rd s. Women’s Utilisation, Experiences and Satisfaction with Postnatal Follow-up Care Systematic literature review 466 | SQU Medical Journal, November 2022, Volume 22, Issue 4 c h a r a c t e r i s t i c s o f i n c l u d e d s t u d i e s Included studies were conducted in low-, middle- and high-income countries, with the majority from Africa (n = 9), followed by Asia (n = 5) and Australia (n = 2).26–41 There was one study each from Europe, North America and the Middle East.42–44 The majority of included studies were quantitative and descriptive (n = 11), with participant response rates ranging from 11.4–80.7%.26–29,31,32,34,36,38,39,44 Five studies were qualitative, two were mixed methods and one was an experimental study.30,33,35,37,40–43 Based on the quality assessment of the studies using the MMAT tool, two studies were rated one star because of concerns regarding the clarity on sampling strategies, sample representative of the target population, measurements used, the risk of nonresponse bias and the appropriateness of the statistical analyses.27,39 Most studies (n = 17) were assigned a rating of three or more stars [Table 1]. u t i l i s at i o n Overall utilisation rates of 11.4–100% were reported in 15 studies.26–34,36,38,39,42–44 The remaining four studies did not report utilisation rates. Several studies reported that while women were aware of the need for regular postnatal visits or the importance of attending, they did not utilise postnatal follow-up care.30,38 Factors that influenced greater utilisation during early and/or late postnatal periods were complications during labour, birth and after birth, distance from a health centre and knowledge on the importance of postnatal review.27–32,34,38,39 Additionally, women who had completed advanced education (secondary and above), and thus who had higher monthly incomes, were reported as having higher utilisation of postnatal care services.26,29,32,38,39 Several studies reported increased use of postnatal care if women’s husbands had completed advanced education from college and above.29,30,39 Women who were 18–48 years and had attended an antenatal review during pregnancy were more likely to utilise postnatal care.26,28–30,32,39 Women who identified that they were able to decide for themselves or were involved in joint decision-making (husband–wife dyad) were more likely to attend postnatal visits.26,28 Other factors that were reported to increase utilisation of postnatal follow-up care included awareness of at least one postpartum danger sign, attendance at family planning services and use of postnatal care after a previous pregnancy.26,29,34 Major factors reported by women that impeded the utilisation of postnatal services included a lack of knowledge about postnatal services, beliefs that there T ab le 1 (c on t’d .): C ha ra ct er is ti cs o f i nc lu de d st ud ie s an d th e M ix ed M et ho ds A pp ra is al T oo l 2 01 8 qu al it y ra ti ng A ut ho r an d ye ar o f pu bl ic at io n C ou nt ry Pa rt ic ip an ts M et ho do lo gi ca l c ha ra ct er ist ic s P os tn at al fo ll ow -u p fi n di n gs M M A T qu al ity ra tin g X ia o et a l.3 7 (2 02 0) C hi na N = 2 2 w om en ag ed b et w ee n 22 – 43 y ea rs w ho ha d gi ve n bi rt h to a h ea lth y te rm ba by w ith in s ix w ee ks , w ith ou t co m pl ic at io ns , re tu rn ed to th e he al th c en tr e fo r a ch ec k- up o n th e 30 th o r 42 nd d ay af te r bi rt h St ud y de si gn : Q ua lit at iv e ex pl or at or y st ud y D at a co lle ct io n: -I n- de pt h, s em i- st ru ct ur ed , f ac e- to -f ac e in te rv ie w s -Th e de m og ra ph ic in fo rm at io n sh ee t a nd th e in te rv ie w g ui de w er e de ve lo pe d ba se d on th e re se ar ch er ’s ex pe ri en ce in w or ki ng w ith p os tp ar tu m w om en , a nd d is cu ss ed w ith tw o ac ad em ic s in ob st et ri c nu rs in g an d fa m ily n ur si ng . D at a w er e co lle ct ed in 2 01 8. S am pl in g: P ur po si ve A ll w om en h ad r ec ei ve d a ho m e vi si t b y a nu rs e w ith in tw o da ys o f d is ch ar ge (s ta nd ar d pr ac tic e at s tu dy s ite h os pi ta l) an d ad di tio na l h om e vi si ts (n ot s ta te d/ re po rt ed fo r ea ch pa rt ic ip an t) . A ls o th ey a tt en de d ei th er 3 0- o r 42 -d ay P N C ch ec k- up a t t he h os pi ta l. H om e vi si t n ur se s w er e w ar m a nd p ro vi de d co nt in uo us c ar e in st ea d of ‘ta sk -o ri en te d’ fr ag m en te d ca re . Sa tis fa ct io n: M os t w om en w er e sa tis fie d w ith th e po st pa rt um h om e vi si t bu t s ug ge st ed th e ne ed fo r a m or e co m pr eh en si ve po st pa rt um c ar e pr og ra m th at c at er ed to th ei r ne ed s. D is sa tis fa ct io n: N ot r ec ei vi ng ti m el y in fo rm at io n fr om h ea lth pr of es si on al s, s ug ge st ed ne ed fo r in te rn et -b as ed or h ot lin e ph on e su pp or t; ne ed in g to ta ke th ei r ba by to a c lin ic fo r ex am in at io n w ith in th e fir st m