Strategies to Increase Use of Postpartum Care Services for Women in Rural Malawi


WellStar School of Nursing

Document Type


Publication Date



Objective To explore strategies to improve use of skilled care after childbirth by examining reasons that women in rural Malawi (a) sought postpartum care from a health care facility after birth, (b) intended to seek future care in that health care facility, and (c) used postpartum care from a traditional birth attendant in the past. Maternal mortality rates remain unacceptably high in subSaharan Africa. The World Health Organization recommends using skilled care before, during, and after childbirth to decrease maternal death rates. However, many women in the region do not receive skilled postpartum care. Design Descriptive, cross-sectional study. Setting Rural communities in the Ntcheu district of Malawi. Patients/Participants A convenience sample of women who were subsistence farmers, 18 years and older, who were able to communicate in Chichewa and who gave birth in the past year. Methods Face-to-face interviews were conducted with 70 women in their homes, using open-ended questions administered in Chichewa. Data were analyzed using descriptive statistics. Participant reasons were ranked by percentage of women mentioning these reasons. Results Sixty-eight of the 70 women returned to a health care facility for their postpartum visit with top three reasons being advised by midwife to return (35%), wanted baby to be examined (29%), and for their own well being (18%). About 54 women said they would return to the health care facility for future care, citing their satisfaction with care (23%), midwife kindness (16%), and short distance (16%) as the top three reasons. Twenty-one percent of women (n ¼ 15) had received prior postpartum care from a traditional birth attendant because there were no health care facilities in the area, a traditional birth attendant was the only option (43%), the hospital was too far (29%), and they lacked awareness about services (14%). Implications for Nursing Practice Health care facility availability and accessibility are important initial steps to ensuring access to care. Advice to return for postpartum visits and education on importance of postpartum checkups for both mother and baby may improve use of services. Women’s perceptions of midwife kindness and satisfaction with care are important factors that can influence whether women seek additional future care in health care facilities. Interventions can focus on improving midwife attitudes toward patients.

Journal Title

Journal of Obstetric, Gynecologic & Neonatal Nursing

Journal ISSN






First Page


Digital Object Identifier (DOI)