on th (d ue to c ul tu ra l b el ie fs th at m ot he rs n ee d to re st a nd s ta y at h om e fo r a m on th to r eg ai n st re ng th ); br ea st fe ed in g co ns ul ta tio ns n ot p ar t o f po st pa rt um h om e vi si ts ** * M M AT = M ix ed M et ho ds A pp ra is al T oo l; PN C = p os tn at al c ar e; A N C = a nt en at al c ar e; G P = ge ne ra l p ra ct iti on er ; E D H S = Et hi op ia n D em og ra ph ic a nd H ea lth S ur ve ys ; W H O = W or ld H ea lth O rg an iz at io n; IP H S = In di an P ub lic H ea lth St an da rd s. Amal Al Hadi, Michelle Paliwoda, Jennifer Dawson, Karen Walker and Karen New Review | 467 was no need for postnatal review if one was feeling well, not being given information regarding postnatal complications before discharge, long distance to health facilities, high transportation costs, home birth, cultural barriers and lack of education, long queues at health facilities, experiences of abandonment by healthcare providers and fears of mistreatment by health professionals.26,27,29–34,38–40 There were also additional impediments [Table 1]. e x p e r i e n c e s A total of 12 studies reported women’s experiences, with most reporting positive and negative factors that influenced their experiences.27,29,30,33–35,37,40–44 Several studies reported that women felt they were not provided with enough information on maternal and newborn postpartum complications or ‘danger signs’, physical changes, breastfeeding and general maternal and newborn care [Table 1].27,35,44 Gebrehiwot et al. found that women had experienced receiving advice or information on fewer than six elements of postnatal care at postnatal follow- up visits.29 The least discussed elements included exclusive breastfeeding, baby care and personal hygiene. Ong et al. reported that women felt that more guidance and support was needed during the early postnatal period, particularly with regard to breastfeeding and also expressed the need for more home visits due to expectations around cultural postnatal confinement practices.35 Women’s positive experiences were predominantly related to quality time with and comprehensive inform- ation provided by the healthcare provider.34,37,40 Three women who received early contact after discharge (home visit, telephone contact) reported feeling reassured and supported.41,42 Postnatal follow-up care that was organised and effective and allowed sufficient time for check-up of both the mother and infant was viewed positively. Negative experiences were more commonly reported by women and were related to cursory examinations or unfulfilling discussions with health professionals, conflicting information given by health professionals and not receiving adequate or enough information from health professionals.29,30,35,40–42 In some countries, women reported experiencing a direct denial of care, discouragement from seeking care or fear of being turned away, particularly if they had given birth at home [Table 1].33 s at i s fa c t i o n The majority of studies (n = 12) did not report on women’s satisfaction with postnatal follow-up care. Satisfaction or dissatisfaction when reported was mostly associated with consistency of advice received and continuity of care.33,37,40–43 Johansson et al. reported that women were satisfied with telephone follow-up (97.2%), home visit (96.5%) and hospital follow-up (91.3%).42 Woodward et al. found that women who had home births were satisfied with follow-up when they received continuity of care.41 Women who attended an integrated community-based clinic providing comprehensive support for postpartum women reported that they were satisfied with the breastfeeding support they received.43 Women reported dissatisfaction with divergent information and impractical advice as well as with a lack of timely advice and a ‘women-centred’ approach and continuity of care [Table 1].35,37,40,41 Discussion This review aimed to explore women’s utilisation of early and late postnatal follow-up and their experiences and satisfaction with it. Overall, the majority of the included studies when appraised using the MMAT tool were assessed as meeting three or more of the five quality criteria.26,28–38,40–44 Low utilisation was mostly reported from low- and middle-income countries (LMICs).26–29,31–33 This finding could be attributed to limited postnatal follow-up care options offered to women and newborns in LMICs, such as lack of home visits and telephone contact, compared to high-income countries. A number of studies reported the use of mobile technology such as short message service as being a cost-effective method in enhancing maternal and newborn outcomes in early postnatal period in both low- and high-income settings.45,46 Furthermore, Perrenoud et al. reported that immediate messaging application from ‘Whatsapping’ contributes to women-centred care and enhances continuity of care.47 This aligns with the recommendations of the American College of Obstetrics and Gynecologists on optimising women’s and newborns’ health through offering various services to meet individualised needs.17 The limited services reflect the distinctive distribution of maternal and newborn deaths globally. International organisations reported that approximately 295,000 maternal deaths occurred globally in 2017, and 86% of these occurred in Sub- Saharan Africa and South Asia.48 In addition, it is estimated that 2.4 million neonatal deaths occurred globally in 2019.49 As such, improving maternal health and putting an end to preventable maternal deaths Women’s Utilisation, Experiences and Satisfaction with Postnatal Follow-up Care Systematic literature review 468 | SQU Medical Journal, November 2022, Volume 22, Issue 4 have been the focus of various organisations, such as the WHO through its launch of the SDGs. An examination of utilisation is needed to identify potential target areas to improve the quality and use of healthcare services provided during the postnatal period. Many of the included studies undertaken in LMICs focused on the utilisation of postnatal care and reported low overall rates, which appeared to be associated with transport costs, distances to health centres and the importance of postnatal follow-up care not being conveyed by healthcare professionals around the time of discharge from hospitals.26–32,34,36,38,39,43,44 Comparatively, the studies conducted in high-income countries reported high rates of utilisation, and the focus was on experiences and satisfaction with postnatal services.35,37,40–43 While some women reported a lack of awareness of the need or availability of services, others who were aware still did not use these services or were likely to use them only once.26,27,29,30,34,36,38–41,44 It appears that women were most likely to utilise postnatal care services during the late postnatal period, despite the fact that the WHO recommends at least three contacts following childbirth: on day three, between days seven and 14 and at six weeks.26,29,31,32,34,36,40,41,44 Women seem to have fewer than the recommended number of contacts during the postnatal period. A lack of knowledge regarding the accessibility and importance of postnatal care services was reported in a number of studies.27,29,33,40 While the study by Angore et al. could not be included in this review as it reported on women using postnatal follow-up care over one year, it is crucial to note that the authors found that women who were informed about the importance of attending postnatal care services after birth had high utilisation rates.50 Cultural practices surrounding non-utilisation did not feature strongly in the studies undertaken in Africa or India. In contrast, the study by Ong et al. with Singaporean mothers in Asian countries revealed that traditional practices, such as ‘seclusion’, may account for the lack of use of care services within the first two weeks postpartum.35 A study conducted by Almalik in Jordan reported that 78% of women attended postnatal follow-up between six and eight weeks, with a focus on whether attendance met their perceived requirements.44 To the best of the authors’ knowledge, no data has been published on either the early postnatal period or the influence of cultural practices such as seclusion, which is practiced in the Middle East. The practice of seclusion is well known in Middle Eastern countries, such as Oman, where women are expected to be confined to their homes for 40 days, to rest and eat traditional foods (e.g. honey) to regain strength and be healthy to take care of their newborn.51 During this period, the mother and newborn are viewed as vulnerable and at high risk for illness and death as well as the ‘evil eye’.52 The women in Ong et al.’s study reported the need for more home visits during this early period when they cannot leave the house.35 Access to detailed information about the postnatal period was reported to have a positive influence on maternal experience.34,37,40,42 In contrast, the scarcity of information was associated with maternal dissatisfaction and increased breastfeeding problems, especially at 3–6 weeks after birth.30,35,41 Women’s satisfaction with the care provided during the postnatal period was explored in a number of studies.33,37,40–43 Women appeared to be dissatisfied when there was a lack of consistent information provided and satisfied when there was continuity of care provided.40,41 Interestingly, two Australian studies reported a lack, or inconsistency, of information.40,41 This may be due to the lack of clarity in the Royal Australian College of General Practice guidelines, which do not make any recommendations regarding the timing and number of postnatal contacts.19 Women reported that information provided by health providers was not practical or helpful and that there was a need for more targeted education, especially related to breastfeeding, physical changes and newborn care.27,35,44 Interestingly, however, Laliberté et al. found that the provision of a community-based clinic with a focus on providing breastfeeding support did not result in significant differences in breastfeeding outcomes or depression scores up to 12 weeks postnatally when comparing women who visited the clinic and those who did not.43 That study concluded that the reason for the lack of significant differences between the two groups could be that the majority of the women were over 29 years old and had a high educational level, hypothesising that this group of well-educated women sought advice from other sources. Health providers’ provision of information and the way in which information is provided are important to women. Almalik stated that women reported unmet needs at 6–8 weeks and emphasised the need to change policymakers’ focus from reducing maternal mortality rates to providing more women- centred approaches that address their needs and concerns.44 Similarly, in Woodward et al.’s Australian study, women attending a community-based child and family health clinic felt that the nurses/midwives were more interested in collecting data and undertaking surveillance than providing support and positive parenting advice.41 Women in that study found nurses/ Amal Al Hadi, Michelle Paliwoda, Jennifer Dawson, Karen Walker and Karen New Review | 469 midwives located in pharmacies to be much more supportive. Thus, the attitudes of health professionals play an important role in whether women seek follow- up care.30,53 This was evident in low-income country settings where women reported they were reluctant to attend postnatal follow-up care because of health workers’ attitudes and fear of mistreatment.31,33 The findings of this review should be considered in light of its strengths and potential limitations. A strength of this review was that the systematic search was developed in conjunction with a senior librarian and was not limited by study design, country context or postnatal follow-up setting. The English language filter was not applied; however, searching with MeSH terms and keywords was undertaken in English only. Therefore, it was unlikely for articles published in Arabic but without an English-translated abstract and keywords to have appeared in the search results. The selection of studies was restricted to data collection taken place within the last 10 years and from women who had given birth within 12 months of the study period, to ensure that the information was contemporary and to limit potential variation in practice change that may have occurred along with changes in and around antenatal and intrapartum care. Additionally, while women’s recall has been shown to be consistent around antenatal and childbirth events, this is not the case for the postnatal period, with sensitivity of reporting lower at six weeks and six months than at one week postnatally.54 Only studies that collected data up to 12 months following childbirth were included in this review; therefore, future reviews should consider studies in which participants are interviewed or surveyed within a shorter time frame following the six-week follow-up appointment. This may provide additional insights due to increased clarity of recall. Conclusion This systematic review highlights the need for increasing women’s awareness of the importance of postnatal follow-up care. This includes discussing postnatal anxiety and depression, providing more individualised options for receiving postnatal follow- up care such as telephone call, home visit or health facility visit and improving conformity of information provided to women by healthcare providers. These could be facilitated by providing written/electronic resources to women around the time of discharge after childbirth, mandating annual training for healthcare providers and ensuring that local policies are aligned with national policies and guidelines. Future research should explore the influence of social and cultural practices on the utilisation of postnatal follow-up care and alignment of postnatal follow-up services and policies such that they are women-centred and culturally acceptable. a u t h o r s’ c o n t r i b u t i o n s AH, MP, JD, KW and KN conceptualised and designed the study. AH administered the study, while MP, JD, KW and KN supervised the work. AH, MP and KN analysed the data. All authors drafted, reviewed and edited the manuscript. All authors approved the final version of the manuscript. a c k n o w l e d g e m e n t The authors would like to thank Mr Michael Fagg, the expert senior librarian at the University of Queensland, for his support during the systematic search for relevant studies. References 1. World Health Organization. WHO Technical Consultation on Postpartum and Postnatal Care. Geneva: World Health Organization. WHO/MPS/10.03. p. 12. 2. Odetola TD, Fakorede EO. 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